Duration and determinants of delayed diagnosis of pulmonary tuberculosis in Algeria

Background Delay in the diagnosis and treatment of pulmonary tuberculosis contributes to its transmission and undermines control efforts, however, these delays have not been systematically assessed in Algeria. Aim To assess the duration and determinants of delay in the diagnosis of pulmonary tuberculosis in Algeria. Methods Between June and December 2019, we reviewed paper-based medical records of, and interviewed, 323 adult patients aged ≥ 15 years at 4 tuberculosis facilities in Blida District of Algeria. The participants were newly diagnosed pulmonary TB patients registered under the revised National Tuberculosis Control Programme. The data were analysed using Epi Info version 7.2.1, and univariable and multivariable logistic regression analyses were performed to identify factors associated with delays at the patient and health system levels. Results The median patient delay was 15 days (interquartile range 7-35), median health system delay was 28 days (interquartile range 14-55), and median total delay was 52 days (interquartile range 33-88). Longer patient delays were observed among patients who initially sought care at a pharmacy, while health system delays were longer among those with delayed chest X-ray examination, comorbidities and sputum culture-based diagnosis. Conclusion Diagnosis delays among patients with pulmonary tuberculosis in Algeria remains substantial and largely attributable to health system delays. Targeted programmes to minimise or eliminate self-medication and reduce the time spent for pre-diagnosis examinations, including chest X-ray services, are needed to reduce diagnosis delays.