Indian Journal of Respiratory Care

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VOLUME 11 , ISSUE 4 ( October-December, 2022 ) > List of Articles

Original Article

A Cross-Sectional Descriptive Study to Ascertain Factors Influencing Delay in Diagnosis among Newly Diagnosed Pulmonary Tuberculosis Patients

Nithin Thomas, Ragulan Rajalingam, Viswambhar Vallabhaneni, Jereen Varghese

Keywords : Diagnostic delay, health system delay, patient delay, tuberculosis

Citation Information : Thomas N, Rajalingam R, Vallabhaneni V, Varghese J. A Cross-Sectional Descriptive Study to Ascertain Factors Influencing Delay in Diagnosis among Newly Diagnosed Pulmonary Tuberculosis Patients. Indian J Respir Care 2022; 11 (4):341-348.

DOI: 10.4103/ijrc.ijrc_74_22

License: CC BY-NC-SA 4.0

Published Online: 01-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: Tuberculosis (TB) is a communicable disease. The management, as well as the outcome, depends upon the early detection and diagnosis of the disease. Delay in diagnosis leads to worsening of the patient's condition as well as the emergence of multi-resistant bacilli. Objectives: The objectives were to know how many persons had diagnostic and treatment delays, as well as the factors that were linked to delayed care-seeking (patient delay) and diagnosis by health-care professionals (health-care system delay) among newly diagnosed pulmonary TB patients. Methodology: A cross-sectional study of 115 diagnosed pulmonary TB patients was done. The time between the initial symptoms and the first encounter with a hospital institution was referred to as the patient's delay. The time between first contact with a health-care facility and diagnosis confirmation was referred to as the diagnostic delay. A cutoff threshold of 4 weeks was used to determine the diagnostic delay. A patient delay of more than 2 weeks and a health-care system delay exceeding 2 weeks were also evaluated. Results: In this study, 94 (81.7%), 69 (60%), and 100 (87%) subjects had patient, health system, and diagnostic delays, respectively. Conclusion: The majority of the participants in the study experienced a diagnostic delay, followed by patient and health-care system delays. The educational status, income status, distance to a health care facility, cost, initial consultation with the type of health-care personnel in the health-care system, and frequency of consultations were associated with the delays.

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  1. World Health Organization. Tuberculosis – Key Facts; 2021. Available from: [Last accessed on 2022 Mar 25].
  2. Park K. Tuberculosis, Park's Text Book of Preventive and Social Medicine. 20th ed. Jabalpur (M.P.), India: M/s Banarsidas Bhanot; 2013. p. 159-75.
  3. Cheng S, Chen W, Yang Y, Chu P, Liu X, Zhao M, et al. Effect of diagnostic and treatment delay on the risk of tuberculosis transmission in Shenzhen, China: An observational cohort study, 1993-2010. PLoS One 2013;8:e67516.
  4. Squeglia F, Ruggiero A, Berisio R. Collagen degradation in tuberculosis pathogenesis: The biochemical consequences of hosting an undesired guest. Biochem J 2018;475:3123-40.
  5. Ravimohan S, Kornfeld H, Weissman D, Bisson GP. Tuberculosis and lung damage: From epidemiology to pathophysiology. Eur Respir Rev 2018;27:170077.
  6. Mathema B, Andrews JR, Cohen T, Borgdorff MW, Behr M, Glynn JR, et al. Drivers of tuberculosis transmission. J Infect Dis 2017;216:S644-53.
  7. Segagni Lusignani L, Quaglio G, Atzori A, Nsuka J, Grainger R, Palma Mda C, et al. Factors associated with patient and health care system delay in diagnosis for tuberculosis in the province of Luanda, Angola. BMC Infect Dis 2013;13:168.
  8. Paramasivam S, Thomas B, Chandran P, Thayyil J, George B, Sivakumar CP. Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Kerala. J Family Med Prim Care 2017;6:643-8.
  9. World Health Organization. Diagnostic and treatment delay in tuberculosis. Geneva, Switzerland: World Health Organization; 2006.
  10. Manjareeka M, Palo SK, Swain S, Pati S, Pati S. Diabetes mellitus among newly diagnosed tuberculosis patients in tribal Odisha: An exploratory study. J Clin Diagn Res 2016;10:LC06-8.
  11. Alavi SM, Bakhtiyariniya P, Albagi A. Factors associated with delay in diagnosis and treatment of pulmonary tuberculosis. Jundishapur J Microbiol 2015;8:e19238.
  12. Paul D, Busireddy A, Nagaraja SB, Satyanarayana S, Dewan PK, Nair SA, et al. Factors associated with delays in treatment initiation after tuberculosis diagnosis in two districts of India. PLoS One 2012;7:e39040.
  13. Rajeswari R, Chandrasekaran V, Suhadev M, Sivasubramaniam S, Sudha G, Renu G. Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India. Int J Tuberc Lung Dis 2002;6:789-95.
  14. Sreeramareddy CT, Qin ZZ, Satyanarayana S, Subbaraman R, Pai M. Delays in diagnosis and treatment of pulmonary tuberculosis in India: A systematic review. Int J Tuberc Lung Dis 2014;18:255-66.
  15. Gebreegziabher SB, Bjune GA, Yimer SA. Patients' and health system's delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: A cross-sectional study. BMC Infect Dis 2016;16:673.
  16. Ebrahimi Kalan M, Yekrang Sis H, Kelkar V, Harrison SH, Goins GD, Asghari Jafarabadi M, et al. The identification of risk factors associated with patient and healthcare system delays in the treatment of tuberculosis in Tabriz, Iran. BMC Public Health 2018;18:174.
  17. Seid A, Metaferia Y. Factors associated with treatment delay among newly diagnosed tuberculosis patients in Dessie city and surroundings, Northern Central Ethiopia: A cross-sectional study. BMC Public Health 2018;18:931.
  18. Asres A, Jerene D, Deressa W. Delays to anti-tuberculosis treatment intiation among cases on directly observed treatment short course in districts of southwestern Ethiopia: A cross sectional study. BMC Infect Dis 2019;19:481.
  19. Alene M, Assemie MA, Yismaw L, Gedif G, Ketema DB, Gietaneh W, et al. Patient delay in the diagnosis of tuberculosis in Ethiopia: A systematic review and meta-analysis. BMC Infect Dis 2020;20:797.
  20. Datiko DG, Jerene D, Suarez P. Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study. BMC Public Health 2020;20:1126.
  21. Getnet F, Demissie M, Worku A, Gobena T, Tschopp R, Girmachew M, et al. Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia. BMC Pulm Med 2019;19:201.
  22. Ayalew YE, Yehualashet FA, Bogale WA, Gobeza MB. Delay for tuberculosis treatment and its predictors among adult tuberculosis patients at debremarkos town public health facilities, North West Ethiopia. Tuberc Res Treat 2020;2020:1901890.
  23. Kunjok DM, Mwangi JG, Mambo S, Wanyoike S. Assessment of delayed tuberculosis diagnosis preceding diagnostic confirmation among tuberculosis patients attending Isiolo County level four hospital, Kenya. Pan Afr Med J 2021;38:51.
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