Longer delay in accessing treatment among current smokers with new sputum smear-positive tuberculosis in Nepal.

SETTING: Kathmandu, Nepal, which has 7% of the national population and 18% of the tuberculosis (TB) burden. OBJECTIVES: To determine the association of smoking with total delay among new sputum smear-positive TB patients. METHODS: Direct interviews were conducted among 605 TB patients registered in 37 randomly selected clinics within 30 days of initiating anti-tuberculosis treatment using a semi-structured questionnaire. Total delay was calculated from the date of the first reported symptom to the commencement of treatment. Logistic regression analyses were performed to determine the factors associated with total delay. RESULTS: Of the 605 TB patients interviewed, 271 (44.8%) were current smokers, 33 (5.5%) were ex-smokers and 301 (49.8%) were never smokers. The median total delay was 103 days (current smokers 133 days, ex-smoker 103 days and never smokers 80 days). Longer delay was more common among current smokers (aOR 2.03, 95%CI 1.24-3.31). Covariates with significantly more delay were female sex, lower levels of education and higher degrees of sputum smear positivity. CONCLUSION: Total delay was unacceptably longer in current smokers. Anti-smoking interventions are needed as an integral part of the TB programme to address this problem.