title: Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a cross-sectional study.
abstract: BACKGROUND
  Early diagnosis and prompt effective therapy are crucial for the prevention of tuberculosis (TB) transmission, particularly in regions with high levels of multi-drug resistant TB. This study aimed to evaluate the extent of delay in diagnosis and treatment of TB in Uzbekistan and identify associated risk factors.
  
  
  METHODS
  A cross-sectional study was performed on hospital patients with newly diagnosed TB. The time between the onset of respiratory symptoms and initiation of anti-TB treatment was assessed and delays were divided into patient, health system and total delays. Univariable and multivariable logistic regression analysis was used to evaluate determinants of diagnostic and treatment delay.
  
  
  RESULTS
  Among 538 patients enrolled, the median delay from onset of symptoms until treatment with anti-TB drugs was 50 days. Analysis of the factors affecting health-seeking behaviour and timely treatment showed the presence of the patient factor. Self-medication was the first health-seeking action for 231 (43%) patients and proved to be a significant predictor of delay (p = 0.005), as well as coughing (p = 0.009), loss of weight (p = 0.001), and visiting private and primary healthcare facilities (p = 0.03 and p = 0.02, respectively).
  
  
  CONCLUSIONS
  TB diagnostic and treatment delay was mainly contributed to by patient delay and should be reduced through increasing public awareness of TB symptoms and improving public health-seeking behaviour for timely initiation of anti-TB treatment. Efforts should be made to minimise irrational use of antibiotics and support interventions to restrict over-the-counter availability of antibiotics.
authors.forename: Tatiana V
authors.initials: TV
authors.lastname: Belkina
authors.forename: Doniyor S
authors.initials: DS
authors.lastname: Khojiev
authors.forename: Mirzagaleb N
authors.initials: MN
authors.lastname: Tillyashaykhov
authors.forename: Zinaida N
authors.initials: ZN
authors.lastname: Tigay
authors.forename: Marat U
authors.initials: MU
authors.lastname: Kudenov
authors.forename: Jurjen Duintjer
authors.initials: JD
authors.lastname: Tebbens
authors.forename: Jiri
authors.initials: J
authors.lastname: Vlcek
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012651:Self Medication / Q000706:statistics & numerical data*; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D014610:Uzbekistan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents