| BackgroundTuberculosis(TB)is one of the main infectious diseases that is harmful to the health of people all over the world.The major components of TB control programme are early detection of infectious patients and effectively treatment of these cases.If TB patient,especially smear positive patients(SP-PTB),delayed to care-seeking (patient delay)and can't diagnoised and/or treated by the health care,that is health delay,the patient may suffer,even die.And the transmission of Mycobacterium tuberculosis may generate more TB patients.As a result it is may not only bring huge burden to the patient and his family and also to the country.It also bring huge challenges on TB control.So it is most important to understand the status on patient delay and health care delay of SP-PTB and to investigate the influencing factors.Then we can prefer scientific evidence for policy making and explore ways and means to solve this problem.Domestic researches on patient delay and health care delay are few.Meanwhile, the definition and categorization are varied.The results of different researches are impossible to be compared.But on overseas researches,definition and categorization are uniform.If use the same definition and categorization,it will be helpful to discover the difference status on patient delay and health care delay,the difference on the influencing factors,then to obtain new ideas for TB control.Objectives1.Understand the patient delay,health care delay and total delay on the new smear positive Pulmonary Tuberculosis(SP-PTB)in Hunan province.2.Explore related factors that influence delay on smear positive pulmonary tuberculosis patients and Lay a scientific foundation for formulating strategies of prevention and control TB. MethodsThe study adopted the prospective survey method which included qualitative and quantitative methods.Quantitative methods adopted non-probability sample,selected Beihu District,Guiyang county,Yizhang county,Yongxing county and Anren county in Chenzhou city of Hunan province,subjects were new SP-PTB patients registered from April 15thto October 31thin 2007.after data collected,input the questionnaires into computer with SPSS 13.0 and analyzed frequency,cox proportional hazards regression models.understood patients delay,health care delay and total delay status on the new SP-PTB,meanwhile analyzed related influencing factors.Qualitative method adopted group interview and individual interview, understood TB patients,health care staffs knowledge and experience on TB, analyzed varied factors which influenced delay.ResultsQuantitative results1.The study investigated 224 persons in all,responding rate is 100%,96.88% (217/224)of the questionnaires were available.2.Delay time2.1 Minimum of patient delay time was 0 day,maximum was 454 days. Median was 21 days.212 persons whose delay days were equal or more than 1 day,5 persons were equal 0 day.2.2 Minimum of health delay time was 0 day,maximum was 1084 days. Median was 16 days.216 persons whose delay days were equal or more than 1 day,1 was equal 0 day.2.2.1 Minimum of diagnosis delay time was 0 day,maximum was 1081 days. Median was 16 days.140 persons whose delay days were equal or more than 1 day,77 persons were equal 0 day.2.2.2 Minimum of treatment delay time was 0 day,maximum was 291 days. Median was 3 days.216 persons whose delay days were equal or more than 1 day,1 was equal 0 day. 2.3 Minimum of total delay was 2 days,maximum was 1117 days.Median was 62 days.217 persons whose delay days were equal or more than 1 day,none was equal 0 day.3.Influencing factors of delay(cox regression)3.1 Two influencing factors on the patient delay:health education on TB(RR=1.38,95%CI:1.05～1.82);onset symptom-others(RR=1.80,95%CI:0.99～3.28).3.2 Five influencing factors on the health care delay:first examination-sputum smear(RR=0.36,95%CI:0.23～0.57);first-examination-X-ray(RR=0.42,95%CI:0.2 8～0.63);first-examination-CT(RR=0.24,95%CI:0.11～0.53),first-medical institute(RR1=1.46,95%CI:0.97～2.20,RR2=1.99,95%CI:1.12～3.55),onset symptom-hemoptysis(RR=0.66,95%CI:0.45～0.96).3.2.1 Three influencing factors on the diagnosis delay:first examination-sputum smear(RR=0.36,95%CI:0.20～0.66);first-examination-X-ray(RR=0.42,95%CI:0.2 8～0.63);first-examination-CT(RR=0.24,95%CI:0.11～0.53).3.2.2 Two influencing factors on the treatment delay:registered residence(RR=1.75,95%CI:1.19～2.58);first-examination-sputum smear(RR=0.42,95%CI:0.27～0.64).4.Three influencing factors on the total delay:sex(RR=1.62,95%CI:1.18～2.23):first fluoroscopic examination (RR=0.24,95%CI:0.10～0.61);first examination-CT(RR=0.50,95%CI:0.30～0.82).Qualitative results1.The related knowledge about TB on new smear positive TB patientThe patients want to get more general message about TB,and they usually neglect the cough symptom as one of major symptoms of TB.2.The related knowledge about TB on the staffs of TB control and preventionThe majorities think it is difficult to control TB,the epidemic situation results from many causes.3.The related knowledge about TB on the staffs of general hospitalThe majorities choose X-ray for suspect patients to diagnosis,for they usually didn't obtain new knowledge of TB from TB control and prevention institutes. The first suptum smear examination is seldom carried on the laboratory of general hospital,and non-standard manipulation is used.And it never participate external quality assessment on suptum smear acid-fast bacilli by microscopy.4.The general knowledge about TB on vallige and twonship doctorsThey all understood the referral policy of TB and have been trained by TB control and prevention institutes.Few township medical organizations can carry on suptum smear acid-fast bacilli by microscopy.Conclusions1.The patient delay,health care delay(diagnosis delay,treatment delay) median is 20,16(5,3),62 days respectively.The delay level on new smear-positive PTB patients on Chenzhou city was similar to other research results both in or out China,better than the patient delay level in poverty area on Hunan province in 2004,the first reason is different economy which resulting in different research focus;the second reason showed that TB control work achieved greater effect in Hunan province.2.The main independent protective factors on patient delay was health education on TB;independent dangerous factors was onset symptom with other non-TB symptoms.Applied different knowledge education forms to different target population.3.The main independent protective factors on health delay included:first sputum smear examination,X-ray examination and CT examination;Main independent dangerous factors included:suspect patients first see a doctor in drug store,village infirmary and the initial consulting in township medical organization.Firstly because of the drug store and village infirmary can't carry any related examinations and township medical organization haven't often carried on related examination.secondly,for some economy reasons both village infirmary and township medical organization didn't referral the patients to TB control institutes.3.1 The main independent protective factors on diagnosis delay were first sputum smear examination,X-ray examination and CT examination and onset symptom has hemoptysis.3.2 The main independent protective factors on treatment delay was first sputum smear examination,the dangerous factors was registered residence.4.The main independent dangerous factors on total delay was male.Because of male is the labour force in one's family and they are usually no time to seek care;so result in delay.Otherwise,male in the study is more than female,lead to bias.The main independent protective factors on total delay were fluoroscopic examination and CT examination.Although they are meaning to diagnosis of TB, in fact,primary level hospitals develop little fluoroscopic examination examination,fee of CT examination is higher,patients were unaffordable. Therefore the two factors are little meaning to reduce delay.
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