title: Health System Delay among the Pulmonary Tuberculosis Patients Presenting in the DOTS Centers of Nepal.
abstract: BACKGROUND
  Health system delay is the time for complete diagnosis of the disease after patient approaches a health care provider.
  
  
  OBJECTIVE
  The study aims to identify the characteristics and the determinants of unacceptable health system delay (≥ 7 days delay from health system) in diagnosis of new pulmonary tuberculosis patients attending in Direct Observation Treatment Short course (DOTS) centers of Nepal.
  
  
  METHODS
  An analytical cross-sectional study was conducted by administrating a structured questionnaire interview and reviewing the medical record of the new sputum smear positive pulmonary tuberculosis cases during January-May 2015. The generalized linear model (GLM) was applied to control the clustering effects. Multiple logistic regressions were performed to identify the association between variables with ≥ 7 days of unacceptable health system delay.
  
  
  RESULTS
  Of the 374 new sputum smear positive pulmonary tuberculosis cases, the factors that were associated with unacceptable health system delay (time ≥ 7 days) were doing business (adj.OR= 1.61, 95% CI: 1.22-2.11; p-value <0.001) and unemployed (adj.OR= 3.04, 95% CI: 1.53-6.04; p-value <0.001) had chances of health system delay. However, getting support from parents (adj.OR= 0.55, 95% CI: 0.44-0.68; p-value <0.001), consultation with the private practitioners/ pharmacists (adj.OR= 0.24, 95% CI: 0.07-0.81; p-value 0.021), visiting government health facilities (adj.OR= 0.31, 95% CI: 0.13-0.73; p-value 0.008), using X-ray (adj.OR= 0.69, 95% CI: 0.49-0.97; p-value 0.032) and advance technologies for diagnosis of TB (adj.OR= 0.60, 95% CI: 0.39-0.94; p-value 0.024) were found contributing to reduce health system delay while controlling socio-economic, knowledge, presence of symptoms and attitude factors.
  
  
  CONCLUSIONS
  About a quarter of new TB patients faced health system delay problems. Socioeconomic factors, unemployment, influences the health system delay when controlled for other covariates.
authors: Associate Professor, Board Committee of Research and Training Centre for Enhancing Quality of Life of Working Age People (REQW), Khon Kaen University; Faculty of Public Health, Khon Kaen University , Khon Kaen, Thailand .
authors: Wongsa
authors: W
authors: Laohasiriwong
authors: MPH (International Health) Faculty of Public Health, Khon Kaen University , Khon Kaen, Thailand .
authors: Roshan Kumar
authors: RK
authors: Mahato
authors: Professor, Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital , Nepal .
authors: Rajendra
authors: R
authors: Koju
keywords: Central region of Nepal; Cross sectional study; Delay in diagnosis