Diagnostic and treatment delay of pulmonary TB in selected rural and urban area of Bangladesh

Introduction: Delay in diagnosis and initiation of treatment of TB results in severe disease and increased burden of the disease in Bangladesh where disease prevalence is high. This study explored the underlying factors that influence delay in diagnosis and treatment of pulmonary TB among adults.

Methods: Newly diagnosed sputum positive TB patients aged 15 years and above attending selected urban and rural TB clinics were interviewed. First two patients attending TB centers were enrolled each day during May to September 2010. Total delay comprises of patient delay (from first symptom to first visit to qualified doctors) and health care system delay (from first visit to qualified doctor to TB diagnosis and treatment initiation).

Results: A total of 278 patients were enrolled, 151 from urban Dhaka and rest from rural Mirzapur sub-district. The median total delay was 62 days (Inter quartile range 37, 96 days). Patient delay was significantly more in rural area compared to urban area and health care system delay was more in urban area compared to rural area (p< 0.001). Higher degree of stigma (OR 2.0; 95% CI 1.2-3.4; p=0.008) and older age group (OR 3.3; 95% CI 1.7-6.4, p<0.001) were associated with longer delay.

Conclusion: There is an urgent need for improving comprehensive service delivery to reduce the total delay in diagnosis and treatment of TB in Bangladesh, particularly patient delay in rural areas and health care system delay in urban areas. Stigma still prevents patients from seeking care and should be alleviated by increased awareness building.