title: Delay in diagnosis and treatment among TB patients registered under RNTCP Mandi, Himachal Pradesh, India, 2010.
abstract: BACKGROUND
  Delay in TB diagnosis and treatment is associated with increased transmission, morbidity and mortality. Patient and provider factors are responsible for such delays. We conducted a study to estimate these delays and identify associated factors among new sputum positive (NSP) TB patients in Mandi district, Himachal Pradesh.
  
  
  METHODS
  We interviewed 234 NSP patients to collect information on their health seeking behaviour. We conducted univariate and multivariate analysis to identify factors associated with longer delays.
  
  
  RESULTS
  Median patient, health system and total delay were 15, 13 and 36 days respectively. Significant factors associated with total delay included patients' knowledge about TB, seeking care from non-specialized individuals as the first action, consulting > 2 health facilities before diagnosis and consulting private health facilities. Patients with low family income and those who had high expenditure on consultations before initial diagnosis were associated with patient and health system delay respectively.
  
  
  CONCLUSIONS
  It is necessary to increase community awareness about TB symptoms and availability of free treatment at public health facilities. Educating private physicians about the need for maintaining a high index of suspicion of tuberculosis and sensitizing drug-store owners to refer the chest symptomatics to government health facilities would also help in reducing these delays.
authors.affiliation: Directorate of Health Services, Government of Himachal Pradesh.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Thakur
authors.forename: Manoj
authors.initials: M
authors.lastname: Murhekar
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology