Patient and health system delays: health-care seeking behaviour among pulmonary tuberculosis patients in Pakistan.

OBJECTIVE To determine the time taken for diagnosis and treatment of pulmonary TB and the factors responsible for delay, by studying the level of awareness regarding TB in the patients, and the extent of social stigmatization associated with TB in Punjab (Multan and Sialkot), Pakistan. METHODS It was a hospital based cross-sectional study using a pre-structured questionnaire. The study was done in two areas Multan (Nishtar Hospital) and Sialkot (Bethania Hospital) in the province of Punjab, Pakistan from May - July 2006. The sample (n = 301) consisted of all the TB patients coming to the hospitals during the study period. The data was analyzed using SPSS version 14.0. RESULTS The median patient delay was 33 days (range 2-90). The median health system delay was 60 days (range 4-365). The median total delay was 90 days (range 23-365). The percentage of patients aware about TB was 37%. The number of patients who perceived stigmatization was 27%. CONCLUSION The major portion of the delay is contributed by the health system, rather than the patient. The awareness about TB is low and emphasis should be given to increasing the awareness of TB among the community.