Factors associated with diagnostic delay for patients with smear-positive pulmonary tuberculosis in rural Hunan, China

Objective To explore the influences of socio-economic, health services, cultural beliefs, and symptoms on health seeking behavior of tuberculosis patients attending county tuberculosis dispensaries in rural Hunan province of China. Methods A cross-sectional descriptive survey was conducted in 4 counties randomly stratified by economic status from 122 counties, Hunan, China. After informed consent, a consecutive sample of patients, aged 15 years and older, with smear-positive pulmonary tuberculosis were interviewed and completed a pre-tested questionnaire. Results A total of 318 patients with smear-positive pulmonary tuberculosis were interviewed. The median of patient delay, health system delay and total delay were 30, 24 and 65 days, respectively. Logistic regression shows that factors significantly contributed to patient delay were haemoptysis, far distance to health institute, seeking folk therapy, and lower per capita income. Factors significantly associated with health system delay were female, lower level of education, prior health education on tuberculosis, seeking folk therapy and stigma associated with tuberculosis. Conclusion In order to reduce diagnostic delay, integrated measures including extensive training of medical staff in non-tuberculosis health facilities, decentralization of services and more specific and effective health education on tuberculosis should be taken.