Factors Related to the Delay in Diagnosis and Treatment of Pulmonary Tuberculosis in the Territory of Malemba Nkulu, Haut Lomami Province in the Democratic Republic of the Congo

Introduction: The territory of Malemba Nkulu experiences the highest rates of pulmonary tuberculosis detection in the country. This rate exceeds the detection rate for the entire Haut Lomami province for pulmonary tuberculosis, surpasses the national average detection rate, and the estimated detection rate by the WHO for the Democratic Republic of the Congo. The aim of this study was to determine the patient delay and the health system delay, as well as to identify the factors associated with these delays. Methods: A cross-sectional study was conducted, and a semi-structured questionnaire, along with documentation referring to the patients’ medical records, served as our data collection tools. We collected data from 786 pulmonary tuberculosis patients with positive microscopy attending the diagnosis and treatment health centers (DTHC) in the four health districts of the Malemba territory, Haut Lomami province. We investigated the patient delay and the health system delay, and we also identified the factors related to these delays. The study covered a period from January to December 2022. The response rate was 47.6%, meaning 374 patients agreed to answer our questionnaire out of 786 selected. The data were analyzed using Epi Info version 7. Results: We found in these patients the median values of patient delay, health system delay, and total delay, which were respectively 62 days, 2 days, and 64 days. Two hundred fifty-eight patients (69%) consulted traditional or spiritual healers before seeking regular medical care. This group of patients experienced a median delay of 121 days, while one hundred sixteen patients (31%) who did not consult these healers had a median delay of 60 days. Among these 116 patients who had not previously consulted traditional or spiritual healers, 21 (18%) preferred to take roots at home, with a median delay of 150 days. Of these 374 patients, only 13 (11%) had directly consulted health centers and public hospitals, experiencing a median delay of 33 days. The risk factors associated with longer patient delays that were identified are: the reliance on informal and untrained caregivers, traditional or spiritual healers, self-medication, and the use of home remedies before the diagnosis of tuberculosis. The distance of the patient’s home from the nearest health center, the lack of awareness about the free treatment of tuberculosis by patients, the lack of understanding of the origin of tuberculosis symptoms, and especially the belief in a supernatural cause of the disease have been identified as factors leading to significant delays in patients seeking appropriate care. Conclusion: The wait time for the patient and the healthcare system in this territory is very high, and as a result, it significantly contributes to the hyper-detection of this disease in the area. Reducing the patient wait time also requires that the population be well-informed about the free treatment for tuberculosis. On their part, private health institutions, traditional and spiritual healers should also be informed and trained by the anti-tuberculosis program on the clinical manifestations and the possibility of free treatment.