Of New Smear Positive Tuberculosis Patients Delay Level And Influence Factors

Objective To describe the tendency of delay for new smear positive tuberculosis (TB) patients in different districts, analyze the influence factors, validate the indicators and the methods used. The findings will facilitate the development of relevant TB control and prevention strategies. Methods Using typical survey method, selected three counties from the eastern, middle and western provinces. The case information was collected from the "China information system for TB control and prevention" between 2005 and 2009. And field investigation was implemented from May.2010 to Sep.2010. SPSS 17.0 software was used for carrying out bivariate and multivariate analysis including chi-square test, rank sum test, logistic regression and Cox regression. Results 5066 cases were involved in the retrospective survey and 329 cases were included in the field investigation. There were more male TB patients than female patients, mainly in the 25-65 age group and most of the patients were peasants; The decline of the delay from 2005 to 2009 are noticeable in the eastern(x2=117.840, P=0.000) and western (x2=166.120, P=0.000), but not in the middle (x2=6.310, P=0.177) county; From the field investigation, the level of delay was 36 days(0～597),15 days (0～594) due to patients' delay and 10 days (0～594) due to diagnosis delay, patients' health care seeking influenced by the medical insurance and the symptom, the delay from patients'transfer is the main influence factor to the diagnosis delay, only 61.9% of the patients were transferred from the village health center to the TB center; the drug resistant rate is 12.7% in total and there is no noticeable difference between delay and drug resistant. Conclusion We found a trend of decline of the delay from 2005 to 2009, and the level of delay was less than the other studies, but the situation was still serious especially in the middle and the western districts, the difference between patients were noticeable. Patients' health care seeking and diagnosis delay were the main influence factor to the delay in total. Besides, the level of the delay could be collected from the "China information system for TB control and prevention", but there was a need for monitoring the field survey. In summary, there is a need to monitor the delay routinely, and facilitate the patients to seek appropriate treatments based on eliminating the economic factors and knowledge factors. It is important to strengthen the training to the doctors in the primary health care system, and to improve the transfer treatment for all TB suspects. Moreover, the further research in this field is urgently needed.