Volume 81, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


This study aimed to determine the psychosocial factors associated with delayed test-seeking among tuberculosis patients. The duration of symptoms before seeking medical care was assessed by interview for 108 newly diagnosed pulmonary tuberculosis patients in the city of Iquitos in the Peruvian Amazon, which has high tuberculosis incidence. Beliefs associated with test-seeking behavior and delay was assessed in these patients. The median delay from symptom onset to seeking diagnostic testing was 61 days (inter-quartile range 30–91 days). The belief that tuberculosis is curable was associated with a 100% longer test-seeking delay; the perception that tuberculosis was common was associated with a 57% longer delay; male gender was associated with a 48% longer delay; and education less than complete secondary schooling was associated with a 44% longer delay. In conclusion, current health promotion activities that emphasize tuberculosis curability and high prevalence may paradoxically increase test-seeking delay and therefore require prospective evaluation.


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  1. World Health Organization, 2008. Global tuberculosis control: surveillance, planning, financing. WHO report 2008. Geneva: World Health Organization.
  2. Suarez PG, Watt CJ, Alarcon E, Portocarrero J, Zavala D, Canales R, Luelmo F, Espinal MA, Dye C, 2001. The dynamics of tuberculosis in response to 10 years of intensive control effort in Peru. J Infect Dis 184: 473–478.
  3. Pelly T, Moore DA, Gilman R, Evans C, 2004. Recent tuberculosis advances in Latin America. Curr Opin Infect Dis 17: 397–403.
  4. Baldwin MR, Yori PP, Ford C, Moore DA, Gilman RH, Vidal C, Ticona E, Evans CA, 2004. Tuberculosis and nutrition: disease perceptions and health seeking behavior of household contacts in the Peruvian Amazon. Int J Tuberc Lung Dis 8: 1484–1491.
  5. Ministerio de Salud Programa Nacional de Control de la Tuberculosis, 2001. Tuberculosis en el Perú: Informe 2000. Lima, Peru.
  6. Campos PE, Suarez PG, Sanchez J, Zavala D, Arevalo J, Ticona E, Nolan CM, Hooton TM, Holmes KK, 2003. Multidrug-resistant Mycobacterium tuberculosis in HIV-infected persons, Peru. Emerg Infect Dis 9: 1571–1578.
  7. World Health Organization, 2003. Global tuberculosis control surveillance, planning, financing. WHO report 2003.
  8. Gibson N, Boillot F, Jalloh H, 1998. The cost of tuberculosis to patients in Sierra Leone’s war zone. Int J Tuberc Lung Dis 2: 726–731.
  9. Styblo K, 1991. Epidemiology of TB. The Hague: Royal Netherlands Tuberculosis Association.
  10. Bayer R, Wilkinson D, 1995. Directly observed therapy for tuberculosis: history of an idea. Lancet 345: 1545–1548.
  11. Barnhoorn F, Adriaanse H, 1992. In search of factors responsible for noncompliance among tuberculosis patients in Wardha District, India. Soc Sci Med 34: 291–306.
  12. Farmer P, Robin S, Ramilus SL, Kim JY, 1991. Tuberculosis, poverty, and “compliance”: lessons from rural Haiti. Semin Respir Infect 6: 254–260.
  13. Rubel AJ, Garro LC, 1992. Social and cultural factors in the successful control of tuberculosis. Public Health Rep 107: 626–636.
  14. Wilkinson D, 1994. High-compliance tuberculosis treatment programme in a rural community. Lancet 343: 647–648.
  15. Jaramillo E, 1998. Pulmonary tuberculosis and health-seeking behaviour: how to get a delayed diagnosis in Cali, Colombia. Trop Med Int Health 3: 138–144.
  16. Liefooghe R, Baliddawa JB, Kipruto EM, Vermeire C, De Munynck AO, 1997. From their own perspective. A Kenyan community’s perception of tuberculosis. Trop Med Int Health 2: 809–821.
  17. Mata JI, 1985. Integrating the client’s perspective in planning a tuberculosis education and treatment program in Honduras. Med Anthropol 9: 57–64.
  18. Sumartojo E, 1993. When tuberculosis treatment fails. A social behavioral account of patient adherence. Am Rev Respir Dis 147: 1311–1320.
  19. Alvarez-Gordillo GC, Alvarez-Gordillo JF, Dorantes-Jimenez JE, Halperin-Frisch D, 2000. Perceptions and practices related with tuberculosis and treatment compliance in Chiapas, Mexico. Salud Publica Mex 42: 520–528.
  20. Kelly P, 1999. Isolation and stigma: the experience of patients with active tuberculosis. J Community Health Nurs 16: 233–241.
  21. Liam CK, Lim KH, Wong CM, Tang BG, 1999. Attitudes and knowledge of newly diagnosed tuberculosis patients regarding the disease, and factors affecting treatment compliance. Int J Tuberc Lung Dis 3: 300–309.
  22. Storla DG, Yimer S, Bjune GA, 2008. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health 8: 15.
  23. Banco Central de Reserva del Peru, 2004. Informe.
  24. Pelly TF, Santillan CF, Gilman RH, Cabrera LZ, Garcia E, Vidal C, Zimic MJ, Moore DA, Evans CA, 2005. Tuberculosis skin testing, anergy and protein malnutrition in Peru. Int J Tuberc Lung Dis 9: 977–984.
  25. Wooldridge JM, 2006. Introductory Econometrics: A Modern Approach. (Third edition). Mason, OH: South-Western College Publication.
  26. Kawai V, Soto G, Gilman RH, Bautista CT, Caviedes L, Huaroto L, Ticona E, Ortiz J, Tovar M, Chavez V, Rodriguez R, Escombe AR, Evans CA, 2006. Tuberculosis mortality, drug resistance, and infectiousness in patients with and without HIV infection in Peru. Am J Trop Med Hyg 75: 1027–1033.
  27. Needham DM, Foster SD, Tomlinson G, Godfrey-Faussett P, 2001. Socio-economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia. Trop Med Int Health 6: 256–259.
  28. Johansson E, Long NH, Diwan VK, Winkvist A, 2000. Gender and tuberculosis control: perspectives on health seeking behaviour among men and women in Vietnam. Health Policy 52: 33–51.
  29. Giorgianni SJ, 2004. The health repercussions of stigma. The Pfizer Journal 5: 13–23.
  30. Rajeswari R, Chandrasekaran V, Suhadev M, Sivasubramaniam S, Sudha G, Renu G, 2002. Factors associated with patient and health system delays in the diagnosis of tuberculosis in south India. Int J Tuberc Lung Dis 6: 789–795.
  31. Yamasaki-Nakagawa M, Ozasa K, Yamada N, Osuga K, Shimouchi A, Ishikawa N, Bam DS, Mori T, 2001. Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. Int J Tuberc Lung Dis 5: 24–31.
  32. Johansson E, Long NH, Diwan VK, Winkvist A, 1999. Attitudes to compliance with tuberculosis treatment among women and men in Vietnam. Int J Tuberc Lung Dis 3: 862–868.
  33. Long NH, Johansson E, Diwan VK, Winkvist A, 2001. Fear and social isolation as consequences of tuberculosis in Viet Nam: a gender analysis. Health Policy 58: 69–81.
  34. Eastwood SV, Hill PC, 2004. A gender-focused qualitative study of barriers to accessing tuberculosis treatment in The Gambia, West Africa. Int J Tuberc Lung Dis 8: 70–75.
  35. Oeser CC, Escombe AR, Gilman RH, Friedland JS, Evans CA, Moore DA, 2005. Does traditional medicine use hamper efforts at tuberculosis control in urban Peru? Am J Trop Med Hyg 73: 571–575.
  36. DFID Health Systems Resource Centre, 2002. Measuring Health and Poverty: A Review of Approaches to Identifying the Poor. London, UK: DFID.

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  • Received : 02 Dec 2008
  • Accepted : 12 Jul 2009

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