Care seeking and treatment related delay among childhood tuberculosis patients in Delhi, India

OBJECTIVE: To examine delays in treatment initiation among child tuberculosis (TB) patients and to identify associated factors. METHOD: A multistage cluster random sampling strategy was used to select 175 parents/care givers of childhood TB patients from eight district TB centres covered by the Revised National Tuberculosis Control Programme in Delhi for interview in a cross-sectional survey. Binary logistic regression analysis was used to identify associated factors. RESULTS: Median estimated patient and health system delay was respectively 3 (range 1-300) and 41 days (range 10-397). Median total delay was 52 days (range 12-553). Among cases with self-reported delay, 64% of care givers thought that the symptoms would subside without treatment. In pulmonary cases, patient's sex, age of the primary care giver, religion and community were associated with patient delay. The child's place of birth and household size were associated with delay among extra-pulmonary TB cases. Type of first provider and number of providers consulted were associated with health system delay. Those who lived at a greater distance from their first health facility (OR 2.2, 95%CI 1.18-4.07) were more likely to experience prolonged patient delay. CONCLUSIONS: As the considerable health system delays were related to the type and number of providers consulted, targeted strategies are required to bring the health system closer to these particularly vulnerable children and their care givers.