Case-finding tuberculosis patients: diagnostic and treatment delays and their determinants

This study in the Syrian Arab Republic assessed the frequency and determinants of delays in diagnosis and treatment of new smear-positive tuberculosis cases at DOTS treatment centres. Among 800 patients, the mean delay due to patient care-seeking behaviour was 52.7 days (range 15–698) and the health system delay before diagnosis was 24.8 days; thus the mean total delay before diagnosis was 77.6 days. The mean delay from diagnosis to start of treatment was very short at 2.9 days. Significant risk factors for total delay were: living far from the health facility, feeling a high degree of stigma, seeking initial care at a non-health care provider and having more than 1 health care encounter before diagnosis.