Understanding delayed diagnosis and treatment of tuberculosis: a cross-sectional study in Semarang, Indonesia

Tuberculosis (TB) is a major public health challenge worldwide. Despite the aspiration of the World Health Organization's 'End TB Strategy', Indonesia continues to struggle with adequate identification and diagnosis of TB cases, resulting in prolonged delays in accessing treatment. This study examined the factors influencing patients' delay and routes to accessing a reliable TB diagnosis.

A cross-sectional survey design was employed, involving 179 TB patients receiving appropriate treatment from 10 primary healthcare services in Semarang, Indonesia. Data were collected through a questionnaire, analyzed using Chi square analysis, and binary logistic regression was used to predict the correlation and odds ratio variables related to the delayed diagnosis.

Most participants were diagnosed by primary healthcare services (89%). Females experienced more delay compared to males (53% vs 47%). The median diagnostic delay was 19 days between the first onset of symptoms and receiving a reliable diagnosis. Education (p value: 0.040; adjusted odds ratio (AOR): 0.348; 95% confidence interval (CI): 0.127-0.951), and belief that TB is a hereditary disease (p value < 0.001; AOR: 1.671; 95% CI: 1.253-2.229) were identified as key factors associated with diagnostic delay.

Comprehensive community interventions targeting the factors identified in this study are needed to improve education with culturally sensitive strategies and greater engagement with both formal and informal care providers.