TB patients care seeking behavior and diagnosis delay in Jogjakarta province Indonesia

Background: Tuberculosis (TB) is one of the world's leading causes of death and disease. The Millennium Development Goals has set target to halt and begin to reverse TB burden. Two specific indicators of TB control program are case detection and treatment success. Recent studies suggest the importance of diagnosis delay as part of the TB control program indicator beyond case detection. Objective: To quantify the duration of diagnosis delay and describe the TB patients care seeking behavior pattern in Jogjakarta province. Method: Both new sputum smear positive and negative TB patients diagnosed in DOTS facilities (i.e. health centers, hospitals and lung clinics) were interviewed using a structured questionnaire. Results: 208 patients were interviewed during the survey. The median time between the start of symptoms and the first visit to a health care provider (patient delay) was 3.3 weeks. The median of overall diagnosis delay was 5 weeks. The median of the number of visit before diagnosis process was 3 visits. Of the 208 patients interviewed, 26% and 33% prefer alternative and private health providers as their first care seeking action, while 41% visited DOTS facilities. However only 10 out of 86 (12%) of the TB patients visited DOTS facilities were diagnosed as TB patients. The proportion of TB patients who chose DOTS facilities increased (49%) as their second care seeking action, while 47% visited either alternative or private providers. Approximately 40% of the TB patients who visited DOTS facilities as their second action were diagnosed, 52% continued their third action in DOTS facilities and 9% visited either alternative or private providers as their third action. Conclusion: The patients delay and diagnosis delay was acceptable. Considerable proportions of TB patients use non-DOTS facilities. Private providers should be educated to be aware of the possibility of tuberculosis when examining out-patients