Paramasivam Selvam, Thomas Bina, Chandran Priya, Thayyil Jayakrishnan, George Biju, Sivakumar C P
Department of Community Medicine, K.A.P.Viswanatham Government Medical College, Tiruchirappalli, Tamil Nadu, India.
Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India.
J Family Med Prim Care. 2017 Jul-Sep;6(3):643-648. doi: 10.4103/2249-4863.222052.
Delay in the diagnosis of tuberculosis (TB) can lead to an increased infectivity period, delayed treatment, and increased severity of the disease. The objective of this study was to estimate the diagnostic delay and factors associated with the delay in diagnosis among the newly diagnosed smear-positive pulmonary TB patients in Kerala, India.
A cross-sectional study was conducted among TB patients who were in the intensive phase of directly observed treatment short-course treatment in four randomly selected TB units in a district in Kerala during the years 2012-2013. Diagnostic delay was defined as the delay between the onset of symptoms and diagnosis. Data collection using a modified World Health Organization questionnaire was done by interviewing 302 participants.
Mean age of the participants was 48.6 ± 14.5 years. Males constituted 76.5% of the study population. The mean diagnostic delay was 43.5 ± 29.1 days (median: 37 days). The median patient and health system delays were 16 days and 15 days, respectively. Patient delay (55.6%) contributed more than health system delay (44.4%). Poor knowledge about TB, first consulting a private physician, and increased number of consultations were found to be significantly associated with diagnostic delay.
The diagnostic delay in tuberculosis reported in this study was lower than other studies in India but it needs further reduction. Both patients and health providers play a role in a delay in diagnosis, and poor knowledge about the disease among the patients was one of the main risk factors. Interventions to improve knowledge and awareness of the disease and to increase the suspicion of chest symptomatic by health-care providers in the private sector are vital to reduce diagnostic delay.
结核病（TB）诊断延迟会导致传染期延长、治疗延误以及病情加重。本研究的目的是估计印度喀拉拉邦新诊断的涂片阳性肺结核患者的诊断延迟情况以及与诊断延迟相关的因素。
2012 - 2013年期间，在喀拉拉邦一个地区随机选取的四个结核病防治单位，对正在接受直接观察短程治疗强化期的结核病患者进行了一项横断面研究。诊断延迟定义为症状出现与诊断之间的延迟。通过访谈302名参与者，使用经修改的世界卫生组织问卷进行数据收集。
参与者的平均年龄为48.6 ± 14.5岁。男性占研究人群的76.5%。平均诊断延迟为43.5 ± 29.1天（中位数：37天）。患者和卫生系统延迟的中位数分别为16天和15天。患者延迟（55.6%）比卫生系统延迟（44.4%）的影响更大。发现对结核病知识了解不足、首次咨询私人医生以及咨询次数增加与诊断延迟显著相关。
本研究报告的结核病诊断延迟低于印度的其他研究，但仍需进一步缩短。患者和卫生服务提供者在诊断延迟中都起到了作用，患者对疾病知识了解不足是主要危险因素之一。改善对疾病的知识和认识以及提高私营部门医疗服务提供者对胸部症状的怀疑度的干预措施对于减少诊断延迟至关重要。
