title: Diagnostic delay among pulmonary tuberculosis patients in Sarawak, Malaysia: a cross-sectional study.
abstract: BACKGROUND
  Delayed diagnosis of tuberculosis (TB) can lead to an increased period of infectivity in the community, a delay in treatment and a severe form of the disease. The objective of this study was to determine the length of delay, and factors linking the delay from the onset of symptoms of pulmonary tuberculosis (PTB) until the commencement of treatment in Sarawak, Malaysia.
  
  
  METHODS
  An institution based cross-sectional study was conducted in 10 TB clinics in randomly selected divisions in Sarawak from June 2003 to May 2004. Delay was analyzed from two perspectives: (1) period between the onset of TB symptoms to any first medical consultation (patients' delay); and (2) period between the first medical consultation to the diagnosis of TB (diagnosis delay). Patients were interviewed on diagnosis or within the admission period using a semi-structured questionnaire.
  
  
  RESULTS
  A total of 316 new smear-positive PTB patients participated in the study. The median patient interval was 30 days. Gender was found to be significantly associated with patient delay. The median diagnosis interval was 22 days. Respondents' incomes, health-care professional first consulted and actions taken by the health-care providers during the first consultation were significantly associated with diagnosis delay. The medium treatment interval was 0 days.
  
  
  CONCLUSIONS
  Both patients and health providers played a role in delaying TB diagnosis. Females appeared to have longer delay. Respondents living above the poverty line had diagnosis delay as they made more visits to GPs or different government clinics without proper investigations for TB. A mechanism is needed to increase all health-care providers' suspicion of TB so that proper investigations can be done during first consultation.
authors.affiliation: Faculty of Medicine & Health Sciences, University Malaysia Sarawak, Jalan Tun Ahmad Zaidi Adruce, Kuching, Malaysia. ccthon@fmhs.unimas.my
authors.forename: Ching Thon
authors.initials: CT
authors.lastname: Chang
authors.forename: Adrain
authors.initials: A
authors.lastname: Esterman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012648:Self Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy