Qom University of Medical Sciences Journal

Introduction
According to the report of the World Health Organization, almost one-third of the world’s population is infected with tuberculosis (TB). The delay in TB diagnosis, in addition to increasing mortality, can increase the duration of disease transmission. In addition to the low level of knowledge in the person, the socio-economic, cultural, and health factors are effective in delaying TB diagnosis. Awareness of the effective factors in early diagnosis of TB can reduce the delay in TB diagnosis and the infection rate in society. This study aims to identify the factors affecting the delay in diagnosing pulmonary TB in Qom Province of Iran.
Methods
In this case-control study, 120 patients with smear-positive pulmonary TB (60 with a diagnosis delayed for more than three months and 60 with a timely diagnosis or less delay) from 2018 to 2021 in Qom Province participated. Patients whose diagnoses took 1-3 months were excluded from the study. For sampling, 60 patients were first selected using a systematic random sampling method. Then, for each case, one age-matched control person was selected and continued until the completion of 60 controls. Finally, 120 patients with delayed and non-delayed TB diagnoses were included in the study. In terms of nationality, group matching was also performed. Since 70% of the cases were Afghan, 70% of the controls were also selected with Afghan nationality. Data were collected from the patients’ medical records or through interview. To determine the factors that are effective in early diagnosis of TB, the odds ratio of each collected factor was calculated, and logistic regression analysis was used to assess the effect size of each factor.
Results
In the control group, the days of delay in total was 25±3 days; the delay by the patient was 8±2 days, and the delay by the doctor was 17±1 days. In the case group, the days of delay in total, by the patient and by the doctor, were 100±6, 33±6, and 66±7 days, respectively. The prescription of the sputum test at the first visit had the most significant effect on the early diagnosis of pulmonary TB (odds ratio=161, P<0.001). Obtaining a chest x-ray alone (with no sputum test) was one of the variables with the highest effect in delaying the diagnosis of pulmonary TB (odds ratio=33, P=0.001). The TB in patients who visited clinics (odds ratio=9, P=0.001) was diagnosed with a higher delay. The diagnosis of pulmonary TB in Iranian patients was done with more delay compared to Afghan patients. General practitioners diagnosed pulmonary TB with more delay compared to specialists and healthcare providers. Occupation, gender, and place of residence were not found to be effective factors.
Conclusion
It seems that most doctors in Iran neglect to prescribe a sputum test for patients suspected of pulmonary TB and only prescribe chest x-rays. Training and informing doctors, private medical centers, and pharmacies in referring patients suspected of pulmonary TB to the health centers where the patients live can cause timely diagnosis of pulmonary TB.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Qom University of Medical Sciences (Code: IR.MUQ.REC.1398.129).
Funding
This study was funded by Qom University of Medical Sciences.
Authors contributions
The authors contributed equally to preparing this article.
Conflicts of interest
The authors declared no conflict of interest
Acknowledgements
The authors would like to thank the deputy for research of Qom University of Medical Sciences, Nikpour (The Head of the Prevention and Control of Diseases Group, the Health Organization, Qom, Iran), and all patients for their support and cooperation in this study.