Treatment Itinerary and Health System Delay Among Patients With Pulmonary Tuberculosis in Ile-ife, South-western Nigeria

Background Timely diagnosis and initiation of appropriate treatment are still being impeded by health system delays (HSD) between the first formal health-seeking and initiation of tuberculosis treatment. This study aimed to investigate the treatment itinerary and determinants of HSD among patients with pulmonary tuberculosis in Ile-Ife, Southwestern Nigeria. Methods This descriptive cross-sectional study involved patients with pulmonary tuberculosis in the Directly Observed Treatment Short Course (DOTS) centres in Ile-Ife. A multistage sampling technique was used to recruit 320 patients, and an interviewer-administered questionnaire was used to obtain data. Descriptive and inferential analyses were done, and a p-value ˂ 0.05 was considered statistically significant Results Only 10.3% of patients sought formal healthcare as their initial action, with 75.6% of them waiting 21 days or more from the onset of symptoms before their first formal health-seeking. The majority of patients (83.1%) visited one or two formal health-care providers for the diagnosis. The median HSD was 13.5 days (Range 0–105). The factors that were independently related to prolonged HSD were monthly family income (Odds Ratio [OR] 1.73; 95% Confidence Interval [CI] 1.02–2.94; p = 0.04), number of health-seeking encounters before TB diagnosis (OR, 0.23; 95% CI, 0.08–0.68; p < 0.01), and the first health facility visited (OR, 0.25; 95% CI, 0.14–0.44; p < 0.01). Conclusion A Significant HSD existed among patients with tuberculosis. These findings emphasise the necessity of increasing diagnostic capacity, decentralising services, and training frontline providers, while enhancing financial protection. Clinical trial number: not applicable