Magnitude and factors associated with diagnostic delay of Tuberculosis among adults in Tarime DC, Mara region, Tanzania

Abstract

ABSTRACT Background: Tuberculosis (TB) is a curable infectious disease, yet it remains a global health concern, especially in sub-Saharan Africa. Tanzania, a high-burden country, faces significant diagnostic delays in TB management. Prompt diagnosis is essential to reduce transmission and improve outcomes. Aim of the study: This study aimed to determine the magnitude and factors associated with delays in TB diagnosis among adult TB patients in Tarime District Council. Materials and methods: A cross-sectional study conducted from May to July 2024 involved 254 adult TB patients from six DOT centers in Tarime District Council. Data were collected through interviews and patient file reviews. Diagnostic delay was defined as a summation of ≥ 30 days including; personal delay (≥23 days from symptom onset to health facility visit) and facility delay (≥7 days from sample collection to result). Data were analyzed using STATA version 18, with modified Poisson regression identifying factors associated with delay. Results: Of 254 participants (median age 39 years [IQR: 28-50]; 61.0% male), 54.7% had basic education, and 53.6% were employed. Median distance to health facilities was 5 km [IQR: 3-8]. High TB knowledge was found in 61.0%, while 26.4% reported stigma. Diagnostic delay prevalence was 16.9%, with median patient and facility delays of 20 and 6 days, respectively. Main delay reasons included lack of symptom awareness (60.5%) and difficulty accessing healthcare (18.6%). Stigma (adjusted prevalence ratio (APR)=3.40; 95% CI 1.79,6.64),alcohol consumption (PR=1.84; 95% CI 1.14,2.99), increased distance to facilities (PR=1.12; 95% CI 1.08,1.16) were positively associated with diagnostic delay while adequate TB knowledge (PR=0.12; 95% CI 0.05,0.32), basic education (PR=0.56; 95% CI 0.33,0.93), married patients (PR=0.5; 95% CI 0.29,0.85) and those satisfied with TB care (PR=0.05; 95% CI 0.02,0.13) were negatively associated with delays; exacerbated delays. Conclusion: TB diagnostic delays in Tarime DC, Tanzania was relatively low as compared to other studies. Contributing factors for diagnostic delays include low knowledge of TB, stigma, and distance to facilities. Reducing these delays requires targeted patient interventions and systemic health infrastructure improvements to enhance TB management and control.