Preprint / Version 1

Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review

Authors

  • Chandrashekhar Sreeramareddy Department of Population Medicine, Faculty of Medicine and Health Science, University Tunku Abdul Rahman, Bandar Sungai Long, 43000, Selangor, Malaysia
  • Zhi Qin McGill University & McGill International TB Centre, Dept of Epidemiology & Biostatistics, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada
  • Srinath Satyanarayana McGill University & McGill International TB Centre, Dept of Epidemiology & Biostatistics, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada
  • Ramnath Subbaraman Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA 02115, USA
  • Madhukar Pai McGill University & McGill International TB Centre, Dept of Epidemiology & Biostatistics, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada

Keywords:

Tuberculosis, Delayed Diagnosis, Delivery of Health Care, Care Seeking Behaviour, India

Abstract

SUMMARY Objective To systematically review Indian literature on delays in TB diagnosis and treatment. Methods We searched multiple sources for studies on delays in pulmonary TB and chest symptomatic patients. Studies were included if numeric data on any delay were reported. Patient delay was defined as the time interval between onset of symptoms and the patient’s first contact with a healthcare provider. Diagnostic delay was defined as the time interval between the first consultation with a healthcare provider and diagnosis. Treatment delay was defined as the time interval between diagnosis and initiation of anti-TB treatment. Total delay was defined as time interval from the onset of symptoms until treatment initiation. Results Among 541 potential citations identified, 23 studies met our inclusion criteria. Included studies used a variety of definitions for onset of symptoms and delays. Median (IQR) estimates of patient, diagnostic and treatment delay were 18.4 (14.3-27.0), 31.0 (24.5-35.4) and 2.5 days (1.9-3.6), respectively, for TB and chest symptomatic patients combined. The median total delay was 55.3 days (46.5-61.5). About 48% of all patients first consulted private providers and 2.7 healthcare providers, on average, were consulted before diagnosis. Number and type of provider first consulted were the most important risk factors for delay. Conclusions These findings underscore the need to develop novel strategies for reducing patient and diagnostic delays and engaging first-contact healthcare providers. Keywords: Tuberculosis, Delayed Diagnosis, Delivery of Health Care, Care Seeking Behaviour, India

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