title: Longer delay in accessing treatment among current smokers with new sputum smear-positive tuberculosis in Nepal.
abstract: METHODS
  Kathmandu, Nepal, which has 7% of the national population and 18% of the tuberculosis (TB) burden.
  
  
  OBJECTIVE
  To determine the association of smoking with total delay among new sputum smear-positive TB patients.
  
  
  METHODS
  Direct interviews were conducted among 605 TB  patients registered in 37 randomly selected clinics within 30 days of initiating anti-tuberculosis treatment using a semi-structured questionnaire. Total delay was calculated from the date of the first reported symptom to the commencement of treatment. Logistic regression analyses were performed  to determine the factors associated with total delay.
  
  
  RESULTS
  Of the 605 TB patients interviewed, 271 (44.8%) were current smokers, 33 (5.5%) were ex-smokers and 301 (49.8%) were never smokers. The median total delay was 103 days (current smokers 133 days, ex-smoker 103 days and never  smokers 80 days). Longer delay was more common among current smokers (aOR 2.03, 95%CI 1.24-3.31). Covariates with significantly more delay were female sex, lower levels of education and higher degrees of sputum smear positivity.
  
  
  CONCLUSIONS
  Total delay was unacceptably longer in current  smokers. Anti-smoking interventions are needed as an integral part of the TB programme to address this problem.
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Jakarta, Indonesia. tsbam@theunion.org
authors.forename: T S
authors.initials: TS
authors.lastname: Bam
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.forename: S G
authors.initials: SG
authors.lastname: Hinderaker
authors.forename: D S
authors.initials: DS
authors.lastname: Bam
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009390:Nepal / Q000453:epidemiology; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents