factors associated with health system delay in accessing pulmonary tuberculosis care in gezira state, sudan

background: tuberculosis (tb) is still a major cause of morbidity and mortality in both developed and developing countries. delay in accessing tuberculosis care is associated with the highest densities of mycobacterium tuberculosis (m. tuberculosis) bacilli on sputum smears. objectives: the current study aimed to determine the extent of delay, and the major health system contributing factors to delays in the diagnosis and treatment of tb patients in gezira state, sudan. patients and methods: this study had a case-control design to explore the delay in the diagnosis and treatment of tb in gezira state, sudan. a cross-sectional phase was conducted to determine the extent of delay, and afterwards, a nested case-control phase was applied. patients reporting a total delay which was longer than the median were considered as “cases”, whereas those with the total delay inferior to the median were considered as “controls”. the study population included the newly diagnosed (within 2 weeks) smear-positive pulmonary tb cases aged 15 years old and above, who attended the selected tb management units (tbmus) during the study period. the sample size included 292 cases. data were collected by a questionnaire and analyzed with statistical software. results: the mean duration of total delay in accessing tb care was 65.6 days. total delay was more prevalent in the general and private hospitals (73.8% and 64.7%, respectively), followed by the health centers (45.7%). tuberculosis basic management units and chest hospitals showed the least delay in accessing tb care, ranging around 34% and 14.3%, respectively. total delay in accessing tb care was more prevalent when the time and distance to reach the service was short. conclusions: total delay in tb care is too long (65.6 days) in average and occurs more frequently in the general and private hospitals. total delay in tb care is more prevalent when the time to reach health facilities that provide tb services is short and the location in close proximity.