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Table 5 Summary of risk factors for delay in diagnosis in low and middle income countries, 2007 to 2015

From: Delay in diagnosis of pulmonary tuberculosis in low-and middle-income settings: systematic review and meta-analysis

Patient delay Health System Delay Total Delay
Socio-demographic:
Poor literacy [21, 24, 28, 29, 35, 62], Rural residence [29, 34, 35], Urban residence [24, 36, 37], Older age [24], long distance to the nearest HF [24, 30,31,32, 35, 59], Being female [30, 32, 36, 59, 63], Being male [21, 50]
Socio-economic: Average monthly working days > 24 [55], Unemployment [36, 59], Being main income earner [51], Low economic status [36, 61]
Socio-demographic:
Older age [24, 60], Long distance to nearest HF [24, 25, 44], Being female [19, 60, 63, 68], Male sex [24, 27, 48, 50]
Socio-economic:
Low income [43], Unemployment [44], Labor migration [44]
Socio-demographic:
Being female [19, 60, 63, 68],Being male [24, 27, 48, 50],Being housewife [19], Higher family size [27], Poor literacy [27],Urban residence [24, 60],Long distance to nearest HF [24, 25, 44], Older age [24, 60], General caste [48]
Behavioral:
Evil/bad luck perception [29], Knowledge of coughing > 3 wks as PTB symptom [58], Poor knowledge of PTB symptoms [25, 37, 48, 49, 57, 59, 61], Perceived social stigma [31, 51], Perceived inability to pay for care [23], Perception that PTB is common [21, 36], Belief of PTB is associated with HIV [59, 61, 64], Perceiving symptoms as non-serious [22, 43], Belief of PTB is curable [21, 64]
Clinical:
Good functional status [35], No cough [56], Unusual symptoms other than common ones [53], Normal chest X-ray [56], Presence of fever [54], Fibrotic changes on chest x-ray ® [52], Smear negativity [28, 37, 53, 54, 58]
Behavioral:
Perceived stigma [25, 27], Sanitation as perceived cause [19],1st visit to informal provider (traditional, religious [24, 25], Self-medication [44], Smoking [45]
Initial Care seeking:
1st visit at informal provider (traditional, religious) [25, 29, 31, 35, 37, 58], Self-medication [31, 32, 44, 51, 52, 62, 63],
Alcoholism [44], smoking /tobacco use [47, 63]
Initial Care seeking:
1st visit to private facilities (clinics, drug vendors) [29,30,31, 35, 44, 50, 58], 1st visit to informal provider (traditional, religious) [23, 24], 1st visit to lower level HF [30, 32, 46, 49], Contact with more than two health providers [35]
Initial Care seeking: Prior antibiotics medication, 1st visit to private facility [44, 50, 60], Multi-facility visit [25]
Clinical: Smear positivity [29, 47], HIV positivity [44], Being new case [58], Chronic/persistent cough [44, 56, 63], Pulmonary co morbidity [37, 63], Mild severity of illness [35], MTB lineage 7 [66], Hemoptysis® [55, 62, 63], Chest pain® [61], Multiple symptoms® [63] Clinical:
Chronic cough [19, 44, 63], Only chest pain [19],
Immunosuppressive therapy (62)
  1. Key: ®: representsthe association is negative (preventive)
  2. HF Health facility, MTB Mycobacterium tuberculosis