Delay in the Diagnosis of Tuberculosis in Banke district, Nepal
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Background: Tuberculosis is one of the major causes of ill health in the world and almost 33% of the global new case was found in South East Asian Region. In 2006, tuberculosis incidence was reported 30,000 and 14,000 of them were sputum smear positive pulmonary tuberculosis in Nepal and still 5,000 to 7,000 people die due to tuberculosis. Delay in diagnosis and starting tuberculosis treatment increases severity, risk of mortality and transmission of the disease in the community. Objectives: This study aims to assess the delay in the diagnosis of tuberculosis and to investigate its determinants. Setting: The study was conducted in 48 out of 55 DOTS centres/sub-centres in Banke district of Nepal. Method: A cross-sectional survey was conducted using a structured questionnaire to 307 newly registered tuberculosis patients, who were on anti-tuberculosis treatment under National Tuberculosis Programme during June to July, 2007. Results: Median patient delay was 50 days, median health system delay was 18 days, median DOTS delay 3 days and median total delay was 60 days and 69% of the participants had 30 days delay or more in the diagnosis of tuberculosis. Total delay was mainly contributed by patient delay (73%). Patient’s occupation was associated with delay in the diagnosis of tuberculosis. Occupation directly involved in income generation had shorter patient delay compared to farmers. Conclusion: Total delay in the diagnosis of tuberculosis in Banke district was shorter (median delay was 60 days) compared to other places in Nepal. Raising public awareness of the disease in the community, collaboration with private health care providers and expansion of the facilities with assured quality especially diagnostic facilities could be helpful to reduce delay in the diagnosis of tuberculosis.