title: Diagnostic Delay among Adults with Pulmonary Tuberculosis in a High Gross Domestic Product Per Capita Country: Reasons and Magnitude of the Problem.
abstract: BACKGROUND
  To determine the mean and median delays in pulmonary tuberculosis (PTB) diagnosis among adults in one of the world's highest gross domestic product per capita countries and identify patient and health system-related reasons for these delays.
  
  
  METHODS
  This is a cross-sectional, face-to-face, prospective study of 100 subjects with confirmed PTB, conducted at main tuberculosis (TB) admitting facilities in Qatar. The mean and median diagnostic delays were measured. The Chi-square test with two-sidedP< 0.05 was considered to determine the association between factors and diagnostic delay.
  
  
  RESULTS
  The mean and median total diagnostic delays of PTB were 53 (95% confidence interval [CI] 42.61-63.59) and 30 (interquartile range; Q1-Q3, 15-60) days, respectively. The mean patient factor delay was 45.7 (95% CI 28.1-63.4) days, and the median was 30 (interquartile range; Q1-Q3, 15-60) days. The mean health system factor delay was 46.3 (95% CI 35.46-57.06) days, and the median was 30 (interquartile range; Q1-Q3, 18-60) days. The most common cause of patient factor delay was neglect of TB symptoms by patients (in 39% of cases), and for health-care system factor delay was a failure (mostly at general and private care levels) to suspect PTB by doctors (in 57% of cases). There were no significant associations between the presence of language barrier, patient occupation or nationality, and diagnostic delay.
  
  
  CONCLUSIONS
  Despite a favorable comparison to other countries, there is a substantial delay in the diagnosis of PTB in Qatar. Relevant actions including health education on TB are required to minimize this delay.
authors.affiliation: Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Wanis H
authors.initials: WH
authors.lastname: Ibrahim
authors.affiliation: Infectious Disease Division, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Faraj H
authors.initials: FH
authors.lastname: Alousi
authors.affiliation: Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Abdulatif
authors.initials: A
authors.lastname: Al-Khal
authors.affiliation: Departmant of Biostatistics and Medical Informatics, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Abdulbari
authors.initials: A
authors.lastname: Bener
authors.affiliation: Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Ahmed
authors.initials: A
authors.lastname: AlSalman
authors.affiliation: Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Aaiza
authors.initials: A
authors.lastname: Aamer
authors.affiliation: Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khaled
authors.affiliation: Pulmonary Division, Hamad General Hospital, Doha, Qatar.
authors.forename: Tasleem
authors.initials: T
authors.lastname: Raza
keywords: Delay; diagnosis; pulmonary tuberculosis