Factors associated with health care-seeking delay and treatment delay in pulmonary tuberculosis patients in Shishou and Badong of Hubei

  Objective  To investigate the current status of health care-seeking delay and treatment delay of pulmonary tuberculosis (TB) patients and the influencing factors in two counties of Hubei Province, and provide evidence for the early detection and early treatment of TB patients.

  Methods  Cross-sectional survey was conducted through face to face interview and collection of patient's medical record information, outpatient and inpatient records of hospitals for univariate analysis and logistic regression analysis to identify the factors independently associated with the health care-seeking delay and treatment delay.

  Results  The median of health care seeking delay was 7 d (IQR: 0–30), the risk factors associated with health care-seeking delay were cough or expectoration (OR=1.97, 95% CI: 1.04–3.75), distance to a health facility for the first health care seeking >20 km (OR=2.35, 95% CI: 1.36–4.06), but chest pain (OR=0.47, 95% CI: 0.25–0.89) was the protective factor for health care seeking delay. The median of treatment delay was 24 days (IQR: 13–54), the number of health care seeking and number of different medical institutions visited were independent factors for treatment delay (P<0.05), the higher the numbers, the higher the risk for treatment delay. The median of total delay was 56 days (IQR: 26–138), the total delay was positively associated with cough or expectoration (OR=2.37, 95% CI: 1.14–4.95), being smear positive (OR=2.07, 95% CI: 1.16–3.68), distance to nearest designated TB medical institution >30 km (OR=1.92, 95% CI: 1.04–3.55), the number of health care seeking (3–4 times: OR=2.50, 95% CI: 1.25–4.97, >4 times: OR=25.42, 95% CI: 5.19–124.44).

  Conclusion  In this study, the total delay of pulmonary TB patients was mainly caused by treatment delay. While taking measures to reduce health care seeking delay, it is still necessary to improve patient's health care seeking behavior, optimize patient access to medical institutions, improve the watchfulness and diagnosis level of TB of non-designated TB medical institutions and use molecular biology and other means for screening to reduce treatment delay of TB patients.