Barriers and Facilitators to Timely Diagnosis of Tuberculosis in Children and Adolescents in Karachi, Pakistan

Background: The diagnosis of tuberculosis (TB) in children and adolescents is often delayed. We conducted a study to understand the barriers and facilitators to the diagnosis of TB in children and adolescents in a not-for-profit private hospital in Karachi, Pakistan. Methods: We conducted a convergent mixed-methods study comprising quantitative surveys with caregivers of 100 TB patients < 18 years old and 40 semi-structured interviews with caregivers and healthcare providers. Results: Among TB patients whose caregivers were surveyed, 82% were adolescents 10–17 years old. Caregivers reported a median of 91 days (IQR 58–160) between symptom onset and treatment initiation. Time was divided relatively evenly between symptom onset and the first visit to a healthcare provider (median 73, IQR 42–130 days), and between this visit and TB diagnosis (median 65 days, IQR 30–114). While 69% of caregivers initially visited general physicians, many felt that these general physicians did not provide satisfactory healthcare. Caregivers mentioned financial constraints as a major barrier affecting all stages of the journey to diagnosis and treatment. Conclusions: Interventions that overcome financial barriers and strategies that enhance the capacity of private sector general physicians are necessary to reduce delays in TB diagnosis and treatment initiation for children and adolescents.