Diagnostic delays in access to tuberculosis care in counties with or without the National Tuberculosis Control Programme in rural China.

SETTING

A county covered by the National Tuberculosis Control Programme (NTP) (Jianhu) and a nonprogramme county (Funing) in Jiangsu Province, China.

OBJECTIVE

To compare diagnostic delays among tuberculosis (TB) patients between counties with and without the NTP, and to study the impact of demographic, socioeconomic and policy factors on the delays.

DESIGN

A cohort study of 493 newly diagnosed TB patients registered in the study sites during 2002 was conducted using a structured questionnaire interview.

RESULT

The median total diagnostic delay was longer in Jianhu County, 31 (14-68) days, compared to Funing County, 19 (12-34) days, with a shorter patient's delay (10 vs. 16 days, P < 0.05) but a longer doctor's delay (6 vs. 0 days, P < 0.01) in Jianhu than in Funing. Smear-positive TB accounted for 86% of patients in Jianhu, compared to 37% in Funing. Less educated and uninsured patients had longer patient's or doctor's delays in Jianhu, while in Funing poor patients and farmers had both longer patient's and doctor's delays.

CONCLUSION

The subsidised NTP leads to a shorter patient's delay, but a longer doctor's delay, with a substantially higher proportion of smear-positive TB diagnosis. Education, medical insurance, poverty and the system of TB control can influence patients' access to TB care.