Abstract: Objective  To analyze the process of pulmonary tuberculosis (TB) patients, who were detected during the 5^th National TB Prevalence Survey in 2010, from onset of symptoms and health care seeking to diagnosis with TB, reporting and treatment; to compare the difference of those in urban and rural areas in China. Methods  A face-to-face interview with structured questionnaire was conducted among pulmonary TB patients who were detected during the TB prevalence survey, which was conducted in 77 urban sites and 99 rural sites in China in 2010. Information and data related to socio-economic, onset of symptoms, health care seeking behaviors, process of diagnosis, reporting and treatment were collected; information and data from 1301 patients who completed the interview (373 patients were from urban and 928 patients were from rural) were analyzed andχ² test was used to compare the difference between urban and rural areas (the level of statistical significance was P<0.05); reasons for the difference were explored. Results  49.3% (184/373) of urban patients had TB-related symptoms before the prevalence survey and this proportion was lower than that of rural patients (59.9%, 556/928); the difference had statistical significance (χ²=12.15, P<0.01). Among urban and rural TB patients, the proportions of symptomatic patients who sought health care were 47.3% (87/184) and 46.6% (259/556) respectively, the proportions of patients diagnosed with TB after sought health care were 41.4% (36/87) and 34.0% (88/259) respectively, the proportions of patients who were reported in the National Infectious Diseases Surveillance System after diagnosis with TB were 69.4% (25/36) and 70.5% (62/88) respectively, the proportions of patients who received anti-TB treatment after diagnosis with TB were 91.7% (33/36) and 88.6% (78/88) respectively; those differences between urban and rural patients had no statistical significance (χ²＝0.03, 1.52, 0.01, 0.03; P>0.05). Throughout the whole journey of the TB patients from onset of symptoms to treatment, we could understand the most important reasons to lead patients to remain undetected and untreated, including patients were asymptomatic (42.1%, 548/1301); patients had symptoms but did not seek health care (30.3%, 394/1301); patients had symptoms and sought health care but were diagnosed with other diseases (17.1%, 222/1301). Only 8.5% (111/1301) of TB patients, who sought health care for symptoms and were diagnosed with TB, got anti-TB treatment before the prevalence survey; another 1.0% (13/1301) of TB patients, who did not have symptoms but visited health facilities due to other reasons, were also diagnosed with TB. Conclusion  The following issues should be regarded as the weak points in TB control and need to be addressed, such as the symptomatic patients do not seek health care and TB patients are not timely diagnosed and treated. Compared with TB patients in urban area, the proportion of asymptomatic patients in rural area was significantly lower; however, the proportions of patients had no statistically significant differences in health care seeking, TB diagnosis and anti-TB treatment.

Key words: Tuberculosis, pulmonary/diagnosis, Appointments and schedules, Attitude to health, Questionnaires