Delay in diagnosis and relative risk of treatment failure and deaths in pulmonary tuberculosis patients at the Antituberculosis center of Brazzaville, Republic of Congo

Delay in diagnosis and relative risk of treatment failure and deaths in pulmonary tuberculosis patients at the Antituberculosis center of Brazzaville, Republic of Congo | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Delay in diagnosis and relative risk of treatment failure and deaths in pulmonary tuberculosis patients at the Antituberculosis center of Brazzaville, Republic of Congo Breli Bonheur Ngouama, Mita Naomie Merveille Dello, Freisnel Hermeland Mouzinga, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7977064/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Introduction Tuberculosis (TB) remains a major public health concern worldwide. Early diagnosis is crucial to reduce TB transmission and improve treatment outcomes. This study assessed diagnostic delays and their impact on the treatment outcomes among pulmonary tuberculosis patients (PTB) at the Antituberculosis center in Brazzaville. Methods We conducted a prospective cohort study from July 2023 to August 2024. Sociodemographic, clinical characteristics, diagnostic delays, and treatment outcomes were recorded. Logistic regression models were used to identify risk factors, reporting crude and adjusted odds ratios (OR, AOR) with 95% confidence intervals (CI). A p-value < 0.05 was considered significant. Results A total of 313 patients were included (median age: 34 years, range 24–41); 295 (94.2%) were newly diagnosed, and 16 (5.1%) were HIV-positive. Men accounted for 69% of cases, and the age group 24–44 was the most represented (55.9%). The median patient delay was 30 days (IQR 21–62), and 135 (43.1%) experienced prolonged delays. Multivariate analysis showed that residence in Mfilou district was associated with longer delays (OR = 2.77, 95%CI: 1.22–6.30; p = 0.004), whereas diabetes mellitus was linked to shorter delays (OR = 0.15, 95%CI: 0.02–1.13; p = 0.008). Although diagnostic delay was not significantly associated with treatment outcomes, patients with delays > 30 days had higher odds of death (OR = 2.50, 95%CI: 0.78–7.76) and treatment failure (OR = 5.68, 95%CI: 0.92–69.81). Conclusion A high median diagnostic delay (30 days) was observed in Brazzaville. Residence and diabetes mellitus status were significant predictors of delay. Although not statistically significant, prolonged delays were associated with higher risks of death and treatment failure. Strengthening case-finding strategies and improving timely health-seeking behaviors are critical to reducing TB burden. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Mycobacterium Tuberculosis Brazzaville Treatment outcome Diagnosis delay Figures Figure 1 Introduction Tuberculosis (TB) is an infectious disease caused mainly by Mycobacterium tuberculosis and remains the leading cause of death from a single infectious agent worldwide. In 2023, TB was responsible for an estimated 1.25 million deaths, including 1.09 million among HIV-negative individuals and 161,000 among people living with HIV. Although this represents a decline compared with 2022 (1.32 million), 2021 (1.42 million), and 2020 (1.40 million), and even lower than the pre-COVID-19 level of 2019 (1.34 million), TB continues to pose a significant global health challenge [ 1 ]. While the global burden of TB is declining slowly, progress in controlling the disease and mitigating its consequences could be accelerated if different programs prioritized early diagnosis and treatment. Early diagnosis and treatment are essential for controlling TB. Delays in diagnosis increase the risk of transmission, disease progression, and mortality, while also generating psychological distress and financial burdens for patients and their families. Previous studies have highlighted that late detection of TB not only worsens individual outcomes but also threatens community health and health system performance [ 2 – 4 ]. Minimizing exposure to infectious individuals requires reducing the number of outpatient visits [ 5 ]. Despite advances in knowledge and diagnosis tools, delayed case detection remains common, particularly in Sub Saharan Africa, where health systems are often fragile [ 6 – 8 ]. The Republic of Congo is classified among the 30 countries with the highest TB burden, with an estimated incidence of 369 cases per 100,000 inhabitants in 2022 [ 9 ]. However, case detection largely relies on passive strategies, when patients present to health facilities after symptom onset. This reliance on passive case finding increases the likelihood of prolonged delays before diagnosis, thereby contributing to continued transmission and poor outcomes. To date, no study in the Republic of Congo has specifically assessed diagnostic delays in TB and their association with treatment outcomes. Understanding these delays and their determinants is essential to inform interventions that improve early case detection and strengthen the national TB program. Therefore, this study aimed to (i) estimate the median time to TB diagnosis, (ii) identify sociodemographic and clinical risk factors associated with prolonged delays, and (iii) examine the impact of diagnostic delay on treatment outcomes among patients with pulmonary TB at the Antituberculosis Center of Brazzaville. Methods Study setting The Republic of Congo is a high TB burden country with a population of approximately 6 million people. The study was conducted at the Antituberculosis Center of Brazzaville, the political and administrative capital, which hosts 35% (2 145 783 inhabitants). In 2023, 5 757 TB cases (including pulmonary and extrapulmonary forms) were reported in Brazzaville. All public health facilities in the country provide free TB diagnostic and treatment services, including Directly Observed Therapy (DOTs), through a network of hospitals and health centers. Study design and participants A prospective cohort study was conducted between July 2023 and August 2024 to estimate the diagnostic delay among TB patients and the impact of this one on treatment outcome. Patients aged from 8 to 80 years were enrolled. Both newly diagnosed and previously treated patients were eligible. Exclusion criteria included refusal to participate or absence of informed consent. Data collection and definitions Data were collected using a structured questionnaire covering sociodemographic and clinical characteristics. Participants were asked to report whether they had experienced key symptoms (cough, chest pain, fever, weight loss, hemoptysis, and night sweats) and to recall the duration of these symptoms. Patient delay was defined as the interval between the onset of pulmonary symptoms (cough used as the defining symptom) and the first consultation at a health facility. We considered 30 days as a cutoff for diagnostic delay, corresponding to the median delay observed in our study population as previously considered by [ 10 ]. Tuberculosis treatment outcomes and their related risk factors were described in our previous study [ 11 ]. Treatment outcomes were monitored according to WHO definitions. Treatment success was defined as the sum of cured and treatment completed. Unsuccessful outcome was defined as the sum of treatment failure, death, lost to follow-up, and transfer out. Sputum samples were examined using Ziehl-Neelsen staining for acid-fast bacilli, and patients were followed throughout the treatment period. Selection and eligibility criteria Individuals with a history of TB treatment or not (≥ 8 years old) diagnosed for pulmonary TB, based on the national TB guideline were included in the study. However, TB patients who do not consent to participate were non­included in the study. Ethical considerations Approval was obtained from the institutional ethics committee of the Fondation Congolaise pour la Recherche Médicale (Reference 045/CEI/FCRM/2023). All participants received full information about the study objectives and procedures and signed an informed consent form prior to inclusion, in accordance with principles of the Declaration of Helsinki. For children aged 8–17 years, assent was obtained along with written consent from parents or guardians. All data were anonymized to ensure participant confidentiality. Data management and statistical analysis Data were entered and analyzed using Rstudio software (Version 8.0.2). Diagnostic delay was categorized as ≤ 30 days or > 30 days. Associations between delay and independent variables (age, sex, education, occupation, marital status, residence, HIV status, diabetes mellitus, TB history and treatment outcomes) were assessed. Bivariate analyses were performed to estimate crude odds ratios (OR) with 95% confidence intervals (CI). Variables with p < 0.10 were included in multivariate logistic regression to calculate adjusted odds ratios (AOR). A p-value < 0.05 was considered statistically significant. Results Sociodemographic and clinical characteristics of the study population A total of 313 patients with pulmonary TB were enrolled. Of these, 161 (51.4%) were diagnosed in 2024 and 152 (48.6%) in 2023. Men accounted for 69.3% (217/313) of participants, with the age group 24–44 years being the most represented (55.9%). The median age was 34 years (IQR 24–41). The majority of patients (98.1%) had at least primary education, while six (1.9%) were illiterate. The most common districts of residence were Mfilou (16.6%), Talangai (16.0%), Makélékélé (15.3%), and Madibou (11.5%). Most patients were employed (85.6%) and single (93.9%). Sixteen patients (5.1%) were HIV-positive (Table 1) . Patient delay The median delay from symptom onset to first consultation was 30 days (IQR 21–62). The longest reported delay was 720 days. Overall, 135 patients (43.1%) experienced a prolonged diagnostic delay (>30 days) (Fig. 1) . Factors associated with diagnostic delay In multivariate analysis, residence in Mfilou district was significantly associated with a prolonged delay (OR=2.77, 95%CI: 1.22–6.30; p=0.004). Conversely, patients with diabetes mellitus were more likely to seek care earlier (OR=0.15, 95%CI: 0.02–1.13; p=0.008). Other variables, including sex, age, marital status, employment status, education, HIV status, year of diagnosis, and TB history, showed no significant associations with diagnostic delay (Table 2) . Treatment outcomes and influence of diagnostic delay Among patients with prolonged delays, 65.6% (84/128) were cured, 8.6% (11/128) completed treatment, 5.5% (7/128) died, 16.4% (21/128) were lost to follow-up, and 3.1% (4/128) experienced treatment failure. In contrast, among those with shorter delays, 74.6% (132/177) were cured, 10.2% (18/177) completed treatment, and 0.6% (1/177) failed treatment. Deaths occurred in 0.6% (1/177), and loss to follow-up in 1.1% (2/177) of this group. Transfer-out rates were comparable (0.8% in delayed vs. 1.1% in non-delayed patients) (Table 3) . Although diagnostic delay was not statistically associated with overall treatment outcome, patients with delays longer than 30 days had higher, though non-significant, odds of death (OR=2.50, 95%CI: 0.78–7.76; p=0.212) and treatment failure (OR=5.68, 95%CI: 0.92–69.81; p=0.165). Discussion This study revealed that nearly half of pulmonary TB patients (43.1%) in Brazzaville experienced a diagnostic delay longer than 30 days, with a median delay of 30 days. This delay is comparable to findings from Ethiopia [ 10 ] and Brazil [ 12 ], where median delays of 30 days were reported. However, it is shorter than the > 45-day delays documented in Tunisia and Angola [ 13 , 14 ]. and considerably shorter than the 68-day delay reported in France [ 15 ]. Variations across studies may reflect differences in health system infrastructure, patient demographics, awareness of TB symptoms, and availability of diagnostic services. Our analysis identified residence in Mfilou district as a key predictor of prolonged delay. Mfilou is located on the periphery of Brazzaville, far from the Antituberculosis Center situated in Bacongo. Distance to healthcare facilities and associated transport costs are well-recognized barriers to timely access to TB care, particularly for socioeconomically disadvantaged populations [ 16 , 17 ]. Additionally, limited awareness of local diagnostic services may contribute to delayed health-seeking behaviors among patients in peripheral districts. Interestingly, patients with diabetes mellitus (DM) were more likely to be diagnosed earlier. [ 18 , 19 ]. This finding contrasts with studies from China and other settings, where DM was associated with longer diagnostic delays. A plausible explanation is that TB patients with DM in our cohort may have presented with more severe symptoms, prompting earlier medical consultation. Alternatively, patients with chronic conditions such as DM may have more frequent contact with healthcare services, facilitating earlier detection [ 20 ]. Contrary to expectations, HIV infection was not significantly associated with diagnostic delay. This finding is in line with some previous studies [ 21 – 24 ]. Our results may reflect improvements in integrated HIV/TB services and expanded access to HIV care in Congo, which could reduce barriers to TB diagnosis among people living with HIV [ 25 , 26 ] [ 27 ]. This result could be the outcome of the significant progress made regarding the integrated care system for PLH. Although not statistically significant, prolonged diagnostic delays were associated with higher odds of death and treatment failure. These findings are consistent with evidence that patients diagnosed late often present with advanced disease, reduced tolerance to treatment, or poor adherence [ 5 , 28 ]. Late-stage disease may also limit the benefits of prolonged TB treatment regimens, contributing to poor prognosis. Nevertheless, we observed no significant association between diagnostic delay and overall treatment outcome. This might be explained by the free access to TB diagnosis and treatment in Congo, which reduces financial barriers once patients engage with the health system. However, the higher, though non-significant, risks of death and failure among delayed patients underscore the clinical importance of addressing diagnostic delays. Our study has some limitations. First, the definition of symptom onset relied on patient self-reporting, which is subject to recall bias. Second, we lacked data on patients’ knowledge, attitudes, and health-seeking behaviors, which may have influenced delays. Third, the relatively small number of patients with poor outcomes limited statistical power to detect significant associations. Despite these limitations, our study provides the first evidence from Congo linking diagnostic delay to treatment outcomes in TB patients. The results highlight the need for targeted interventions to improve early case detection, particularly in peripheral districts of Brazzaville. Strengthening community awareness, decentralizing diagnostic services, and addressing geographic and socioeconomic barriers could significantly reduce diagnostic delays. Conclusions This study highlights a substantial diagnostic delay among pulmonary TB patients in Brazzaville, with a median time of 30 days between symptom onset and first consultation. Residence in peripheral districts was identified as a major predictor of prolonged delay, while diabetes mellitus was unexpectedly associated with earlier diagnosis. Although diagnostic delay was not statistically linked to treatment outcomes, patients with delays longer than 30 days faced higher-albeit non-significant-risks of death and treatment failure. These findings underscore the urgent need to strengthen case-finding strategies, improve awareness of TB symptoms, and expand access to diagnostic services in peripheral communities. Reducing diagnostic delays will be essential to improve patient outcomes and curb TB transmission in the Republic of Congo. Declarations Author contributions FN, BBN, JCD, FHM and DOEA conceptualized the study; FN, BBN, JCD, FHM, DOEA, JCV and MNMD were involved in the data collection and analysis; FN acquired the funding; FN, and AMM supervised the work; FN, AMM, BBN, JCD, FHM, DOEA, MNMD, FHOO, LKS, ABVM, MIA, JCV and VAE reviewed and edited the draft. All authors contributed to, and approved the final manuscript for submission. Acknowledgements We thank all the patients who consented to participate in this study. We also thank the Antituberculosis Center of Brazzaville Staff for their kind contributions. We express our gratitude to Roélie Foxie Mizele Kitoti for her support in data management. FN is member of the Pan-African Network for Rapid Research, Response, Relief and Preparedness for Emerging and Re-Emerging Infections (PANDORA-ID-NET) and the Central Africa Clinical research Network, CANTAM.) . Funding This work was funded by the Central Africa Clinical Research Network, CANTAM- CSA2020 NoE-3100 which is a network of excellence supported by EDCTP2 and by Alexander von Humboldt Foundation through the Central Africa Research Hub (HR-COCA). The Fondation Merieux and CACTR project (101145698 funded by Global Health EDCTP3 Joint Undertaking) supported JCD and FHM respectively. The funders did not play a role in the design of the study, collection, analysis, and interpretation of data, as well as the writing of the manuscript. Potential conflicts of interest The authors declare no competing interests Availability of Data Upon request to the corresponding author, raw data will be made available. References Global Tuberculosis Report. 1st ed. Geneva: World Health Organization; 2024. 1 p. (2024). Storla, D. G., Yimer, S. & Bjune, G. A. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public. Health . 8 (1), 15 (2008). Li, Y. et al. Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis. BMC Med. 11 (1), 156 (2013). Yimer, S., Bjune, G. & Alene, G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infect. Dis. 5 (1), 112 (2005). WHO Policy on TB Infection Control in Health-Care Facilities. Congregate Settings and Households [Internet]. Geneva: World Health Organization; 2009 [cited 2025 May 23]. (WHO Guidelines Approved by the Guidelines Review Committee). Available from: http://www.ncbi.nlm.nih.gov/books/NBK179249/ Buregyeya, E., Criel, B., Nuwaha, F. & Colebunders, R. Delays in diagnosis and treatment of pulmonary tuberculosis in Wakiso and Mukono districts, Uganda. BMC Public. Health . 14 (1), 586 (2014). Odusanya, O. O. & Babafemi, J. O. Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria. BMC Public. Health . 4 (1), 18 (2004). Ribeiro, C. C. et al. Delay in the diagnosis and treatment of tuberculosis in prisons in Mato Grosso do Sul, Brazil. Rev. Soc. Bras. Med. Trop. 56 , e0015–2023 (2023). PNLT. Rapport annuel 2023 des activites du Programme National de Lutte contre la Tuberculose. (2023). Fuge, T. G., Bawore, S. G., Solomon, D. W. & Hegana, T. Y. Patient delay in seeking tuberculosis diagnosis and associated factors in Hadiya Zone, Southern Ethiopia. BMC Res. Notes . 11 (1), 115 (2018). Ngouama, B. B. et al. Tuberculosis treatment outcomes and their related factors in patients with tuberculosis treated at the Antituberculosis Center of Brazzaville, Republic of Congo. IJID Reg. 15 , 100647 (2025 June). Machado, A. C. D. F. T. et al. Fatores associados ao atraso no diagnóstico da tuberculose pulmonar no estado do Rio de Janeiro. J. Bras. Pneumol . 37 (4), 512–520 (2011). Ben Amar, J. et al. Pulmonary tuberculosis: Diagnostic delay in Tunisia. Médecine Mal Infect. 46 (2), 79–86 (2016). Santos, E., Felgueiras, Ó., Oliveira, O. & Duarte, R. Diagnosis delay of tuberculosis in the Huambo province. Angola Pulmonol. 2018 Sept 30 ;24(5):294–299 . Tattevin, P. et al. Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France. Int. J. Tuberc Lung Dis. 16 (4), 510–515 (2012). Zerbini, E. et al. Delay in tuberculosis diagnosis and treatment in four provinces of Argentina. Int. J. Tuberc Lung Dis. Off J. Int. Union Tuberc Lung Dis. 12 (1), 63–68 (2008). Mfinanga, S. G. et al. The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania. BMC Health Serv. Res. 8 (1), 158 (2008). Wang, Q. et al. Hyperglycemia is associated with increased risk of patient delay in pulmonary tuberculosis in rural areas: 高血糖与农村地区肺结核患者延误就诊风险增加相关. J. Diabetes . 9 (7), 648–655 (2017 July). Chen, H. G. et al. Impact of diabetes on diagnostic delay for pulmonary tuberculosis in Beijing. Int. J. Tuberc Lung Dis. 18 (3), 267–271 (2014). Xiao, W. et al. Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China. BMC Infect. Dis. 21 (1), 272 (2021). Rossato Silva, D., Müller, A. M. & de Dalcin, P. Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting: a cross-sectional study. BMC Infect. Dis. 12 , 57 (2012). Otwombe, K. N., Variava, E., Holmes, C. B., Chaisson, R. E. & Martinson, N. Predictors of delay in the diagnosis and treatment of suspected tuberculosis in HIV co-infected patients in South Africa. Int J Tuberc Lung Dis. Sept 1;17(9):1199–205. (2013). Franco, J. et al. [Analysis of the diagnostic delay in tuberculosis]. Med. Clin. (Barc) . 107 (12), 453–457 (1996). Lawn, S. D., Afful, B. & Acheampong, J. W. Pulmonary tuberculosis: diagnostic delay in Ghanaian adults. Int. J. Tuberc Lung Dis. Off J. Int. Union Tuberc Lung Dis. 2 (8), 635–640 (1998). Fetensa, G., Wirtu, D., Etana, B., Tolossa, T. & Wakuma, B. Magnitude and determinants of delay in diagnosis of tuberculosis patients in Ethiopia: a systematic review and meta-analysis: 2020. Arch. Public. Health . 80 (1), 78 (2022). Kraef, C. et al. Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality-a multicentre prospective cohort study. BMC Infect. Dis. 21 (1), 1038 (2021). Needham, D. M., Foster, S. D., Tomlinson, G. & Godfrey-Faussett, P. Socio‐economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia. Trop. Med. Int. Health . 6 (4), 256–259 (2001). Getnet, F. et al. Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia. BMC Pulm Med [Internet]. 2019 Dec [cited 2025 July 14];19(1). Available from: https://bmcpulmmed.biomedcentral.com/articles/ 10.1186/s12890-019-0971-y Tables Table 1. Sociodemographic and clinical characteristics of the study patients. Variables Frequency N=313 Percentage (%) Sexe Male 217 69.3 Female 96 30.7 Age group <24 71 22.7 24-44 175 55.9 ≥44 67 21.4 Place of living Makelekele 48 15.3 Bacongo 28 8.9 Poto-Poto 9 2.9 Moungali 29 9.3 Ouenze 26 8.3 Talangai 50 16.0 Mfilou 52 16.6 Madibou 36 11.5 Djiri 35 11.2 Level of education Illiterate 6 1.9 Literate 307 98.1 Employment status Employed 268 85.6 Unemployed 45 14.4 Marital status Married 8 2.6 Single 298 95.2 Separated/Widow/Divorce 15 4.8 Year of diagnosis 2022 161 51.4 2023 152 48.6 HIV/AIDS status Negative 298 91.7 Positive 15 5.1 History of diabetes mellitus No 304 97.1 Yes 9 2.9 History of TB New 295 94.2 Previously diagnosed 18 5.8 Table 2. Predictors of unacceptable patient delay (>30 days). Variables Delay n (%) No patient delay n (%) COR [95% CI] AOR [95% CI] P value Sex Male 90 (41.5) 127 (58.5) 0.80 [0.49-1.30] -- 0.374 Female 45(46.9) 51 (53.1) 1 Age group <24 30 (42.3) 41 (57.7) 1 24-44 77 (44.0) 98 (56.0) 1.07 [0.61-1.87] -- 0.802 ≥44 28 (41.8) 39 (58.2) 0.98 [0.50-1.93] -- 0.956 Patient residence Makelekele 15 (31.3) 33 (68.7) 1 1 Bacongo 13 (46.4) 15 (53.6) 1.91 [0.73-4.99] 1.88 [0.70-5.05] 0.211 Poto-Poto 5 (55.6) 4 (44.4) 2.75 [0.64-11.72] 2.61 [0.60-11.41] 0.201 Moungali 14 (48.3) 15 (51.7) 2.05 [0.79-5.31] 1.88 [0.71-4.98] 0.204 Ouenze 11 (42.3) 15 (57.7) 1.61 [0.60-4.34] 1.53 [0.56-4.21] 0.409 Talangai 22 (44.0) 28 (56.0) 1.72 [0.76-3.95] 1.90 [0.81-4.43] 0.139 Mfilou 29 (55.8) 23 (44.2) 2.77 [1.22-6.30] 3.39 [1.44-7.96] 0.004 Madibou 14 (38.9) 22 (61.1) 1.40 [0.57-3.46] 1.32 [0.52-3.35] 0.554 Djiri 12 (34.3) 23 (65.7) 1.15 [0.45-2.90] 1.14 [0.44-2.98] 0.780 Education Illiterate 2 (33.3) 4 (66.7) 1 Literate 133 (43.3) 174 (56.7) 1.53 [0.28-8.47] -- 0.627 Employment status Employed 114 (42.5) 154 (57.5) 0.85 [0.44-1.59] -- 0.605 Unemployed 21 (46.7) 24 (53.3) 1 Marital status Married 2 (25.0) 6 (75.0) 0.42 [0.08-2.12] -- 0.294 Single 130 (44.2) 164 (55.8) 1 Separated/Widow/Divorce 3 (27.3) 8 (72.7) 0.47 [0.12-1.82] -- 0.276 Year of diagnosis 2022 62 (38.5) 99 (61.5) 1 1 2023 73 (48.0) 79 (52.0) 1.48 [0.94-2.31] 1.45 [0.90-2.33] 0.122 HIV/AIDS status Negative 133 (44.6) 165 (54.4) 1 Positive 5 (33.3) 10 (66.7) 1.368 [0.51-3.83] -- 0.434 Diabetis mellitus No 134 (44.1) 170 (55.9) 1 Yes 1 (11.1) 8 (88.9) 0.16 [0.02-1.13] 0.15 [1.01-1.27] 0.008 History of TB New 128 (43.4) 167 (56.6) 1 Previously diagnosed 7 (38.9) 11 (61.1) 0.83 [0.31-2.20] -- 0.709 Table 3. Tuberculosis treatment outcome according to the median cut-off of diagnosis delay of 30 days. Variables Delay n (%) No patient delay n (%) COR [95% CI] AOR [95% CI] P value Treatment success Cured Yes 84 (38.9) 132 (61.1) 1.54 [0.95-2.50] -- 0.098 No 44 (49.4) 45 (50.6) 1 Treatment completed Yes 11 (37.9) 18 (62.1) 1.20 [0.56-2.67] -- 0.696 No 117 (42.4) 159 (57.6) 1 Treatment unsuccess Died Yes 7 (63.5) 4 (57.7) 1 No 121 (41.2) 173 (58.8) 2.50 [0.78-7.76] -- 0.212 Loss to follow up Yes 21 (51.2) 20 (48.4) 1 No 107 (40.5) 157 (59.5) 1.717 [0.91-3.25] -- 0.124 Treatment failure Yes 4 (80) 1(20) 1 No 124 (41.3) 176 (58.7) 5.68 [0.92-69.81] -- 0.165 Transfered Yes 1 (33.3) 2 (66.7) 1 No 127 (42.1) 175 (57.9) 0.69 [0.052-5.98] -- >0.999 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7977064","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":546475507,"identity":"cf3e9f60-01a6-41d5-9c7f-27aa410edfd9","order_by":0,"name":"Breli Bonheur Ngouama","email":"","orcid":"","institution":"Fondation Congolaise Pour La Recherche Médicale","correspondingAuthor":false,"prefix":"","firstName":"Breli","middleName":"Bonheur","lastName":"Ngouama","suffix":""},{"id":546475509,"identity":"d7aa6b0b-71ae-4cc7-9329-ef6d5f4178d1","order_by":1,"name":"Mita Naomie Merveille Dello","email":"","orcid":"","institution":"Fondation Congolaise 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Médicale","correspondingAuthor":false,"prefix":"","firstName":"Jean","middleName":"Claude","lastName":"Djontu","suffix":""},{"id":546475519,"identity":"dae956a0-5477-4ca9-9ac9-dda124a53a2d","order_by":5,"name":"Franck Hardain Okemba Okombi","email":"","orcid":"","institution":"Marien Ngouabi University","correspondingAuthor":false,"prefix":"","firstName":"Franck","middleName":"Hardain Okemba","lastName":"Okombi","suffix":""},{"id":546475523,"identity":"59df573f-3888-417c-b6c7-ad649f3d189f","order_by":6,"name":"Michel Illoye Ayet","email":"","orcid":"","institution":"Centre antituberculeux de Brazzaville","correspondingAuthor":false,"prefix":"","firstName":"Michel","middleName":"Illoye","lastName":"Ayet","suffix":""},{"id":546475524,"identity":"673c61ad-ee80-47a3-aa4d-8407fb629f04","order_by":7,"name":"Jeannhey Christevy Vouvoungui","email":"","orcid":"","institution":"Fondation Congolaise Pour La Recherche 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08:47:18","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105275,"visible":true,"origin":"","legend":"","description":"","filename":"c823e513285c46178b59442a8149d4131structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7977064/v1/c5aaf238b6781cd7e91637d4.xml"},{"id":96160226,"identity":"1b5dcc5a-6eac-4ba5-9bde-5f1a8dae616e","added_by":"auto","created_at":"2025-11-18 08:47:18","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116773,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7977064/v1/0063a7afee5b8d43c7dd1308.html"},{"id":96160216,"identity":"8c7a5589-bdd4-47ea-9985-ebfd076c3057","added_by":"auto","created_at":"2025-11-18 08:47:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":80255,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatient delay in days.\u003c/strong\u003e This figure shows the time intercourring between the onset of symptoms and the day of TB diagnosis: among 313 surveyed patients, 178 reported their symptoms to the Antituberculosis center within 30 days and 135 after 30 days.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7977064/v1/361f5033f166462e03ed05a7.png"},{"id":96257003,"identity":"f78c01a6-a38b-4e83-8d4c-ddfa63736349","added_by":"auto","created_at":"2025-11-19 07:51:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1444068,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7977064/v1/ec01a1b2-c3ec-4277-b723-70772ccb861e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Delay in diagnosis and relative risk of treatment failure and deaths in pulmonary tuberculosis patients at the Antituberculosis center of Brazzaville, Republic of Congo","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTuberculosis (TB) is an infectious disease caused mainly by \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e and remains the leading cause of death from a single infectious agent worldwide. In 2023, TB was responsible for an estimated 1.25\u0026nbsp;million deaths, including 1.09\u0026nbsp;million among HIV-negative individuals and 161,000 among people living with HIV. Although this represents a decline compared with 2022 (1.32\u0026nbsp;million), 2021 (1.42\u0026nbsp;million), and 2020 (1.40\u0026nbsp;million), and even lower than the pre-COVID-19 level of 2019 (1.34\u0026nbsp;million), TB continues to pose a significant global health challenge [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While the global burden of TB is declining slowly, progress in controlling the disease and mitigating its consequences could be accelerated if different programs prioritized early diagnosis and treatment.\u003c/p\u003e\u003cp\u003eEarly diagnosis and treatment are essential for controlling TB. Delays in diagnosis increase the risk of transmission, disease progression, and mortality, while also generating psychological distress and financial burdens for patients and their families. Previous studies have highlighted that late detection of TB not only worsens individual outcomes but also threatens community health and health system performance [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Minimizing exposure to infectious individuals requires reducing the number of outpatient visits [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Despite advances in knowledge and diagnosis tools, delayed case detection remains common, particularly in Sub Saharan Africa, where health systems are often fragile [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Republic of Congo is classified among the 30 countries with the highest TB burden, with an estimated incidence of 369 cases per 100,000 inhabitants in 2022 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, case detection largely relies on passive strategies, when patients present to health facilities after symptom onset. This reliance on passive case finding increases the likelihood of prolonged delays before diagnosis, thereby contributing to continued transmission and poor outcomes. To date, no study in the Republic of Congo has specifically assessed diagnostic delays in TB and their association with treatment outcomes. Understanding these delays and their determinants is essential to inform interventions that improve early case detection and strengthen the national TB program. Therefore, this study aimed to (i) estimate the median time to TB diagnosis, (ii) identify sociodemographic and clinical risk factors associated with prolonged delays, and (iii) examine the impact of diagnostic delay on treatment outcomes among patients with pulmonary TB at the Antituberculosis Center of Brazzaville.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy setting\u003c/h2\u003e\u003cp\u003eThe Republic of Congo is a high TB burden country with a population of approximately 6\u0026nbsp;million people. The study was conducted at the Antituberculosis Center of Brazzaville, the political and administrative capital, which hosts 35% (2 145 783 inhabitants). In 2023, 5 757 TB cases (including pulmonary and extrapulmonary forms) were reported in Brazzaville. All public health facilities in the country provide free TB diagnostic and treatment services, including Directly Observed Therapy (DOTs), through a network of hospitals and health centers.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy design and participants\u003c/h3\u003e\n\u003cp\u003eA prospective cohort study was conducted between July 2023 and August 2024 to estimate the diagnostic delay among TB patients and the impact of this one on treatment outcome. Patients aged from 8 to 80 years were enrolled. Both newly diagnosed and previously treated patients were eligible. Exclusion criteria included refusal to participate or absence of informed consent.\u003c/p\u003e\n\u003ch3\u003eData collection and definitions\u003c/h3\u003e\n\u003cp\u003eData were collected using a structured questionnaire covering sociodemographic and clinical characteristics. Participants were asked to report whether they had experienced key symptoms (cough, chest pain, fever, weight loss, hemoptysis, and night sweats) and to recall the duration of these symptoms.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePatient delay\u003c/b\u003e was defined as the interval between the onset of pulmonary symptoms (cough used as the defining symptom) and the first consultation at a health facility.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWe considered 30 days as a cutoff for diagnostic delay, corresponding to the median delay observed in our study population as previously considered by [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Tuberculosis treatment outcomes and their related risk factors were described in our previous study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eTreatment outcomes were monitored according to WHO definitions.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eTreatment success\u003c/b\u003e was defined as the sum of cured and treatment completed.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eUnsuccessful outcome\u003c/b\u003e was defined as the sum of treatment failure, death, lost to follow-up, and transfer out.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eSputum samples were examined using Ziehl-Neelsen staining for acid-fast bacilli, and patients were followed throughout the treatment period.\u003c/p\u003e\n\u003ch3\u003eSelection and eligibility criteria\u003c/h3\u003e\n\u003cp\u003e Individuals with a history of TB treatment or not (\u0026ge;\u0026thinsp;8 years old) diagnosed for pulmonary TB, based on the national TB guideline were included in the study. However, TB patients who do not consent to participate were non\u0026shy;included in the study.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e Approval was obtained from the institutional ethics committee of the Fondation Congolaise pour la Recherche M\u0026eacute;dicale (Reference 045/CEI/FCRM/2023). All participants received full information about the study objectives and procedures and signed an informed consent form prior to inclusion, in accordance with principles of the Declaration of Helsinki. For children aged 8\u0026ndash;17 years, assent was obtained along with written consent from parents or guardians. All data were anonymized to ensure participant confidentiality.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData management and statistical analysis\u003c/h2\u003e\u003cp\u003eData were entered and analyzed using Rstudio software (Version 8.0.2). Diagnostic delay was categorized as \u0026le;\u0026thinsp;30 days or \u0026gt;\u0026thinsp;30 days. Associations between delay and independent variables (age, sex, education, occupation, marital status, residence, HIV status, diabetes mellitus, TB history and treatment outcomes) were assessed.\u003c/p\u003e\u003cp\u003eBivariate analyses were performed to estimate crude odds ratios (OR) with 95% confidence intervals (CI). Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.10 were included in multivariate logistic regression to calculate adjusted odds ratios (AOR). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic and clinical characteristics of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 313 patients with pulmonary TB were enrolled. Of these, 161 (51.4%) were diagnosed in 2024 and 152 (48.6%) in 2023.\u0026nbsp;Men accounted for 69.3% (217/313) of participants, with the age group 24\u0026ndash;44 years being the most represented (55.9%). The median age was 34 years (IQR 24\u0026ndash;41). The majority of patients (98.1%) had at least primary education, while six (1.9%) were illiterate. The most common districts of residence were Mfilou (16.6%), Talangai (16.0%), Mak\u0026eacute;l\u0026eacute;k\u0026eacute;l\u0026eacute; (15.3%), and Madibou (11.5%). Most patients were employed (85.6%) and single (93.9%). Sixteen patients (5.1%) were HIV-positive \u003cstrong\u003e(Table 1)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient delay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median delay from symptom onset to first consultation was 30 days (IQR 21\u0026ndash;62). The longest reported delay was 720 days. Overall, 135 patients (43.1%) experienced a prolonged diagnostic delay (\u0026gt;30 days) \u003cstrong\u003e(Fig. 1)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with diagnostic delay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn multivariate analysis, residence in Mfilou district was significantly associated with a prolonged delay (OR=2.77, 95%CI: 1.22\u0026ndash;6.30; p=0.004). Conversely, patients with diabetes mellitus were more likely to seek care earlier (OR=0.15, 95%CI: 0.02\u0026ndash;1.13; p=0.008). Other variables, including sex, age, marital status, employment status, education, HIV status, year of diagnosis, and TB history, showed no significant associations with diagnostic delay \u003cstrong\u003e(Table 2)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment outcomes and influence of diagnostic delay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong patients with prolonged delays, 65.6% (84/128) were cured, 8.6% (11/128) completed treatment, 5.5% (7/128) died, 16.4% (21/128) were lost to follow-up, and 3.1% (4/128) experienced treatment failure. In contrast, among those with shorter delays, 74.6% (132/177) were cured, 10.2% (18/177) completed treatment, and 0.6% (1/177) failed treatment. Deaths occurred in 0.6% (1/177), and loss to follow-up in 1.1% (2/177) of this group. Transfer-out rates were comparable (0.8% in delayed vs. 1.1% in non-delayed patients) \u003cstrong\u003e(Table 3)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eAlthough diagnostic delay was not statistically associated with overall treatment outcome, patients with delays longer than 30 days had higher, though non-significant, odds of death (OR=2.50, 95%CI: 0.78\u0026ndash;7.76; p=0.212) and treatment failure (OR=5.68, 95%CI: 0.92\u0026ndash;69.81; p=0.165).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study revealed that nearly half of pulmonary TB patients (43.1%) in Brazzaville experienced a diagnostic delay longer than 30 days, with a median delay of 30 days. This delay is comparable to findings from Ethiopia [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and Brazil [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], where median delays of 30 days were reported. However, it is shorter than the \u0026gt;\u0026thinsp;45-day delays documented in Tunisia and Angola [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. and considerably shorter than the 68-day delay reported in France [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Variations across studies may reflect differences in health system infrastructure, patient demographics, awareness of TB symptoms, and availability of diagnostic services.\u003c/p\u003e\u003cp\u003eOur analysis identified residence in Mfilou district as a key predictor of prolonged delay. Mfilou is located on the periphery of Brazzaville, far from the Antituberculosis Center situated in Bacongo. Distance to healthcare facilities and associated transport costs are well-recognized barriers to timely access to TB care, particularly for socioeconomically disadvantaged populations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, limited awareness of local diagnostic services may contribute to delayed health-seeking behaviors among patients in peripheral districts.\u003c/p\u003e\u003cp\u003eInterestingly, patients with diabetes mellitus (DM) were more likely to be diagnosed earlier. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This finding contrasts with studies from China and other settings, where DM was associated with longer diagnostic delays. A plausible explanation is that TB patients with DM in our cohort may have presented with more severe symptoms, prompting earlier medical consultation. Alternatively, patients with chronic conditions such as DM may have more frequent contact with healthcare services, facilitating earlier detection [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eContrary to expectations, HIV infection was not significantly associated with diagnostic delay. This finding is in line with some previous studies [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our results may reflect improvements in integrated HIV/TB services and expanded access to HIV care in Congo, which could reduce barriers to TB diagnosis among people living with HIV [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This result could be the outcome of the significant progress made regarding the integrated care system for PLH.\u003c/p\u003e\u003cp\u003eAlthough not statistically significant, prolonged diagnostic delays were associated with higher odds of death and treatment failure. These findings are consistent with evidence that patients diagnosed late often present with advanced disease, reduced tolerance to treatment, or poor adherence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Late-stage disease may also limit the benefits of prolonged TB treatment regimens, contributing to poor prognosis.\u003c/p\u003e\u003cp\u003eNevertheless, we observed no significant association between diagnostic delay and overall treatment outcome. This might be explained by the free access to TB diagnosis and treatment in Congo, which reduces financial barriers once patients engage with the health system. However, the higher, though non-significant, risks of death and failure among delayed patients underscore the clinical importance of addressing diagnostic delays.\u003c/p\u003e\u003cp\u003eOur study has some limitations. First, the definition of symptom onset relied on patient self-reporting, which is subject to recall bias. Second, we lacked data on patients\u0026rsquo; knowledge, attitudes, and health-seeking behaviors, which may have influenced delays. Third, the relatively small number of patients with poor outcomes limited statistical power to detect significant associations. Despite these limitations, our study provides the first evidence from Congo linking diagnostic delay to treatment outcomes in TB patients. The results highlight the need for targeted interventions to improve early case detection, particularly in peripheral districts of Brazzaville. Strengthening community awareness, decentralizing diagnostic services, and addressing geographic and socioeconomic barriers could significantly reduce diagnostic delays.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights a substantial diagnostic delay among pulmonary TB patients in Brazzaville, with a median time of 30 days between symptom onset and first consultation. Residence in peripheral districts was identified as a major predictor of prolonged delay, while diabetes mellitus was unexpectedly associated with earlier diagnosis. Although diagnostic delay was not statistically linked to treatment outcomes, patients with delays longer than 30 days faced higher-albeit non-significant-risks of death and treatment failure. These findings underscore the urgent need to strengthen case-finding strategies, improve awareness of TB symptoms, and expand access to diagnostic services in peripheral communities. Reducing diagnostic delays will be essential to improve patient outcomes and curb TB transmission in the Republic of Congo.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFN, BBN, JCD, FHM and DOEA conceptualized the study; FN, BBN, JCD, FHM, DOEA, JCV and MNMD were involved in the data collection and analysis; FN acquired the funding; FN, and AMM supervised the work; FN, AMM, BBN, JCD, FHM, DOEA, MNMD, FHOO, LKS, ABVM, MIA, JCV and VAE reviewed and edited the draft. All authors contributed to, and approved the final manuscript for submission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the patients who consented to participate in this study. We also thank the Antituberculosis Center of Brazzaville Staff for their kind contributions. We express our gratitude to Roélie Foxie Mizele Kitoti for her support in data management. FN is member of the Pan-African Network for Rapid Research, Response, Relief and Preparedness for Emerging and Re-Emerging Infections (PANDORA-ID-NET) and the Central Africa Clinical research Network, CANTAM.) .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Central Africa Clinical Research Network, CANTAM- CSA2020 NoE-3100 which is a network of excellence supported by EDCTP2 and by Alexander von Humboldt Foundation through the Central Africa Research Hub (HR-COCA). The Fondation Merieux and CACTR project (101145698 funded by Global Health EDCTP3 Joint Undertaking) supported JCD and FHM respectively. The funders did not play a role in the design of the study, collection, analysis, and interpretation of data, as well as the writing of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePotential conflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUpon request to the corresponding author, raw data will be made available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGlobal Tuberculosis Report. 1st ed. Geneva: World Health Organization; 2024. 1 p. (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStorla, D. G., Yimer, S. \u0026amp; Bjune, G. A. A systematic review of delay in the diagnosis and treatment of tuberculosis. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e8\u003c/b\u003e (1), 15 (2008).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi, Y. et al. Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis. \u003cem\u003eBMC Med.\u003c/em\u003e \u003cb\u003e11\u003c/b\u003e (1), 156 (2013).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYimer, S., Bjune, G. \u0026amp; Alene, G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. \u003cem\u003eBMC Infect. Dis.\u003c/em\u003e \u003cb\u003e5\u003c/b\u003e (1), 112 (2005).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO Policy on TB Infection Control in Health-Care Facilities. Congregate Settings and Households [Internet]. Geneva: World Health Organization; 2009 [cited 2025 May 23]. (WHO Guidelines Approved by the Guidelines Review Committee). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK179249/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK179249/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuregyeya, E., Criel, B., Nuwaha, F. \u0026amp; Colebunders, R. Delays in diagnosis and treatment of pulmonary tuberculosis in Wakiso and Mukono districts, Uganda. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e14\u003c/b\u003e (1), 586 (2014).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOdusanya, O. O. \u0026amp; Babafemi, J. O. Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e4\u003c/b\u003e (1), 18 (2004).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRibeiro, C. C. et al. Delay in the diagnosis and treatment of tuberculosis in prisons in Mato Grosso do Sul, Brazil. \u003cem\u003eRev. Soc. Bras. Med. Trop.\u003c/em\u003e \u003cb\u003e56\u003c/b\u003e, e0015\u0026ndash;2023 (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePNLT. Rapport annuel 2023 des activites du Programme National de Lutte contre la Tuberculose. (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFuge, T. G., Bawore, S. G., Solomon, D. W. \u0026amp; Hegana, T. Y. Patient delay in seeking tuberculosis diagnosis and associated factors in Hadiya Zone, Southern Ethiopia. \u003cem\u003eBMC Res. Notes\u003c/em\u003e. \u003cb\u003e11\u003c/b\u003e (1), 115 (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNgouama, B. B. et al. Tuberculosis treatment outcomes and their related factors in patients with tuberculosis treated at the Antituberculosis Center of Brazzaville, Republic of Congo. \u003cem\u003eIJID Reg.\u003c/em\u003e \u003cb\u003e15\u003c/b\u003e, 100647 (2025 June).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMachado, A. C. D. F. T. et al. Fatores associados ao atraso no diagn\u0026oacute;stico da tuberculose pulmonar no estado do Rio de Janeiro. \u003cem\u003eJ. Bras. Pneumol\u003c/em\u003e. \u003cb\u003e37\u003c/b\u003e (4), 512\u0026ndash;520 (2011).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBen Amar, J. et al. Pulmonary tuberculosis: Diagnostic delay in Tunisia. \u003cem\u003eM\u0026eacute;decine Mal Infect.\u003c/em\u003e \u003cb\u003e46\u003c/b\u003e (2), 79\u0026ndash;86 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSantos, E., Felgueiras, \u0026Oacute;., Oliveira, O. \u0026amp; Duarte, R. Diagnosis delay of tuberculosis in the Huambo province. \u003cem\u003eAngola Pulmonol. 2018 Sept\u003c/em\u003e \u003cb\u003e30\u003c/b\u003e;24(5):294\u0026ndash;299 .\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTattevin, P. et al. Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France. \u003cem\u003eInt. J. Tuberc Lung Dis.\u003c/em\u003e \u003cb\u003e16\u003c/b\u003e (4), 510\u0026ndash;515 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZerbini, E. et al. Delay in tuberculosis diagnosis and treatment in four provinces of Argentina. \u003cem\u003eInt. J. Tuberc Lung Dis. Off J. Int. Union Tuberc Lung Dis.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (1), 63\u0026ndash;68 (2008).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMfinanga, S. G. et al. The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania. \u003cem\u003eBMC Health Serv. Res.\u003c/em\u003e \u003cb\u003e8\u003c/b\u003e (1), 158 (2008).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang, Q. et al. Hyperglycemia is associated with increased risk of patient delay in pulmonary tuberculosis in rural areas: 高血糖与农村地区肺结核患者延误就诊风险增加相关. \u003cem\u003eJ. Diabetes\u003c/em\u003e. \u003cb\u003e9\u003c/b\u003e (7), 648\u0026ndash;655 (2017 July).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen, H. G. et al. Impact of diabetes on diagnostic delay for pulmonary tuberculosis in Beijing. \u003cem\u003eInt. J. Tuberc Lung Dis.\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e (3), 267\u0026ndash;271 (2014).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiao, W. et al. Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China. \u003cem\u003eBMC Infect. Dis.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e (1), 272 (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRossato Silva, D., M\u0026uuml;ller, A. M. \u0026amp; de Dalcin, P. Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting: a cross-sectional study. \u003cem\u003eBMC Infect. Dis.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e, 57 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOtwombe, K. N., Variava, E., Holmes, C. B., Chaisson, R. E. \u0026amp; Martinson, N. Predictors of delay in the diagnosis and treatment of suspected tuberculosis in HIV co-infected patients in South Africa. Int J Tuberc Lung Dis. Sept 1;17(9):1199\u0026ndash;205. (2013).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFranco, J. et al. [Analysis of the diagnostic delay in tuberculosis]. \u003cem\u003eMed. Clin. (Barc)\u003c/em\u003e. \u003cb\u003e107\u003c/b\u003e (12), 453\u0026ndash;457 (1996).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLawn, S. D., Afful, B. \u0026amp; Acheampong, J. W. Pulmonary tuberculosis: diagnostic delay in Ghanaian adults. \u003cem\u003eInt. J. Tuberc Lung Dis. Off J. Int. Union Tuberc Lung Dis.\u003c/em\u003e \u003cb\u003e2\u003c/b\u003e (8), 635\u0026ndash;640 (1998).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFetensa, G., Wirtu, D., Etana, B., Tolossa, T. \u0026amp; Wakuma, B. Magnitude and determinants of delay in diagnosis of tuberculosis patients in Ethiopia: a systematic review and meta-analysis: 2020. \u003cem\u003eArch. Public. Health\u003c/em\u003e. \u003cb\u003e80\u003c/b\u003e (1), 78 (2022).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKraef, C. et al. Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality-a multicentre prospective cohort study. \u003cem\u003eBMC Infect. Dis.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e (1), 1038 (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeedham, D. M., Foster, S. D., Tomlinson, G. \u0026amp; Godfrey-Faussett, P. Socio‐economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia. \u003cem\u003eTrop. Med. Int. Health\u003c/em\u003e. \u003cb\u003e6\u003c/b\u003e (4), 256\u0026ndash;259 (2001).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGetnet, F. et al. Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia. BMC Pulm Med [Internet]. 2019 Dec [cited 2025 July 14];19(1). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpulmmed.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpulmmed.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12890-019-0971-y\u003c/span\u003e\u003cspan address=\"10.1186/s12890-019-0971-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Sociodemographic and clinical characteristics of the study patients.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency N=313\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of living\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMakelekele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBacongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePoto-Poto\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMoungali\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOuenze\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTalangai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMfilou\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMadibou\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDjiri\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of \u0026nbsp; \u0026nbsp; education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e85.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeparated/Widow/Divorce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear of diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV/AIDS status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of diabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of TB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNew\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreviously diagnosed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;Predictors of unacceptable patient delay (\u0026gt;30 days).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDelay\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo patient delay\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR [95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR [95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e90 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e127 (58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.80 [0.49-1.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45(46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77 (44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98 (56.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.07 [0.61-1.87]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.802\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28 (41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.98 [0.50-1.93]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMakelekele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33 (68.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBacongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.91 [0.73-4.99]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.88 [0.70-5.05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePoto-Poto\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.75 [0.64-11.72]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.61 [0.60-11.41]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMoungali\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.05 [0.79-5.31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.88 [0.71-4.98]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOuenze\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.61 [0.60-4.34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.53 [0.56-4.21]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTalangai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28 (56.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.72 [0.76-3.95]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.90 [0.81-4.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMfilou\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.77 [1.22-6.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.39 [1.44-7.96]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMadibou\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.40 [0.57-3.46]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.32 [0.52-3.35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDjiri\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.15 [0.45-2.90]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.14 [0.44-2.98]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e133 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e174 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.53 [0.28-8.47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e114 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e154 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.85 [0.44-1.59]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.605\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.42 [0.08-2.12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e130 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e164 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeparated/Widow/Divorce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.47 [0.12-1.82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear of diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e99 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79 (52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.48 [0.94-2.31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.45 [0.90-2.33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV/AIDS status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e133 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e165 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.368 [0.51-3.83]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetis mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e134 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e170 (55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.16 [0.02-1.13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.15 [1.01-1.27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of TB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNew\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e167 (56.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreviously diagnosed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 \u0026nbsp;(38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;11 (61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.83 [0.31-2.20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;Tuberculosis treatment outcome according to the median cut-off of diagnosis delay of 30 days.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDelay\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo patient delay\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR [95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR [95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment success\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCured\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132 (61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.54 [0.95-2.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44 (49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45 (50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment completed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.20 [0.56-2.67]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e117 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e159 (57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment unsuccess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e121 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e173 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.50 [0.78-7.76]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLoss to follow up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (51.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e107 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e157 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.717 [0.91-3.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment failure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e124 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e176 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.68 [0.92-69.81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransfered\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e127 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e175 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.69 [0.052-5.98]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mycobacterium Tuberculosis, Brazzaville, Treatment outcome, Diagnosis delay","lastPublishedDoi":"10.21203/rs.3.rs-7977064/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7977064/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eTuberculosis (TB) remains a major public health concern worldwide. Early diagnosis is crucial to reduce TB transmission and improve treatment outcomes. This study assessed diagnostic delays and their impact on the treatment outcomes among pulmonary tuberculosis patients (PTB) at the Antituberculosis center in Brazzaville.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a prospective cohort study from July 2023 to August 2024. Sociodemographic, clinical characteristics, diagnostic delays, and treatment outcomes were recorded. Logistic regression models were used to identify risk factors, reporting crude and adjusted odds ratios (OR, AOR) with 95% confidence intervals (CI). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 313 patients were included (median age: 34 years, range 24\u0026ndash;41); 295 (94.2%) were newly diagnosed, and 16 (5.1%) were HIV-positive. Men accounted for 69% of cases, and the age group 24\u0026ndash;44 was the most represented (55.9%). The median patient delay was 30 days (IQR 21\u0026ndash;62), and 135 (43.1%) experienced prolonged delays. Multivariate analysis showed that residence in Mfilou district was associated with longer delays (OR\u0026thinsp;=\u0026thinsp;2.77, 95%CI: 1.22\u0026ndash;6.30; p\u0026thinsp;=\u0026thinsp;0.004), whereas diabetes mellitus was linked to shorter delays (OR\u0026thinsp;=\u0026thinsp;0.15, 95%CI: 0.02\u0026ndash;1.13; p\u0026thinsp;=\u0026thinsp;0.008). Although diagnostic delay was not significantly associated with treatment outcomes, patients with delays\u0026thinsp;\u0026gt;\u0026thinsp;30 days had higher odds of death (OR\u0026thinsp;=\u0026thinsp;2.50, 95%CI: 0.78\u0026ndash;7.76) and treatment failure (OR\u0026thinsp;=\u0026thinsp;5.68, 95%CI: 0.92\u0026ndash;69.81).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eA high median diagnostic delay (30 days) was observed in Brazzaville. Residence and diabetes mellitus status were significant predictors of delay. Although not statistically significant, prolonged delays were associated with higher risks of death and treatment failure. Strengthening case-finding strategies and improving timely health-seeking behaviors are critical to reducing TB burden.\u003c/p\u003e","manuscriptTitle":"Delay in diagnosis and relative risk of treatment failure and deaths in pulmonary tuberculosis patients at the Antituberculosis center of Brazzaville, Republic of Congo","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 08:47:13","doi":"10.21203/rs.3.rs-7977064/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-12T07:33:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-10T09:24:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83702445940229649259302220503958199627","date":"2026-01-02T08:06:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-04T14:05:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120926013287899833990026687353811293233","date":"2025-12-01T17:38:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158815721895201780655222173320300794098","date":"2025-11-29T17:49:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-06T17:44:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-03T12:53:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-31T02:54:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-31T02:54:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-29T07:49:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2480739d-b836-4345-ae61-f15908c89a17","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":58135090,"name":"Health sciences/Diseases"},{"id":58135091,"name":"Health sciences/Health care"},{"id":58135092,"name":"Health sciences/Medical research"},{"id":58135093,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-04-20T14:42:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 08:47:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7977064","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7977064","identity":"rs-7977064","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}