Abstract: Objective  To analyze the factors associated with patients’ delay and diagnosis delay for patients with smear positive pulmonary tuberculosis in order to provide evidence base for the formulation of relevant TB control and prevention strategies. Methods  The typical survey methods were adopted and 3 counties were selected from the eastern, middle and western provinces each. New smear positive TB patients registered during May 2010 to September 2010 were administered face-to-face self-designed questionnaire survey, 329 effective questionnaires were collected. t test was used for comparing the difference between patients’ delay and diagnosis delay, Cox proportional hazards regression model was used for analyzing the factors associated with health seeking delay, and rank sum test was used for comparing the diagnosis delay between different facilities. Results  Health seeking delay was 15 d(0－594 d) and diagnosis delay was 10 d(0－429 d), there is no statistically significant difference between these two indicators(t=1596, P=0.111). Patients who had medical insurance(except for the new rural cooperative medical care) （β=0.701，Waldχ²=6.223，P=0.013，RR=2.015） or suffering from fever（β=0.430，Waldχ²=11.556，P=0.001，RR=1.537） are more likely to go hospitals quickly, but patients with symptom of cough（β=-0.711，Waldχ²=9.314，P=0.002，RR=0.491） or sputum（β=-0.429，Waldχ²=8.549，P=0.003，RR=0.651） are more likely to have a longer delay. For TB case detection, the delays vary caused by different medical institutions（χ²=115.134，P=0.000）,shortest in county hospital or above (0 d, Q 0 d), township hospital (0 d, Q 6 d) and TB facilities (0 d, Q 0 d), longest in pharmacy (26 d, Q 66.5 d). And there are difference between medical institutions on TB patients’ referral（χ²=55.476，P=0.000）, shortest in TB facilities (0 d, Q 1 d), longest in individual private clinics (9 d, Q 19.5 d).  Conclusion  The factors of delay for patients with smear positive pulmonary tuberculosis will be considered from patients and medical institution. The main factors related to patients were lack of the knowledge of TB suspected symptoms or attaching no importance on it. Delay in TB suspects’ detection and referral in primary care facilities are the main factors affecting medical institutions delay.

Key words: Tuberculosis,pulmonary/diagnosis, Diagnostic errors, Referral and consultation