Factors associated with patient delay and diagnostic delay among TB patients in China: A critical appraisal

Background: Delay in seeking care is a major impediment against effective management of TB in China. There is a need to elucidate factors that are associated with patient delay and diagnostic delay. Methods: Medline/PubMed, Embase, CNKI were searched up to November 2012 to identify relevant data for review and meta-analyses. Results: Twenty-nine studies involving 38947 PTB patients from 17 provinces in China were included in the review. Results of the review indicated: at the individual level, socio-demographic and economic factors, mostly poverty, rural residence, lack of health insurance, educational level, stigma, and low knowledge of TB were important determinants of delays; prominent among health systems determinants of patient and diagnostic delays were financial barriers (patients' lack of health insurance), health providers' poor knowledge of TB management, patients' perceived poor quality of care. Conclusions: Population-based interventions that seek to reduce TB stigma and raise awareness about the benefits of early diagnosis and prompt treatment are needed as are strategies to increase the TB case management skills of health workers. Policies that remove patients' financial barriers in access to TB care, and integration of informal care sector into the TB management in urban and rural settings are urgently needed.