Factors affecting delays in tuberculosis diagnosis in rural China: a case study in four counties in Shandong Province.

Improving case detection is an urgent and serious challenge for tuberculosis (TB) control in China. We investigated the extent to which TB patients delayed seeking TB care and health services delayed reaching a diagnosis, and socio-economic factors associated with the delays. Standard questionnaires were administered to 190 new smear-positive TB patients who had completed treatment at TB dispensaries in four counties of Shandong Province in 2001. Multivariate analysis using Cox Regression showed that old age, lack of education and distance from home to a township health centre were significantly associated with delay in seeking care from service providers. In examining the delay between first contact with a service provider and diagnosis, we found that women experienced longer delays than men, and that the higher the level of facility patients first visited, the less time was needed to achieve a diagnosis. These two factors were statistically significant in multivariate Cox Regression analysis. We concluded that the elderly, the less educated, women, and those living far from health facilities face the longest delays in reaching TB services and achieving diagnosis.