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Free Content Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review

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OBJECTIVE: To systematically review Indian literature on delays in tuberculosis (TB) diagnosis and treatment.

METHODS: We searched multiple sources for studies on delays in patients with pulmonary TB and those with chest symptoms. Studies were included if numeric data on any delay were reported. Patient delay was defined as the interval between onset of symptoms and the patient's first contact with a health care provider. Diagnostic delay was defined as the interval between the first consultation with a health care provider and diagnosis. Treatment delay was defined as the interval between diagnosis and initiation of anti-tuberculosis treatment. Total delay was defined as time interval from the onset of symptoms until treatment initiation.

RESULTS: Among 541 potential citations identified, 23 studies met the inclusion criteria. Included studies used a variety of definitions for onset of symptoms and delays. Median estimates of patient, diagnostic and treatment delay were respectively 18.4 (IQR 14.3–27.0), 31.0 (IQR 24.5–35.4) and 2.5 days (IQR 1.9–3.6) for patients with TB and those with chest symptoms combined. The median total delay was 55.3 days (IQR 46.5–61.5). About 48% of all patients first consulted private providers; an average of 2.7 health care providers were consulted before diagnosis. Number and type of provider first consulted were the most important risk factors for delay.

CONCLUSIONS: These findings underscore the need to develop novel strategies for reducing patient and diagnostic delays and engaging first-contact health care providers.
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Keywords: India; care seeking behaviour; delayed diagnosis; delivery of health care; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Population Medicine, Faculty of Medicine and Health Science, University Tunku Abdul Rahman, Selangor, Malaysia 2: Department of Epidemiology and Biostatistics, McGill International TB Centre, McGill University, Montreal, Quebec, Canada 3: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA

Publication date: March 1, 2014

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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