ArticlePLOS global public health2025
Patient and health system delays in the diagnosis and treatment of tuberculosis in Gandaki, Nepal.
Article in PLOS global public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Comparison of active and passive case finding on diagnostic delay and treatment outcomes in older patients with pulmonary tuberculosis: a cohort study using real-world data.BMC infectious diseases · 2026Article
- Comparative evaluation of sputum microscopy and Xpert MTB/RIF assay for tuberculosis detection and rifampicin resistance surveillance in Biratnagar, Nepal.Microbiology spectrum · 2026Article
- Article
- Experiences and understanding of diagnosis and treatment among drug-resistant extrapulmonary tuberculosis patients: A qualitative study from Central India.PLOS global public health · 2026Article
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5 authors.
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Abstract
Delays in accessing healthcare worsen disease outcomes, increasing Tuberculosis (TB) transmission rates and mortality. Prolonged delays may contribute to drug-resistant TB strains in some cases, this study assessed delays in diagnosis and treatment among TB patients in Gandaki, Nepal. A cross-sectional study was conducted among a randomly selected sample of 194 TB patients enrolled in Direct Observed Treatment Short-course (DOTS) therapy. The data were collected through face-to-face interviews using a semi-structured interview schedule, which was developed through literature review and adaptation of the World Health Organization's multi-country study. Multivariate logistic regression was employed to identify factors associated with delays in diagnosis and treatment, considering a p value < 0.05 to indicate statistical significance. The median patient and health system delays were 35 (7-120) and 9 (2-98) days, respectively. Furthermore, 55.7% and 58.2% of patients experienced patient and health system delays, respectively. In the multivariable logistic regression analysis, factors associated with unacceptable patient delay included non enrollment in government health insurance programmes (AOR: 3.19; 95% CI: 1.29-7.98), seeking care from non-National Tuberculosis Program (non-NTP) providers (AOR: 3.19; 95% CI: 1.460-6.97), poor knowledge of TB (AOR: 3.74; 95% CI: 1.67-8.37), and high levels of perceived stigma (AOR: 3.15; 95% CI: 1.42-6.94). Furthermore, undergoing an initial diagnostic test other than GeneXpert (AOR: 3.25; 95% CI: 1.19-8.87) and visiting healthcare facilities multiple times before being diagnosed with TB (AOR: 5.62; 95% CI: 2.26-13.96) were significantly associated with unacceptable health system delay. Patient and health system delays were prevalent among TB patients. Reducing these delays is crucial for improving TB control. Therefore, urgent action is needed to implement education campaigns to improve TB literacy. Additionally, engaging private and informal healthcare providers and enhancing their capacity to deliver timely and effective TB care could potentially mitigate delays in diagnosis and treatment.
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