title: Treatment pathways of extrapulmonary patients diagnosed at a tertiary care hospital in Delhi, India.
abstract: BACKGROUND
  In order to put extrapulmonary tuberculosis patients early on treatment, it is important to study pathways, which these patients adopt in for seeking treatment.
  
  
  METHODS
  In order to study the treatment pathways of extrapulmonary patients and assess appropriate points for intervention, a cross-sectional study was conducted in chest clinic of a tertiary care hospital in Delhi.
  
  
  RESULTS
  Factors associated with longer paths included reason for going to first health facility (nearness and known provider), availing more than one health facilities, presenting symptoms of fever, joint pain, nodular skin swelling and skin lesion. Self-referral to the chest clinic was associated with shorter paths. Lower level of education, occupation, non-serious perception of the disease and visiting five health facilities were significantly associated with patient delay of more than 3.5 weeks. Symptoms of fever, joint pain and skin lesion, visiting private health facility first, availing more than two health facilities and travelling distance of more than 100 km to reach chest clinic were significantly associated with the health facility delay of more than 4.5 weeks.
  
  
  CONCLUSIONS
  Increasing public awareness, training of private practitioners and capacity building of government facilities will help in reducing delay.
authors.affiliation: Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Grover
authors.affiliation: Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
authors.forename: Neelima
authors.initials: N
authors.lastname: Bhagat
authors.affiliation: Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
authors.forename: Nandini
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Department of Epidemiology, New Delhi Tuberculosis Centre, New Delhi, India.
authors.forename: Meera
authors.initials: M
authors.lastname: Dhuria
keywords: Behavior; extrapulmonary; health facility delay; patient delay