title: Pathways from first health care seeking to diagnosis: obstacles to tuberculosis care in rural China.
abstract: OBJECTIVE
  To examine health care seeking pathways for patients with tuberculosis (TB) and barriers related to these pathways in counties under the National TB Control Programme in rural China.
  
  
  METHODS
  A cross-sectional study was conducted in two counties of east China in 2004-2005. A total of 557 TB patients were recruited and interviewed by physicians at the time of TB diagnosis.
  
  
  RESULTS
  Of 557 participants, 13.3% had presented to a specialised county TB dispensary (CTD) directly after onset of symptoms, 31.4% had first sought care at a village health station and 51.2% had visited a township or county hospital first. The proportion of referral by a first health care provider to a CTD was highest in county level hospitals (73.5%) and lowest in village health stations (21.7%). The most prompt pathway from first health care seeking to TB diagnosis was to visit a CTD directly, with a median provider's delay of only one day. There was an increase in provider's delay when more health facilities were involved.
  
  
  CONCLUSIONS
  To improve direct referral from general health care providers, especially village health care workers, to TB specialists would significantly shorten the delays in TB diagnosis in rural China.
authors: School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China. bxu@shmu.edu.cn
authors: W B
authors: WB
authors: Wang
authors: Q W
authors: QW
authors: Jiang
authors: Y
authors: Y
authors: Chen
authors: B
authors: B
authors: Xu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D019035:Rural Health Services; D012923:Social Class; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*