Predictors of Delay in Diagnosis and Treatment for Tuberculosis in North India: A Cross Sectional Analytical Study

Abstract

Introduction: Tuberculosis (TB) has been a continuous major public health problem.The treatment delay affects an individual, the community, a country’s health and economy. In general, it is very difficult to quantify the crisis in country’s health and economy, especially in the era of MDR-TB, from suffering and death of economically productive individuals from such preventable and treatable disease because of delayed initiation of treatment.Understanding the causes behind delay in diagnosis and treatment is essential for all partners involved in tuberculosis control. Material and Methods: The cross-sectional study was conducted among the patients of tuberculosis diagnosed at I.G.M.C. Shimla from 1st August 2018 through 31st July 2019.A structured, validated and pretested questionnaire was adapted from the WHO multi country tuberculosis treatment delay survey. Questionnaire consists of basic demographic profile of patients, type of tuberculosis and associated co-morbidities, TB knowledge, attitude toward TB and regarding potential delays. Data was collected from patients at the time of their registration for treatment at DOTS centre. Results: The most common levels of delays identified in study participants were patient delay and health care provider delay.The mean delay at patient level was 66 days and delay at health care provider was 83 days. Total delay among participants was 130 days.Among all study participants, 31.03% thought that their symptoms would go at their own. The economic constraint was found in 22.41 %.Reason of delay among 41.42 % participants was Late diagnosis at level of health care provider. Out of total, 18.5% who visited private practitioner, were not diagnosed. Conclusion: There was a delay of 66 days for seeking treatment and 84 days for diagnosis of tuberculosis at health care provider level. A longer delay was revealed in smoker, residents of rural area and patients from low income group for seeking treatment.The delay at the level of health care provider was significantly associated in participants who travelled less than five kilometers to reach first health facility for seeking treatment.