BMC Public Health 2009, 9:53 http://www.biomedcentral.com/1471-2458/9/53 Table 5: Knowledge and perception of tuberculosis and status of patient delay at first consultation among pulmonary tuberculosis patients (n = 924) in Ethiopia during 2005–2006. Variables Ever heard of PTB Yes No Patients' awareness about the main cause of PTB Contact with another patient Evil spirit, gods will, other 1 Exposure to cold I do not know Patients' perception bout the main cause of their illness Contact with a TB patient Evil, gods' will and other 1 Exposure to cold Inherited, malnutrition and sexually I do not know Do you think that you could potentially transmitting TB to your family? Yes No Would you be worried if others know about your disease? No Yes Patient delay ≥ 30 days n (%) <30 days n (%) COR (95% CI) P-value 433(52) 59(69) 60(38) 64(63) 260(53) 109(64) 71(47) 48(65) 234(52) 46(49) 94(60) 425(53) 68(56) 431(53) 62(55) 402(48) 27(31) 97(62) 37(37) 235(47) 62(36) 79(53) 26(35) 216(48) 48(51) 62(40) 377(47) 54(44) 381(47) 50(45) 1 0.49(0.31, 0.79) 1 2.8(1.6, 4.6) 1.8(1.2, 2.5) 2.7(1.8, 4.4) 1 2.1(1.15, 3.6) 1.2 (0.84, 1.7) 1.1(0.65, 1.78) 1.7(1.1, 2.6) 1 1.1 (0.7, 1.5) 1 1.1(0.73,1.6) 0.004 0.0001 0.002 0.0001 0.014 0.3 0.7 0.024 0.5 0.6 1 Exhaustion and eating certain types of food the following alternative sources of treatment were identi- fied: holy water from orthodox churches, private practi- tioners, traditional healers and private drug vendors/ pharmacies. The Orthodox Church, the most prominent religious institution in Ethiopia, widely practices faith-based ther- apy with holy water. Patients get holy water treatment both at home and in designated monasteries/churches with springs believed to have supernatural powers includ- ing healing. The home-based treatment is prescribed by priests after sanctifying a small volume of water to be applied over the body of the diseased and sprayed inside his/her living room. An alternative approach demands patients' stay close to holy water springs that are mostly located adjoining to churches/monasteries representing different saints. The choice and duration of treatment depends on patients' beliefs about a particular saint and priests' recommendations. In the study region, there are over 5000 Orthodox Churches with nearly 20,000 priests giving services. Followers of Orthodox Christianity consti- tute 95% of the total regional population. The use of holy waters as an initial treatment will probably continue to be a cause of patient delayed presentation in areas where public health facilities are remotely located. In Ethiopia, the TB control programme does not extend into the formal private health sector. In this study, 13% of patients visited private practitioners prior to first consulta- tion at a public health facility. More urban than rural (17% versus 10%) patients made their first consultation at a private practitioner. Smaller proportions of patients consulted private drug vendors and traditional healers (7% and 3% respectively). The involvement of these pri- mary sources of care in TB control will be crucial in addressing the prolonged patient delay in Ethiopia. We therefore suggest that public-private partnership [23] may play a significant role in the early referral and treatment of pulmonary patients. The involvement of these institu- tions in TB control could be a feasible strategy to reduce prolonged patient delays in urban areas. In contrast to previous reports [4,24,25], poor access to health care in terms of travel time from patients' areas of residences to public health facilities was not significantly associated with prolonged patient delay. After prolonged delay, the pattern of utilization of public health facilities was found to be complex. In this study, a majority of patients bypassed nearby facilities in favour of a district diagnostic centre. More than half of rural patients bypassed nearby clinics and made their first consultation at a district diagnostic centre (a hospital or health centre). Similarly, more than half of the patients whose residence was closer to a health centre still made their first consulta- tion at district hospitals. These attendance patterns are summarised in Figure 1. These findings suggest that prox- Page 7 of 10 (page number not for citation purposes)