title: Major Delays in the Diagnosis and Management of Tuberculosis Patients in Nepal.
abstract: BACKGROUND
  Early diagnosis is a determining factor for spread of tuberculosis. Delay in diagnosis and treatment of tuberculosis geometrically increases spread and infectivity of the disease and is associated with higher risk of mortality.
  
  
  OBJECTIVE
  The present study aimed to investigate the length of delays in diagnosis and treatment among new pulmonary tuberculosis patients in central development region of Nepal.
  
  
  METHODS
  A cross-sectional study was conducted by administration of structured questionnaire interview and reviewing the medical records of the new sputum smear positive pulmonary tuberculosis cases during January-May 2015. Simple random sampling was applied to select samples from 5 districts of 19 districts comprising at least one each from 3 ecological regions of Nepal.
  
  
  RESULTS
  A total of 374 new sputum smear positive pulmonary tuberculosis cases were included in the study. The median patient delay, health system delay, and total delay were 32 days, 3 days and 39.5 days respectively. The unacceptable patients delay was 53.21% (95% CI: 48.12-58.29) of all new patients, whereas it was 26.74% (95% CI: 22.23-31.24) for the unacceptable health system delay and the unacceptable total delay was 62.83% (95% CI: 57.91-67.75).
  
  
  CONCLUSIONS
  TB diagnosis and treatment is still a significant problem of Nepal. Majority of unacceptable delays were from patients. Identifying factors influencing delays and developing evidence-based approaches to address those delays will help in advancing tuberculosis prevention and management in low-income settings.
authors.affiliation: Faculty, Department of Public Health, MPH (International Health) Program, Khon Kaen University , Khon Kaen, Thailand .
authors.forename: Roshan Kumar
authors.initials: RK
authors.lastname: Mahato
authors.affiliation: Associate Professor, Department of Public Health, Board Committee of Research and Training Centre for Enhancing Quality of Life of Working Age People (REQW), Faculty, Department of Public Health, Khon Kaen University , Khon Kaen, Thailand .
authors.forename: Wongsa
authors.initials: W
authors.lastname: Laohasiriwong
authors.affiliation: Faculty, Department of Public Health, Khon Kaen University , Khon Kaen, Thailand .
authors.forename: Kriangsak
authors.initials: K
authors.lastname: Vaeteewootacharn
authors.affiliation: Professor, Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital , Nepal .
authors.forename: Rajendra
authors.initials: R
authors.lastname: Koju
authors.affiliation: Senior Monitoring and Evaluation Officer, National TB Center , Thimi, Kathmandu, Nepal .
authors.forename: Ratna
authors.initials: R
authors.lastname: Bhattarai
keywords: Cross-sectional study; DOTS; Health system delay; Patient delay