PATIENT RELATED FACTORS FOR DELAY IN TUBERCULOSIS DETECTION AND TREATMENT IN JAMMU & KASHMIR STATE, INDIA

BACKGROUND This study was conducted with an aim of understanding the patient related factors that influence timely diagnosis and case detection rate in Jammu and Kashmir. MATERIALS AND METHODS This cross-sectional study was conducted in sixteen designated microscopy centres that is equal to 20% of all DMC's in Kashmir Valley. A multistage random sampling procedure was used to select the DMC's. The diagnosed TB patients of the selected DMC's formed the unit of the study. RESULTS Out of 231 registered TB patients, 86.9% were sputum positive. The females outnumbered males. Patient's age ranged from 5-80 years with a mean age of 38 years; 63.2% of patients belonged to the productive age group (15 to 45 years). Despite that 98.3% of patients were concerned about their health, only 21.6% of them had sought treatment within 1st week of appearance of symptoms, while 62.8% had delayed TB treatment seeking. Only 29.4% were referred by health workers for diagnosis and treatment of TB. Out of those who had a delay in diagnosis, 44.4% had reported to a private facility without being diagnosed for TB over there, while 35.6% had neglected their symptoms initially and sought treatment late. In children less than 15 years, urban dwellers and unemployed visiting a private facility for initial care were the main reason of delay; 23.5% of rural people reported financial reason for delay as also 46.6% of unemployed had the same reason. A small percentage of people (12.1%) had health system related delay. Knowledge about various aspects of TB was also poor among these patients. CONCLUSION The study revealed a significant delay in TB detection in studied patients. The main determinants of delay were: socio-demographic, economic, gender (female) seeking initial care from private practitioners and neglecting their TB symptoms due to poor knowledge of the disease. Rural, illiterate and employed people depicted more delay than urban, literate and unemployed. Once diagnosed, TB treatment was initiated within a reasonable period of time.