Impact of Delayed Diagnosis on Treatment Outcomes among Pulmonary Tuberculosis Patients in Rural Communities: A Mixed-Methods Study

Abstract

Background: Pulmonary TB continues to be a significant public health issue, especially in the rural areas where health care services are inadequate. Late diagnosis can worsen the disease, make it infectious for a longer period and have detrimental treatment outcomes. Timely diagnosis of TB is crucial for the control of TB in rural areas; understanding the clinical implications and reasons for delayed diagnosis is vital.

Objective: To assess the impact of delayed diagnosis on treatment outcomes among pulmonary tuberculosis patients in rural communities and to explore patient-related and health-system factors contributing to diagnostic delay.

Methods: The study was a mixed-methods study that took place at Gomal Medical College, DI Khan, between January 2025 and June 2025. The total number of diagnosed pulmonary tuberculosis patients in the rural areas was 85, and was obtained using non-probability consecutive sampling. Socio-demographic data, clinical presentation, delay to diagnosis, treatment adherence, sputum conversion, hospitalisation and final outcome of treatment were quantified. Diagnostic delay was considered to be more than 30 days from symptom onset. The results of treatment were classified as good or bad. The qualitative data was gathered by interviewing patients to explain the reasons for delayed diagnosis. The quantitative data was analysed through frequencies, percentages, mean, standard deviation and Chi-square or Fisher exact test, and the qualitative data was analysed thematically.

Results: Among 85 patients, 52 (61.2%) experienced delayed diagnosis, while 33 (38.8%) were diagnosed without major delay. The mean total diagnostic delay was 47.8 ± 21.6 days. Favorable treatment outcomes were observed in 57 (67.1%) patients, whereas 28 (32.9%) had unfavorable outcomes. Patients with delayed diagnosis had a higher frequency of unfavorable outcomes compared with those diagnosed without delay (42.3% vs. 18.2%, p = 0.021). Delayed diagnosis was also associated with poor adherence, reduced sputum conversion at two months, treatment interruption, and hospitalization. Qualitative findings showed that poor awareness, self-medication, financial hardship, long distance from health facilities, stigma, and limited diagnostic access were major contributors to delay.

Conclusion: Delayed diagnosis was common among pulmonary tuberculosis patients in rural communities and was significantly associated with poorer treatment outcomes. Strengthening rural diagnostic services, improving community awareness, reducing financial barriers, and promoting early referral may help improve treatment success and reduce tuberculosis transmission.