Factors associated with patient and healthcare system delay in diagnosis and treatment of tuberculosis

BACKGROUND: More than 90% of the worldwide tuberculosis (TB) cases and deaths arise in the developing world. Delay in the diagnosis and treatment of TB potentially extents and aggravates the infection in the public leading to increased risk of death. Identifying the delays in the diagnosis of TB is indispensable to the health system to prevent spread of the disease. The current study was conducted to identify the factors related to patients and health care systems which delay diagnosis and treatment of TB in Qom Province, Iran. METHODS: A cross-sectional survey was conducted on 661 patients with TB registered in healthcare units of Qom during 7 years (April 2011 to March 2017). Data regarding the patients' demographic characteristics and clinical factors associated with diagnosis and treatment delay and total delay were analyzed using Student's t-test and one-way analysis of variance (ANOVA). Multivariate logistic regression was also employed to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using SPSS software. RESULTS: The means of patient, healthcare, treatment, and total delay were 27.7 days, 53.7 days, 1.64 days, and 82.5 days, respectively. Additionally, 550 (83.2%) cases had total delay. It was determined that inhabitance, nationality, and type of extrapulmonary TB were significantly associated with diagnosis delay (P < 0.05). CONCLUSION: Diagnostic delay in this study was mainly due to healthcare systems' facilities. Modern and efficient facilities would contribute a lot to early diagnosis of TB and improve the quality of TB management.