Factors associated with patient and health system delays in the diagnosis of tuberculosis, South India

Rajeswari, R and Chandrasekaran, V and Suhadev, M and Sivasubramanian, S and Sudha, G and Renu, G (2002) Factors associated with patient and health system delays in the diagnosis of tuberculosis, South India. International Journal of Tuberculosis and Lung Disease, 6 (9). pp. 789-795. ISSN Print: 1027-3719; Online: 1815-7920

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Abstract

OBJECTIVES: To investigate the factors associated with delay in 1) care-seeking (patient delay), and 2) diagnosis by health providers (health system delay), among smearpositive tuberculosis patients, before large-scale DOTS implementation in South India. METHODS: New smear-positive patients were interviewed using a structured questionnaire. RESULTS: Among 531 participants, the median patient, health system and total delays were 20, 23 and 60 days, respectively. Twenty-nine per cent of patients delayed seeking care for �1 month, of whom 40% attributed the delay to their lack of awareness about TB. Men postponed seeking care for longer periods than women (P � 0.07). In multivariate analysis, the patient delay was greater if the patient had initially consulted a government provider (adjusted odds ratio [AOR] 2.2, P � 0.001), resided at a distance �2 km from a health facility (AOR 1.6, P � 0.04), and was an alcoholic (AOR 1.6, P � 0.04). Health system delay was �7 days among 69% of patients. Factors associated with health system delay were: first consultation with a private provider (AOR 4.0, P � 0.001), a shorter duration of cough (AOR 2.6, P � 0.001), alcoholism (P � 0.04) and patient’s residence �2 km from a health facility (AOR 1.8, P � 0.02). The total delay resulted largely from a long patient delay when government providers were consulted first, and a long health system delay when private providers were consulted first. CONCLUSION: Public awareness about chest symptoms and the availability of free diagnostic services should be increased. Government and private physicians should be educated to be aware about the possibility of tuberculosis when examining out-patients. Effective referrals for smear microscopy should be developed between private and public providers.

Item Type:	Article
Uncontrolled Keywords:	tuberculosis; patient delay; health system delay; factors for delay; India
Subjects:	Tuberculosis > Clinical Research
Divisions:	Clinical Research
Depositing User:	Dr. Rathinasabapati R
Date Deposited:	08 Nov 2013 10:06
Last Modified:	10 Mar 2016 04:41
URI:	http://eprints.nirt.res.in/id/eprint/571

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