Regional differences in delay to tuberculosis treatment in Afghanistan: A cross-sectional study

Delay in the diagnosis and treatment of pulmonary tuberculosis is problematic. It results in increasing severity, mortality, and transmission of tuberculosis. Little is known about regional differences among delays. This study aims to compare total treatment delays (total delays) among tuberculosis patients between privileged and disadvantaged areas in Afghanistan, and to study the impacts of social, medical, and health system factors on the delays. A cross-sectional study of 259 newly diagnosed tuberculosis patients registered at the study sites (six hospitals and three clinics) was conducted from September 2008 to February 2009 using a structured questionnaire interview. The median total delay (interquartile range) was longer in the disadvantaged areas, 366.5 (274–444) days, than in the privileged areas, 62.0 (38–82) days (p < 0.001). Using a cut-off of 60.0 days, the prevalence of delay >60 days was 71 (51.8%) in the privileged areas and 113 (92.6%) in the disadvantaged areas (p < 0.001). Increasing numbers of visits (multiple visits) were associated with longer total delays in both privileged and disadvantaged areas (p < 0.01), but unemployment was associated with longer total delays only in the PAs (p < 0.05). Total delay is very much longer in the disadvantaged than in the privileged areas. The inability of health care providers to promptly diagnose tuberculosis is the key cause of delayed initiation of tuberculosis treatment. Increasing public awareness about tuberculosis and improving diagnostic capabilities of health care providers in both privileged and disadvantaged areas and active case finding in the remote and disadvantaged areas could help reduce delays in the commencement of tuberculosis treatment, decreasing their geographical disparity.

► Delay in the diagnosis and treatment of pulmonary tuberculosis is problematic.
► It results in spread of infection, more extensive disease, and a higher mortality.
► This study found huge geographical differences in the delay and other characteristics.
► Inability of health care providers commonly predicts the delay in both areas.
► Active case finding and improving quality of health care are recommended.