Barriers in accessing to tuberculosis care among non-residents in Shanghai: a descriptive study of delays in diagnosis

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Abstract
Objectives: To describe accessibility to tuberculosis (TB) diagnosis in non-resident TB patients in Shanghai, China, and to identify factors associated with delay in diagnosis. Methods: A face-to-face interview of 222 newly diagnosed, non-resident TB patients registered in two districts of Shanghai: Changning District and Putuo District, was conducted using a structured questionnaire. Results: Among the 222 non-resident TB patients, median patient's delay was 21 days and median doctor's delay was 8 days. The duration of doctor's delay was significantly longer in Changning District than Putuo District (13 vs. 5 days, P < 0.001). One-fourth of the subjects had a patient's delay longer than 42 days and a doctor's delay longer than 15 days. Logistic regression model shows that patients at lower income level, and who did not have haemoptysis symptom were more likely to have longer patient's delay. Patients who registered in Changning were more likely to have a longer doctor's delay. The proportion of diagnosis or consideration as suspected TB for referral was significantly higher in hospitals than non-hospitals. Conclusion: The results of this study indicate that patient- and doctor-related factors contribute significantly to delays in the diagnosis of non-resident TB patients in Chinese cities. Non-resident's poor economic status, clinical status, complexities in referral and diagnostic procedure at different districts accounted for delayed TB care-seeking and diagnosis.

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