Diagnostic Delay among Adults with Pulmonary Tuberculosis in a High Gross Domestic Product Per Capita Country: Reasons and Magnitude of the Problem

Abstract

Background: To determine the mean and median delays in pulmonary tuberculosis (PTB) diagnosis among adults in one of the world’s highest gross domestic product per capita countries
and identify patient and health system‑related reasons for these delays.

Methods: This is a cross‑sectional, face‑to‑face, prospective study of 100 subjects with confirmed PTB, conducted at main tuberculosis (TB) admitting facilities in Qatar. The mean and median diagnostic delays were measured. The Chi‑square test with two‑sided P < 0.05 was considered to determine the association between factors and diagnostic delay.

Results: The mean and median total diagnostic delays of PTB were 53 (95% confidence interval [CI] 42.61–63.59) and 30 (interquartile range; Q1–Q3, 15–60) days, respectively. The
mean patient factor delay was 45.7 (95% CI 28.1–63.4) days, and the median was 30 (interquartile range; Q1–Q3, 15–60) days. The mean health system factor delay was 46.3 (95% CI 35.46–57.06) days, and the median was 30 (interquartile range; Q1–Q3, 18–60) days. The most common cause of patient factor delay was neglect of TB symptoms by patients (in 39% of cases), and for health‑care system factor delay was a failure (mostly at general and private care levels) to suspect PTB by doctors (in 57% of cases). There were no significant associations between the presence of language barrier, patient occupation or nationality, and diagnostic delay.

Conclusions: Despite a favorable comparison to other countries, there is a substantial delay in the diagnosis of PTB in Qatar. Relevant actions including health education on TB are required
to minimize this delay.

Keywords: Delay, diagnosis, pulmonary tuberculosis