Diagnostic and Treatment Delays among the Tuberculosis Patients in the Urban Area of Western Nepal.

Background Diagnosis and treatment of tuberculosis is vital for health system to identify, treat patients as early as possible and to reduce frequency of new cases of a disease among the contacts of known cases. Objective To determine the diagnostic and treatment delay in the urban population of the western, Nepal and factors associated to it. Method An institutional based cross-sectional study was conducted in urban area of Western Nepal. Category I 142 TB patients aged over 15 years visiting DOTs centre during period of three months were included in study. Interview schedule was designed to elicit information on socio- demographic characteristics and history of symptoms. Diagnostic and treatment delay was calculated, chi square test was applied to find associations and non - parametric tests (Mann Whitney U test and Kruskal Wallis H test) for evaluating group differences. Result Out of 142 TB clients, mean age was 38.12 years. Majority (58%) were males. Around 44% belong to upper, 30% middle and 26% lower economic class. Study showed median diagnostic delay 34 days (Q3 =68 Days, Q1 =19 Days), treatment delay less than a day (Q3 =1 Day, Q1 =0 Day) and total delay 33.50 days (Q3 =71 Days, Q1 =19 Days). Smear positive patients had significantly higher risk of diagnostic delay compared to negative (OR=2.18. P=0.035). However, no significant associations found between socio-economic/demographic classes with delay. Median delays was more amongst married (Q3 =86 Days, Median =72 days, Q1=24 Days compared to single/separated (Q3 =74 Days, Median =57 days, Q1 =15 Days) and other socio-demographic variables had no significant differences. Conclusion Delay in diagnosis and treatment in Urban region of Western, Nepal was shorter compared to other places in Nepal and neighboring countries. Shorter delay for smear negative pulmonary tuberculosis raises doubt that cases are not examined according to the national TB control programs manual.