# Factors associated with delayed diagnosis of pulmonary tuberculosis in Chitwan district of Nepal

## TL;DR

This study in Nepal found that factors like self-medication and poor healthcare access delay tuberculosis diagnosis, worsening outcomes.

## Contribution

The study identifies specific patient and health system factors contributing to diagnostic delays for pulmonary tuberculosis in Nepal.

## Key findings

- 42.6% of patients experienced delays due to self-medication and lack of TB knowledge.
- Health system delays were linked to untrained workers and distant facilities.
- Total diagnostic delay affected 58% of patients, with a median of 30 days.

## Abstract

Pulmonary Tuberculosis (PTB) remains a major public health issue in Nepal and is among the top ten causes of death from a single infectious agent globally. Diagnostic delay refers to the time lag between the onset of symptoms and the confirmation of a correct diagnosis. Delayed diagnosis increases disease severity, prolongs infectivity, and hinders timely treatment. This study aimed to identify factors contributing to diagnostic delays of PTB in Chitwan district, Nepal. A cross-sectional study was conducted among 317 PTB patients receiving Directly-Observed Therapy short-course (DOTS) treatment across all DOTS centers in Chitwan district, using complete enumerative sampling. Data were collected using a semi-structured questionnaire through face-to-face interviews, then analyzed using SPSS version 22 with descriptive and multivariate analysis at a 95% confidence level. Of the 317 PTB patients, 42.6% experienced patient delay, 33.8% health system delay, and 58% total delay. The median delays were 25 days (patient), 5 days (health system), and 30 days (total). Self-medication significantly increased the likelihood of patient delay (AOR = 5.893, 95% CI: 2.133–16.285), as did lack of TB knowledge (AOR = 3.355, 95% CI: 1.603–7.018), poor economic status (AOR = 2.149, 95% CI: 1.109–4.162), and domestic preoccupation (AOR = 2.017, 95% CI: 1.154–3.528). Health system delay was strongly associated with a lack of trained health workers (AOR = 66.202, 95% CI: 27.070–161.906), poor quality services (AOR = 1.102, 95% CI: 1.102–11.078), and distant health facilities (AOR = 4.830, 95% CI: 1.554–15.017). The study identified significant diagnostic delays in Pulmonary Tuberculosis, primarily influenced by self-medication, poor TB knowledge, low socioeconomic status, lack of trained health workers and domestic responsibilities. The findings emphasize the need for community awareness, socioeconomic support, and strengthened primary health services to promote early diagnosis and timely treatment for effective TB control.