title: Diagnostic delay amongst tuberculosis patients in Jogjakarta Province, Indonesia is related to the quality of services in DOTS facilities.
abstract: OBJECTIVE
  To understand determinants of care-seeking patterns and diagnostic delay amongst tuberculosis (TB) patients diagnosed at direct observed treatment short course (DOTS) facilities in Jogjakarta, Indonesia.
  
  
  METHODS
  Cross-sectional survey amongst newly diagnosed TB patients in 89 DOTS facilities whose history of care-seeking was reconstructed through retrospective interviews gathering data on socio-demographic determinants, onset of TB symptoms, type of health facilities visited, duration of each care-seeking action were recorded.
  
  
  RESULTS
  Two hundred and fifty-three TB patients were included in the study whose median duration of patients' delay was 1 week and whose total duration of diagnostic delay was 5.4 weeks. The median number of visits was 4. Many of the patients' socio-demographic determinants were not associated with the care-seeking patterns, and no socio-demographic determinants were associated with the duration of diagnostic delay. More than 60% of TB patients started their care-seeking processes outside DOTS facilities, but the number of visits in DOTS facilities was greater during the overall care-seeking process. Surprisingly, patient's immediate visits to a DOTS facility did not correspond to shorter diagnostic delay.
  
  
  CONCLUSIONS
  Diagnostic delay in Jogjakarta province was not associated with patients' socio demographic factors, but rather with the health system providing DOTS services. This suggests that strengthening the health system and improving diagnostic quality within DOTS services is now a more rational strategy than expanding the TB programme to engage more providers.
authors.affiliation: Department of Public Health, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia. risandono.ahmad@gmail.com
authors.forename: Riris Andono
authors.initials: RA
authors.lastname: Ahmad
authors.forename: Yodi
authors.initials: Y
authors.lastname: Mahendradhata
authors.forename: Adi
authors.initials: A
authors.lastname: Utarini
authors.forename: Sake J
authors.initials: SJ
authors.lastname: de Vlas
mesh_terms: D000293:Adolescent; D000328:Adult; D057210:Delayed Diagnosis; D003695:Delivery of Health Care / Q000592:standards*; D023801:Directly Observed Therapy / Q000592:standards*; D004812:Epidemiologic Methods; D005260:Female; D006078:Government Programs / Q000592:standards; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult