Delay in the diagnosis of tuberculosis in Nepal

Abstract

BackgroundIdentifying reasons for delay in diagnosis and treatment of tuberculosis is important for the health system to find ways to treat patients as early as possible, and hence reduce the suffering of patients and transmission of the disease. The objectives of this study was to assess the duration of delay in the diagnosis of tuberculosis and to investigate its determinants.MethodsA cross-sectional survey was conducted using a structured questionnaire in 307 new tuberculosis patients registered by the National Tuberculosis Programme (NTP) in all DOTS centres in Banke district of Nepal.ResultsThe median patient delay was 50 days, the median health system delay was 18 days, and the median total delay was 60 days. Sputum smear negative participants had significantly lower risk of patient delay. Smokers using >5 cigarettes per day had higher risk of patient delay and health system delay.ConclusionTotal delay in the diagnosis of tuberculosis in Banke district is shorter compared to other places in Nepal and neighbouring countries. The shorter delay for smear negative pulmonary tuberculosis raises suspicion that many of these patients are not examined according to the NTP manual before being diagnosed. Increasing public awareness of the disease and expansion of the facilities with assured quality could be helpful to reduce the delay in the diagnosis of tuberculosis.

Magnitude da tuberculose pulmonar na população fronteiriça de Mato Grosso do Sul (Brasil), Paraguai e Bolívia

“…No entanto, o retardo no diagnóstico aumenta a gravidade da doença e potencializa a disseminação da infecção na comunidade, elevando a mortalidade 29,30 .…”

Delay in Diagnosis of Tuberculosis among Under Treatment Patients in Rajshahi City, Bangladesh

“…20 A study in South India found longer diagnostic delay among men. 21 Another study in Nepal summarized that male patients experienced higher diagnostic delay 22 but several studies in developing countries reported longer diagnostic delay among women. 19,23 In our study, male patients experienced remarkable delay in diagnosis and constituted the higher percentage as compare to female patients.…”

Delay in Tuberculosis Diagnosis among Tuberculosis Patients at the Three Hospitals: Asella, Robe and Abomsa of Arsi Zone, Oromia Regional State, March, 2015

“…Median patient delay is as high as 8 weeks in Brazil [23] and 50 days in Nepal [18]; as medium as 23.5 days in Georgia [24], 3 weeks in Vietnam [25].…”

“…Delay was defined as any time period from the onset of symptoms to presentation, to diagnosis, to treatment initiation; or from presentation to diagnosis or treatment initiation; or else from diagnosis to treatment initiation based on their objective of study [14]. Almost all studies reviewed used "patient delay" contextually as the time interval between the onset of major symptoms of TB to the first presentation to formal health care facility [2] [5] [7] [8] [15]- [18]. One study defined "patient delay" as the time interval between the onsets of TB symptoms-and the first formal or informal health care received [19].…”