Barriers to prompt TB diagnosis—a comparative study between northern Malawi and eastern rural China

Abstract Background Tuberculosis (TB) case detection in China has improved remarkably, partly benefiting from the reducing delay to TB care, whereas the timeliness of TB care in Malawi remains problematic. Methods This study investigates barriers hindering timely TB diagnosis in Malawi and China, and attempts to share the experience in high burden countries. A cross-sectional study on TB diagnostic delay was conducted among 254 Malawian and 146 Chinese TB patients. Results The medians of patient’s delays were 22 and 20 days (p>0.05), and provider delays were 12 and 11.5 days (p>0.05) in Malawi and China, respectively. Malawian patients had a higher proportion (72.05% vs 67.12%) of patient’s delay longer than 14 days (p=0.042), which was significantly associated with initial visits to lower-level health providers in the villages (aOR=1.989, 95% CI: 1.075–3.682), and patients conducting casual/piece work (aOR=3.318, 95% CI: 1.228–8.964). Initial healthcare visits at village level also led to longer provider delay in both Malawi (aOR=2.055, 1.211–3.487) and China (aOR=5.627, 2.218–14.276). Conclusion Establishing a good communication and referral mechanism between different levels of health facilities is crucial to timely TB diagnosis. China’s experience on pro-poor interventions could be useful to its Malawian counterpart and other similar settings with high TB burden.