Factors associated with patient and health care system delay among migrant and local tuberculosis patients in Istanbul: a cross-sectional study.

BACKGROUND

Effective tuberculosis (TB) management requires timely diagnosis and immediate treatment initiation. The urgency for diagnosing and treating TB is particularly acute among immigrants, who face heightened health risks due to factors such as poverty, hazardous working conditions, and limited healthcare access. The objective of this study was to examine the characteristics of patient and health care delays among migrant and local TB patients in Istanbul and to identify factors associated with delays in the diagnosis and treatment of TB in both migrant and local patients.

METHODS

This cross-sectional study was conducted in six Tuberculosis Control Dispensaries (TCDs) in Istanbul, the city with the highest number of TB cases in Turkey. A total of 211 TB patients, including 140 local residents and 71 migrants, participated. Data were collected through interviews via a structured questionnaire and patient files, following the patients' consent.

RESULTS

Among migrant patients, the time from the onset of TB-related symptoms to the first contact with a health institution (patient delay) was 4.7 times longer (95% Confidence Interval [CI] = 1.1-20.9) than that in local resident patients. Compared with local patients, migrant patients were predominantly male, younger, had lower education levels, had a history of previous TB, and were less likely to smoke. Additionally, the frequency of working without insurance and unemployment was greater among migrant patients than among those employed with insurance.

CONCLUSION

Our research underscores the importance of focusing on the migrant community to achieve tuberculosis control goals, potentially through interventions to increase knowledge of healthcare system access and the significance of working conditions, including health insurance. While we profiled migrant TB patients, qualitative research is needed to elucidate the underlying reasons for delays in diagnosis and treatment.