Assessment of related factors on delay in diagnosis of patients with smear-positive pulmonary tuberculosis

Abstract

Background: Approximately, one third of the world population is infected with tuberculosis (TB) germs and is put at risk of tuberculosis. Pulmonary tuberculosis accounts for more than 80 percent of cases, mostly in adults with positive sputum smear. The mortality and morbidity of the disease are associated with delay in diagnosis. Delay in diagnosis can be related to the patients or the health care system. Methods: In this historical cohort study, all the patients with smear-positive pulmonary tuberculosis in Hamadan province from 21 March 2006 to 20 March 2012 were studied. Data on demographic characteristics, and clinical and treatment status of patients were extracted using patient registry software entitled TB Register. To determine the relationship between variables and the bacillus load, chi-square test was used. The logistic regression model was used to examine the co-effects of both variables on bacillus load of the patients at the time of the diagnosis. Data were analyzed using Stata11 software. Findings: From 440 patients with smear-positive pulmonary tuberculosis, 51 (221 patients) were men and 49 (219 patients) were women. 57 (251 people) were living in urban and others in rural areas. The grade of sputum smear at the time of diagnosis was associated with area of residence, age group, and gender, that all were statistically significant. Delay in diagnosis among women, was approximately 0.55 of men and those in urban areas were 67 higher than in rural areas, which were both statistically significant. Conclusion: Individual factors play important role in delayed diagnosis, regarding that men are diagnosed later than the women. Screening programs in the workplace are recommended. Sensitization of private physicians would be effective in early identification of patients in urban areas. © 2015 Isfahan University of Medical Sciences(IUMS). All rights reserved.