title: Predictors of treatment delays for tuberculosis in Sikkim.
abstract: BACKGROUND
  This study examined the factors associated with delays (i) between the onset of symptoms and the patient's first visit to a medical facility (patient delay), and (ii) between a patient's visit to a medical facility and the diagnosis of tuberculosis (health system delay).
  
  
  METHODS
  A cross-sectional survey was conducted of 323 patients (median age 30 years, men: 190) reporting to 2 tuberculosis units and 4 microscopy centres in East Sikkim using a pre-tested structured interview schedule. Patient records were verified for dates of investigations, diagnosis and treatment. Bivariate and multivariate analyses were done to find out the associations between dependent and independent variables.
  
  
  RESULTS
  The median patient and health system delays were 21 and 7 days, respectively. Patient delay >30 days was reported by 17% and health system delay > 7 days by 49% of the participants. Patient delay was associated with self-medication (OR 2.28, 95% CI: 1.0-5.18), choice of government doctors as first contact (OR 2.76, 95% CI: 1.15-6.62), use of traditional healers (OR 2.18, 95% CI: 1.03-4.61) and cost of treatment 3Rs 400 compared with <Rs 100 (OR 2.52, 95% CI: 1.17-5.38). Important predictors of health system delays were first contact with private doctors (OR 33.1, 95% CI: 13.44-81.49) and cost of treatment (OR 2.5; 95% CI: 1.22-5.128).
  
  
  CONCLUSIONS
  Efforts need to be made to eliminate the factors causing a delay in the initiation of treatment of patients with tuberculosis. These should include increasing awareness to avoid self-medication, the availability of free treatment, and training traditional healers and private doctors in the treatment of tuberculosis.
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapurm, Kerala, India.
authors.forename: Karma Jigme
authors.initials: KJ
authors.lastname: Tobgay
authors.forename: P Sankara
authors.initials: PS
authors.lastname: Sarma
authors.forename: K R
authors.initials: KR
authors.lastname: Thankappan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D002648:Child; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy; D042241:Early Diagnosis; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012819:Sikkim; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*