Diagnostic and Treatment Delay in Tuberculosis in 7 Countries of the Eastern Mediterranean Region

Objectives A multicountry study was conducted during 2003-2004 to study the extent of delay in the diagnosis and treatment of patients with tuberculosis and its determinants. Methods The study was conducted in 7 countries of the Eastern Mediterranean Region. Five thousand fifty-three newly diagnosed, adult, smear-positive, pulmonary tuberculosis cases were enrolled in the study. They were interviewed according to a pretested and structured questionnaire about the various factors affecting timely treatment. Results and Conclusions The mean delay duration between the onset of symptoms until treatment with antituberculosis drugs ranged from 1.5 to 4 months in different countries. Patient delay-defined as the time interval between the onset of symptoms and first health-seeking behavior-ranged from a mean of 9.9 days in Pakistan to 69 days in Somalia, whereas system delay-defined as the time interval between the first health-seeking behavior and treatment-ranged from 5 days in Iraq to 90.7 days in Pakistan. The private sector was the first choice for more than two thirds of patients. The main determinants of delay were sociodemographic, economic, stigma, time to reach the health facility, seeking care at nonspecialized individuals, and visiting more than 1 health care encounter before diagnosis.