Table 2.

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

Risk factors	Number of studies that reported the risk factors associated with the different types of delay by economies
	Patient delay		Health system delay		Treatment delay		Total delay
	LIC and LMIC	UMIC	LIC and LMIC	UMIC	LIC and LMIC	UMIC	LIC and LMIC	UMIC
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, 32–34, 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[30–32, 35, 42–44, 50–52, 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[94–98]
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]

The number at the normal line of type in each cell referred to the number of study/ies that reported the risk factors associated with the type of delay, respectively. The number/s in bracket indicate the source article/s. Blank cells indicate that no studies reported the respective risk factor. The studies are further grouped by economies based on World Bank classifications

ART antiretroviral therapy; DOTS directly observed treatment, short course; HIV human immunodeficiency virus; LIC low-income countries; LMIC low-middle-income countries; NTP national TB program; TB tuberculosis; UMIC upper-middle-income countries