title: Delay in the diagnosis of tuberculosis in Nepal.
abstract: BACKGROUND
  Identifying reasons for delay in diagnosis and treatment of tuberculosis is important for the health system to find ways to treat patients as early as possible, and hence reduce the suffering of patients and transmission of the disease. The objectives of this study was to assess the duration of delay in the diagnosis of tuberculosis and to investigate its determinants.
  
  
  METHODS
  A cross-sectional survey was conducted using a structured questionnaire in 307 new tuberculosis patients registered by the National Tuberculosis Programme (NTP) in all DOTS centres in Banke district of Nepal.
  
  
  RESULTS
  The median patient delay was 50 days, the median health system delay was 18 days, and the median total delay was 60 days. Sputum smear negative participants had significantly lower risk of patient delay. Smokers using >5 cigarettes per day had higher risk of patient delay and health system delay.
  
  
  CONCLUSIONS
  Total delay in the diagnosis of tuberculosis in Banke district is shorter compared to other places in Nepal and neighbouring countries. The shorter delay for smear negative pulmonary tuberculosis raises suspicion that many of these patients are not examined according to the NTP manual before being diagnosed. Increasing public awareness of the disease and expansion of the facilities with assured quality could be helpful to reduce the delay in the diagnosis of tuberculosis.
authors: Centre for International Health, University of Bergen, Bergen, Norway. basnetr@gmail.com
authors: Rajendra
authors: R
authors: Basnet
authors: Sven Gudmund
authors: SG
authors: Hinderaker
authors: Don
authors: D
authors: Enarson
authors: Pushpa
authors: P
authors: Malla
authors: Odd
authors: O
authors: Mørkve
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009390:Nepal; D015397:Program Evaluation; D012307:Risk Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis*; D055815:Young Adult