Patient and health system delays in diagnosis and treatment of tuberculosis patients in an urban tuberculosis unit of south India

Abstract

Background: Early diagnosis and prompt initiation of treatment is an essential component of revised National Tuberculosis Control Programme. Any type of delay (patient delay, health system delay) may worsen the disease, increase the risk of death and enhance disease transmission in the community. The study intended to know the extent of patient delay and health system delay in diagnosis and treatment of tuberculosis (TB) patients and to assess factors associated with patient and health system delay . Methods: A cross sectional study on 217 new smear positive tuberculosis patients aged above 15 years who were registered between Nov-2008 to Sept-2009 for DOTS under RNTCP in Mysore tuberculosis unit was included in the study. Interview was conducted using pre tested semi structured questionnaire within 2 months of diagnosis to minimize recall bias. Results: The median delay among 217 participants was 27 days due to patient delay, 17 days due to health system and 49 days in total delay respectively. The delay in seeking care was more than one month in 39% patients. In 44% of patients there was more than 15 days delay in the diagnosis by the health care providers. In 10% of patients treatment was not initiated within 7 days of diagnosis . Conclusions: More specific and effective health education to the general public on seeking of appropriate medial consultation through proper channel is likely to decrease patient delay. Continuing medical education for private practitioners is needed to encourage vigilance for TB and earlier use of diagnostic tests.