Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in morocco: a cross-sectional study/Determinants des delais de consultation, de diagnostic et de traitement pour les nouveaux patients tuberculeux pulmonaires a microscopie positive au maroc : etude transversale

We conducted a cross-sectional survey in 2012 in 12 selected provinces and prefectures in Morocco to determine consultation delay (patient delay), diagnosis delay and treatment delay (health system delays), and factors relating to these delays. The sample included 250 eligible and consenting newly diagnosed smearpositive pulmonary tuberculosis patients who were interviewed at the time of their registration within Diagnosis of Tuberculosis and Respiratory Diseases Reference Centers (CDTMR) or Integrated Health Centers (CSI) using a pretested and structured questionnaire. The median total delay was 46 days [inter-quartile interval (IQI) = 29-84 days]. Patient delay (median = 20; IQI = 8-47 days) was higher than health system delay (median=15; IIQ = 7-35 days). Being illiterate, thinking symptoms will disappear by themselves; having financial constraints and feeling fear of diagnosis or social isolation were associated with patient delay. Consulting first in the private sector or having 3 or more consultations before diagnosis was associated with health system delay. Nous avons conduit en 2012 une etude transversale dans une selection de 12 provinces/prefectures au Maroc pour determiner les delais de consultation (delai patient), de diagnostic et de mise sous traitement (delai systeme de sante) chez les nouveaux cas de tuberculose pulmonaire a microscopie positive et les facteurs en relation avec ces delais. L'echantillon comprenait 250 patients, eligibles et consentants, qui ont ete interviewes lors de leur enregistrement aux Centres de Diagnostic de la Tuberculose et des Maladies Respiratoires (CDTMR) ou aux Centres de Sante Integres (CSI), en utilisant un questionnaire structure et preteste. Le delai total median est de 46 jours (intervalle interquartile [IIQ] : 29-84 jours). Le delai patient (mediane : 20 jours; IIQ : 8-47) est superieur au delai systeme de sante (mediane : 15 jours; IIQ : 7-35). Etre analphabete, croire a la disparition spontanee des symptomes, avoir des contraintes economiques ou peur du diagnostic et de l'isolement social sont associes au delai patient. Consulter en premier dans le secteur prive ou faire trois consultations au moins avant le diagnostic sont associes au delai systeme de sante.