Table 2 Summary of risk factors for patient delay, health system delay, and treatment delay in high TB burden countries

Socio-demographic and economic

Sex

 Female

3[38, 39, 61]

4[21, 69, 82, 83]

1[69]

1[108]

 Male

3[56, 58, 62]

1[86]

3[60, 102, 107]

Age

 Older age

5[27, 30, 31, 40, 61]

3[20, 21, 74]

1[92]

3[48, 93, 95]

5[34, 47, 60, 107, 108]

 Younger age

1[72]

1[94]

Low education

8[26, 32, 33, 40, 46, 54, 58, 60]

2[67, 71]

1[102]

Residence

 Rural

7[25, 26, 32,33,34, 47, 54]

1[21]

5[25, 34, 47, 105, 108]

1[87]

 Urban

3[28, 60, 62]

1[89]

1[60]

 Sub-urban

1[46]

[106]

 In areas without health centres

1[97]

Marital status

 Married

1[94]

 Widowed/divorced/separated/not married

1[57]

2[71, 79]

1[48]

Finances

 Low income

5[25, 28, 33, 38, 50]

5[20, 66, 72, 77, 83]

1[90]

1[100]

2[25, 108]

 High income

2[41, 62]

1[104]

 More working days per week

1[72, 77, 78]

1[72]

 Unemployed

3[39, 40, 43]

3[67, 69, 87]

1[103]

1[87]

 No health insurance

[72, 76, 77, 83]

 Cost of treatment/transport to health facilities

1[51]

1[88]

 Cost of health care incurred before diagnosis

1[50]

2[103, 106]

Long distance/traveling time to

health facilities

9[29, 33, 35, 36, 43, 52, 53, 55, 57]

4[20, 72, 77, 101]

1[72]

1[48]

1[60]

Larger family size

3[27, 38, 49]

1[27]

Behavioural

Tobacco and substance use

 Smoking

1[41]

1[81]

 Non-smoking

1[101]

 Alcohol use

1[87]

1[104]

1[87]

 Recreational drug use

1[65]

1[109]

Poor TB knowledge

12[30,31,32, 35, 42,43,44, 50,51,52, 57, 59]

5[68, 74, 79, 83, 84]

1[100]

2[50, 106]

Poor perceived benefit that TB is incurable

1[28]

Poor perceived severity (perceived well and not sick)

1[40]

Stigma

3[29, 44, 61]

2[76, 85]

1[102]

Health-seeking

Types of facilities and providers

 Traditional/spiritual medicine

3[32, 42, 44]

1[93]

 Self-medication

5[24, 27, 31, 50, 63]

1[83]

1[27]

 Private health practitioner

1[32]

1[34]

1[50]

1[50]

 Pharmacy

2[32, 58]

 Non-formal health provider

5[24, 25, 30, 31, 33]

2[50, 103]

 Rural primary health facility/non-DOTS facility

2[46, 63]

1[46]

1[106]

1[101]

 Non-hospital/lower-level facilities

2[34, 90]

2[72, 75]

1[24]

Care-seeking

 Multiple care-seeking prior to diagnosis

1[59]

2[50, 51]

5[25, 27, 50, 103, 106]

 Did not seek treatment because of first symptoms

1[64]

 Not aware of other TB patients around

1[80]

Clinical/health services

Signs and symptoms

 No chest pain

1[44]

 Cough

6[69, 70, 74, 80, 86, 88]

 Chest pain

2[70, 88]

1[109]

 Cough without sputum

1[88]

 Night sweats

1[74]

 Fever

1[88]

 No cough

1[70]

 No haemoptysis

3[74, 78, 80]

 No weight loss

1[64]

 Pulmonary cavities

1[73]

 No cavitary lesion

1[70]

 Shorter duration of symptoms

1[39]

 Presence of more than 1 symptom

1[45]

 Longer duration of suspicious symptoms

1[81]

 Mild symptoms at onset

1[72]

Co-morbidities/infection

 Presence of other known medical conditions

1[42]

 Hyperglycaemia

2[73, 74]

 HIV status not known

1[96]

 HIV negative

1[25]

1[25]

 TB-HIV co-infection/HIV positive

2[34, 90]

1[98]

2[87, 101]

 Not on ART

1[92]

 High HIV viral load

1[92]

History and types of TB

 No history of TB

4[36, 37, 39, 40]

2[71, 82]

1[99]

1[103]

 History of TB

1[82]

 Smear positive

1[32]

2[73, 82]

2[82, 101]

 Smear negative

1[27]

3[81, 82, 91]

2[48, 97]

1[27]

1[109]

 Extrapulmonary TB

2[27, 34]

1[91]

3[24, 27, 34]

 Retreatment cases

5[94,95,96,97,98]

Health services

 Long waiting time in the health facility

1[46]

 Untraceable contact details (loss to follow-up post diagnosis)

1[95]

 Absence of TB diagnostic services in the local health facility

1[96]