Healthcare seeking pathways and diagnostic delays among extra-pulmonary tuberculosis patients: a study from Pakistan

Abstract

Extra-pulmonary tuberculosis (EPTB) most often remains undiagnosed or even untreated due to the complicated healthcare-seeking pathways, diagnostic and management challenges that lead to either over or under treatment, which may cause diagnostic delays, development of drug resistance, and an increase in morbidity and mortality. The study aimed to assess the healthcare-seeking pathways, delays, and factors associated with longer delays. The study was conducted at a private tertiary hospital in Lahore, Pakistan. Data were obtained prospectively by a pre-designed questionnaire from the two common types of EPTB, "tuberculous lymphadenitis, and pleuritis," patients. Patients9, health-system (HS), and total delays were analyzed according to sociodemographic and clinical characteristics, healthcare-seeking pathways, and factors associated with these delays. Out of 339 patients, 82% were adults, between 15-72 years. Systemic symptoms such as fever, appetite loss, weight loss, and local symptoms such as neck mass, difficulty in breathing, and chest pain attributed to seeking healthcare. The median patient, HS, and total delays were 14, 40, and 69 days. Health system delay was longer than the patient’s delay, a maximum contributor to the total delay, and was associated with tuberculous lymphadenitis, poor socioeconomic status, and poor TB knowledge. A considerable health system delay in the management of TB lymphadenitis and pleuritis patients. TB control programs’ initiatives must emphasize efforts to minimize health system delays for screening, diagnosis, and management with a feasible and cost-effective algorithm that is workable in a resource-limited high TB burden setting.