Gender and socio-cultural determinants of delay to diagnosis of TB in Bangladesh, India and Malawi.

Gosoniu, G.D.; Ganapathy, S.; Kemp, J.; Auer, C.; Somma, D.; Karim, F.; Weiss, M.G.

International Journal of Tuberculosis and Lung Disease; 2008; 12; 848–855.

Setting: Tuberculosis (TB) control programmes in Bangladesh, India and Malawi.

Objective: To compare the interval from symptom onset to diagnosis of TB for men and women, and to as­sess socio-cultural and gender-related features of illness explaining diagnostic delay.

Design: Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of dis­tress, perceived causes and help seeking. Based on time from initial symptoms to diagnosis of TB, patients were classified with problem delay ( > 90 days), timely diag­nosis ( < 30 days) or moderate delay. EMIC interview data were analysed to explain problem delay.

Results: The median interval from symptom onset to d i agnosis was longest in India and shortest in Malawi. With adjustment for confounding, female sex (Bangla­desh), and status of married woman (India) and house­wife (M a lawi) were associated with problem delay. Prom­inent non-specific symptoms—chest pain (Bangladesh) and breathlessness (Malawi)—were also significant. Cough in India, widely associated with TB, was associ­ated with timely diagnosis. Sanitation as a perceived cause linked to poor urban conditions was associated with delayed diagnosis in India. Specific prior help seek­ing with circuitous referral patterns was identified.

Conclusion: The study identified gender- and illness-related features of diagnostic delay. Further research dis­tinguishing patient and provider delay is needed.

Keywords: tuberculosis; gender; diagnostic delay; cultural epidemiology; DOTS treatment

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