Factors associated with delayed tuberculosis test-seeking behavior in the Peruvian Amazon

Abstract

This study aimed to determine the psychosocial factors associated with delayed test-seeking among tuberculosis patients. The duration of symptoms before seeking medical care was assessed by interview for 108 newly diagnosed pulmonary tuberculosis patients in the city of Iquitos in the Peruvian Amazon, which has high tuberculosis incidence. Beliefs associated with test-seeking behavior and delay was assessed in these patients. The median delay from symptom onset to seeking diagnostic testing was 61 days (inter-quartile range 30-91 days). The belief that tuberculosis is curable was associated with a 100% longer test-seeking delay; the perception that tuberculosis was common was associated with a 57% longer delay; male gender was associated with a 48% longer delay; and education less than complete secondary schooling was associated with a 44% longer delay. In conclusion, current health promotion activities that emphasize tuberculosis curability and high prevalence may paradoxically increase test-seeking delay and therefore require prospective evaluation.

Figure 1

Delay in test-seeking behavior for tuberculosis symptoms in tuberculosis patients (N = 108). A, Number of days between tuberculosis symptom onset and test-seeking behavior. Each bar represents one month. B, The natural logarithm (ln, log_e) of the number of days between tuberculosis symptom onset and test-seeking behavior.

Figure 2

Association between days of test-seeking delay and patient factors. (The educational level was classified as low for patients who had failed to commence or complete secondary schooling and high for those who completed secondary schooling.)