Decentralized DOTS shortens delay to TB treatment significantly in Cambodia

Rural districts in Cambodia with and without decentralized health center based DOTS program.

To compare delays to treatment and behavior of patients up to diagnosis, between the pilot districts where DOTS is decentralized through the health centers, and the control districts where DOTS is provided through hospitals.

A cross sectional study with structured questionnaire interviews to all new smear-positive TB patients aged 15 years or older who were registered in the study sites from May 1st to July 31st in 2002.

The total delay in the pilot districts was significantly shorter than that in the control districts (median 58 days vs. 232 days, p < 0.01). The median doctors' delay within TB service in the pilot districts was 10 days and that in the control was 6 days. The period between first consultation to any health care provider and first visit to a TB service center, subsequent contact delay, was longer than any other type of delay and significantly different (24 days in pilot vs. 185 days in control, p < 0.01). The distance and travel costs to a TB service center were the factors associated with delay in seeking diagnosis of tuberculosis. No other variables had any significant association with the delay.

Decentralizing DOTS to primary care health centers is highly effective in reducing the delay to TB treatment in Cambodia.