Pulmonary Tuberculosis in Mumbai, India: Factors Responsible for Patient and Treatment Delays

Purpose: to determine the factors responsible for patient delayand treatment delay in newly diagnosed sputum smear-positivepulmonary tuberculosis (tb) patients.methods: study subjects (n = 150) were randomly selected frommunicipal health centers in mumbai, india. duration of symptoms,treatment, and reason for delay were assessed using interviews andmedical records. we defined patient delay as presentation to a healthcare provider (hcp) > 20 days of the onset of tb-related symptomsand treatment delay as therapy initiated more than 14 days after the firstconsultation (for tb-related symptoms) with an hcp.results: of the 150 subjects, 29% had patient delays and 81% hadtreatment delays. in multivariable analysis, patient delay was significantlyassociated with the self-perception that initial symptoms were due totb [odds ratio (or) = 3.8, 95% confidence interval (ci) = 1.1–12.6]and perceived inability to pay for care (or = 2.9, 95% ci = 1.2–7.1).treatment delay was significantly associated with consulting a nonallopathicprovider (or = 12.3, 95% ci = 1.4–105) and consulting > 3providers (or = 5.0, 95% ci = 1.4–17.4). patient interval was half thetreatment interval (median days: 15 vs. 31). women were slightly morelikely to experience patient and treatment delays than men. for twothirdsof the patients, another tb patient was a source of tb-relatedknowledge, while health education material (16%) and television (10%)played a smaller role.conclusion: treatment delay, primarily due to diagnosis delay,was a greater problem than patient delay. expanding public–publicand public–private partnerships and regular training sessions forhcps might decrease treatment delay. media coverage and curedtb patients as peer advocates may help to reinforce tb-relatedhealth education messages.