Review Article | DOI: https://doi.org/10.31579/2639-4162/373
PhD Public Health, Epidemiology, Pharmacoepidemiology & Biostatistics Clinical Pharmacist, Public Health Researcher.
*Corresponding Author: Magoba Ronald Arnold, PhD Public Health, Epidemiology, Pharmacoepidemiology & Biostatistics Clinical Pharmacist, Public Health Researcher. Kenya
Citation: Magoba R. Arnold, (2026), Determinants and Consequences of Patient and Health System Delays in Tuberculosis Diagnosis and Treatment Among Individuals Aged ≥15 Years at Kenyatta National Hospital, Nairobi, Kenya, J. General Medicine and Clinical Practice, 9(10); DOI:10.31579/2639-4162/373
Copyright: © 2026, Magoba Ronald Arnold. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 19 August 2026 | Accepted: 05 September 2026 | Published: 25 September 2026
Keywords: tuberculosis; patient delay; health system delay; diagnostic delay; kenya
Tuberculosis (TB) remains a major global public health concern, particularly in low- and middle-income countries, where delayed diagnosis and treatment continue to contribute to ongoing transmission, poor treatment outcomes, and increased mortality. Patient and health system delays remain critical barriers to effective TB control. This study assessed the determinants and consequences of patient and health system delays in tuberculosis diagnosis and treatment among individuals aged 15 years and above at Kenyatta National Hospital, Nairobi, Kenya.
Methods
A retrospective cohort study was conducted among 127 tuberculosis patients aged ≥15 years receiving treatment at Kenyatta National Hospital. Data were collected using structured questionnaires and clinical records. Descriptive statistics were used to summarize participant characteristics, while chi-square tests and logistic regression analyses were performed to determine factors associated with delay. Results were presented as adjusted odds ratios (AORs) with 95% confidence intervals.
Results
The majority of participants were aged 40–49 years (32.3%). More than half of the participants (59.8%) experienced delays exceeding two months before seeking healthcare services. Perceived stigma (96.9%), fear following diagnosis (66.9%), and long distance to health facilities were major barriers to timely care-seeking. Participants who initially sought care from informal providers and practiced self-medication experienced longer delays before diagnosis and treatment initiation. Age group, distance to health facility, and education level were significantly associated with delay at bivariate analysis (p < 0.05), although no independent predictors remained statistically significant after multivariable analysis.
Conclusion
Patient and health system delays remain major challenges in tuberculosis control. Stigma, fear, and barriers to healthcare access contribute substantially to delayed diagnosis and treatment. Strengthening community awareness, improving access to TB services, and enhancing early detection strategies are essential for reducing delays and improving tuberculosis outcomes.
Tuberculosis (TB) remains a major global public health problem and continues to be a leading cause of morbidity and mortality, particularly in low- and middle-income countries. Despite the availability of effective diagnostic tools and curative treatment, TB control is still hindered by delayed diagnosis and treatment initiation, which contribute to ongoing transmission and poor clinical outcomes [1].
Delayed healthcare seeking is a critical challenge in TB control. Patient delay, defined as the time between onset of symptoms and first contact with a healthcare provider, has been consistently associated with advanced disease, increased infectiousness, and unfavorable treatment outcomes [2,3]. Prolonged delays not only affect individual patient prognosis but also sustain community-level transmission.
A range of factors contribute to delays in TB diagnosis. These include limited awareness of TB symptoms, socioeconomic constraints, stigma, and reliance on informal healthcare providers. TB-related stigma remains a particularly important barrier, as it influences individuals’ willingness to seek care and disclose symptoms [4,5]. In addition, structural challenges such as long distances to health facilities, high indirect costs, and inefficiencies within the health system further limit timely access to diagnosis and treatment [6].
Care-seeking pathways in high-burden settings are often complex and non-linear. Many patients initially engage in self-medication or seek care from pharmacies and informal providers before presenting to formal health facilities. These multiple steps can introduce substantial delays in diagnosis and treatment initiation, reducing opportunities for early detection and increasing the risk of transmission [7].
Tuberculosis also disproportionately affects individuals in economically productive age groups, with important implications for both disease transmission and socioeconomic burden. Adults in this age group are more likely to experience repeated exposure and maintain higher levels of social interaction, which may contribute to increased risk of infection and spread [8].
Although previous studies have examined individual aspects of delay, there remains a need for a more comprehensive understanding of how patient-related factors, healthcare-seeking behavior, and health system barriers interact within specific contexts. This study therefore aimed to assess patient delay, barriers to care, and care-seeking pathways among individuals diagnosed with TB, with particular attention to age distribution and its implications for TB control.
Study Design
This study employed a retrospective observational design to assess patient and health-system delays in tuberculosis diagnosis and treatment among individuals aged ≥15 years receiving care at Kenyatta National Hospital. Information from clinical records and structured participant interviews was used to reconstruct the sequence of events from symptom onset through first healthcare contact, tuberculosis diagnosis, and initiation of treatment.
The study therefore focused on the timing of events that had already occurred and used retrospectively obtained information to quantify patient and health-system delays. Patient delay was assessed as the interval between onset of TB-related symptoms and first contact with a healthcare provider, while health-system delay was assessed as the interval between first healthcare contact and confirmed diagnosis. Total delay was derived from the relevant intervals.
A retrospective cohort approach was appropriate for examining temporal relationships between exposures and outcomes using existing data. In this study, exposures included patient-related and health system factors associated with delays, while outcomes focused on time to diagnosis and treatment initiation. This design enabled the reconstruction of patient care pathways and identification of key points at which delays occurred. Retrospective cohort studies are widely applied in investigations of diagnostic and treatment delays due to their ability to provide practical and reliable epidemiological insights without the need for prolonged follow-up [1,2].
Study Setting
The study was conducted in a high tuberculosis burden setting in Kenya, where TB remains a significant public health concern. The healthcare system is characterized by a mix of public facilities, private providers, pharmacies, and informal care options, all of which influence patient care-seeking behavior [1].
The study site was Kenyatta National Hospital, the largest national referral and teaching hospital in the country. The facility serves as a major center for TB diagnosis and management and receives referrals from across Kenya, including patients with advanced or complicated disease. As a tertiary institution with established TB programs and comprehensive patient records, the hospital provides an appropriate setting for examining diagnostic and treatment delays in a real-world context. Similar referral hospitals in high-burden settings are commonly used in delay studies due to their capacity to capture diverse patient populations and complex care pathways [2].
The study was conducted during the approved study period in 2022. Following data collection, verification and analysis, the findings formed part of the broader doctoral research programme. The present manuscript reports findings from the approved 2022 study period and does not represent a contemporaneous assessment of TB delays in 2026.
Study Population
The study population comprised individuals aged 15 years and above with a confirmed diagnosis of pulmonary tuberculosis and receiving treatment at Kenyatta National Hospital. Participants were selected based on predefined eligibility criteria, including confirmed diagnosis and willingness to participate in the study.
The inclusion of individuals aged 15 years and above was considered appropriate, as this group represents adolescents and adults who exhibit distinct healthcare-seeking behaviors compared to children. Additionally, individuals within this age group contribute significantly to TB transmission due to higher levels of social interaction and mobility, making them a critical population for TB control interventions.
Sample Size and Sampling Technique
A representative sample of TB patients was selected using systematic random sampling. The sample size was determined based on prevalence estimates from previous TB studies and adjusted for expected non-response rates to ensure statistical validity (Storla et al., 2008). Sample size calculation followed the Fisher et al. formula; a standard method used in health research for estimating proportions in populations.
The formula:
n=(Z^2 pq)/d^2
Where:
Z=1.96(for 95% confidence level)
p=0.5(assumed proportion for maximum variability)
q=1-p
d=0.05(margin of error)
This method is widely recommended because using p = 0.5 ensures the largest possible sample size, making the study more statistically robust when the true proportion is unknown (Lwanga & Lemeshow, 1991).
A finite population correction was applied because the target population was less than 10,000, reducing the required sample size to 96. The final analytical sample comprised 127 eligible participants. All analyses presented in this manuscript were based on these 127 participants.
Sampling Procedure
A systematic sampling technique was used, which is appropriate in clinical settings where patients are listed in chronological or sequential order.
The process involved:
Identifying the sampling frame (TB register)
Calculating the sampling interval (K)
Selecting a random starting point
Selecting every Kth patient thereafter
Systematic sampling reduces selection bias while ensuring that the sample is spread evenly across the population (Kothari, 2004).
In addition, purposive sampling was used to select key informants. This is a qualitative sampling method where participants are intentionally chosen because they possess specific knowledge or experience relevant to the study. This approach is widely used in health systems research to capture in-depth contextual insights (Patton, 2015).
Eligibility Criteria
Participants were eligible for inclusion if they were aged 15 years or older, had a confirmed diagnosis of pulmonary tuberculosis, and were actively receiving treatment at the study site during the study period. All participants provided informed consent prior to participation.
Participants were excluded if they had extra-pulmonary tuberculosis, as the diagnostic pathways and disease progression differ from pulmonary TB. Individuals with a history of previous TB treatment were also excluded to minimize potential bias related to recurrent or drug-resistant disease. In addition, patients who were too ill to participate at the time of data collection were excluded to ensure reliability of responses. Non-residents were also excluded to maintain consistency with the study context and ensure that findings reflected the local setting.
These eligibility criteria were applied to ensure a relatively homogeneous study population and to improve the internal validity of the findings [3].
Data Collection
Data were collected using a structured questionnaire administered through face-to-face interviews. The tool captured information on socio-demographic characteristics, patient delay (defined as the time from symptom onset to first healthcare contact), barriers to care, and care-seeking pathways prior to diagnosis.
The questionnaire was adapted from previously validated tools used in tuberculosis research and was pre-tested prior to data collection to ensure clarity, consistency, and reliability. Minor adjustments were made following pre-testing to improve comprehension and flow [5].
Quantitative Component
Quantitative data were obtained through a combination of retrospective chart review and structured questionnaires. Clinical records were reviewed to extract information on diagnosis timelines, treatment initiation dates, and relevant clinical characteristics. The structured questionnaires provided complementary data on socio-demographic factors, healthcare-seeking behavior, and knowledge related to tuberculosis.
The use of multiple data sources allowed for triangulation of information, thereby enhancing the completeness and validity of the dataset [6].
Bias and Limitations
Recall bias may have occurred, as the estimation of delay relied partly on patient self-report of symptom onset. To minimize this, interviews were conducted as close to the time of diagnosis as possible, and clinical records were used to validate reported timelines where available.
Qualitative Component
A qualitative component was incorporated through Key Informant Interviews (KIIs) to provide deeper insight into patient experiences, health system barriers, and decision-making processes related to care-seeking. This approach complemented the quantitative findings by exploring underlying reasons for delays and contextual factors influencing healthcare utilization. Qualitative methods are particularly valuable in delay studies, as they help explain patterns observed in quantitative data [7].
Measurement of Delays
Delays were defined and categorized in accordance with established global frameworks. Patient delay was defined as the time from onset of symptoms to first contact with a healthcare provider, while health system delay referred to the time from first contact to confirmed diagnosis. Total delay was calculated as the sum of these intervals. A threshold of more than 14 days was used to define prolonged delay, consistent with standard definitions in tuberculosis research [1,2].
Data were analyzed using SPSS version 25. Descriptive statistics were used to summarize participant characteristics. Associations between independent variables and delay outcomes were initially assessed using chi-square tests. Variables of interest were then included in binary logistic regression models to identify predictors of delay while controlling for potential confounders. Results were presented as adjusted odds ratios with corresponding 95% confidence intervals, and statistical significance was set at p < 0.05 [8].
Qualitative data were analyzed using thematic analysis. This involved systematic coding of transcripts, grouping of codes into categories, and development of themes that captured recurring patterns in participant responses. This approach allowed for structured interpretation of qualitative data and facilitated integration with quantitative findings [9].
Reliability and Validity
Measures were taken to ensure the reliability and validity of the study. The data collection tools were pre-tested prior to use to enhance clarity and consistency. Standardized procedures were followed during data collection to minimize variability. These steps helped improve the accuracy and credibility of the findings [3].
Ethical Considerations
The study was conducted in accordance with established ethical principles for human subject’s research. Participation was voluntary, and informed consent was obtained from all participants. Confidentiality of participant information was maintained throughout the study.
Ethical approval was obtained from relevant institutional review bodies, including the University of Nairobi/Kenyatta National Hospital and Mount Kenya University, as well as the National Commission for Science, Technology and Innovation. Adherence to these ethical standards was essential to ensure the protection of participants and the integrity of the research process [10].
A total of 127 participants were included in the study. Females accounted for 51.2% (n = 65), while males comprised 48.8% (n = 62). The majority of participants were aged 40–49 years (32.3%), followed by 30–39 years (26.8%). Most participants had attained primary (31.5%) or secondary education (27.6%), and 43.3% were self-employed.
More than half of the participants (59.8%) reported seeking care after more than two months of symptom onset. Only 17.3% sought care within the first month.
A high proportion of participants reported perceived stigma (96.9%), while 66.9% reported fear following diagnosis. Regarding access, 31.5% of participants resided more than 10 km from a health facility.
Participants reported multiple initial points of care before diagnosis. These included self-medication, pharmacies, and informal providers prior to presentation at formal healthcare facilities.
Bivariate analysis showed that age group (p = 0.032), distance to health facility (p = 0.015), and education level (p = 0.041) were significantly associated with delay. Sex was not significantly associated (p = 0.210).
In multivariable logistic regression analysis, none of the variables remained statistically significant predictors of delay after adjustment (p > 0.05).
Integrated Scientific Synthesis (High-Level Discussion)
Across all variables, the findings demonstrate that TB delays are driven by an interaction of:
This aligns with TB control frameworks emphasizing that delays occur at both:
| Variable | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Sex | Male | 62 | 48.8 |
| Female | 65 | 51.2 | |
| Age Group | 15–29 | 25 | 19.7 |
| 30–39 | 34 | 26.8 | |
| 40–49 | 41 | 32.3 | |
| ≥50 | 27 | 21.2 | |
| Education Level | No formal | 18 | 14.2 |
| Primary | 40 | 31.5 | |
| Secondary | 35 | 27.6 | |
| Tertiary | 34 | 26.8 | |
| Occupation | Unemployed | 30 | 23.6 |
| Self-employed | 55 | 43.3 | |
| Formal employment | 42 | 33.1 |
Table 1: Socio-demographic Characteristics (n = 127)
Table 1 presents the socio-demographic characteristics of the participants. Females constituted a slightly higher proportion (51.2%) compared to males (48.8%). The majority of participants were aged 40–49 years (32.3%), with most having attained at least primary or secondary education.
| Variable | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Time to First Care | <1 month | 22 | 17.3 |
| 1–2 months | 29 | 22.8 | |
| 2–3 months | 38 | 29.9 | |
| >5 months | 38 | 29.9 | |
| Perceived Stigma | Yes | 123 | 96.9 |
| No | 4 | 3.1 | |
| Fear After Diagnosis | Yes | 85 | 66.9 |
| No | 42 | 33.1 | |
| Distance to Facility | <5 km | 46 | 36.2 |
| 5–10 km | 41 | 32.3 | |
| >10 km | 40 | 31.5 |
Table 2: Patient Delay and Related Factors
Table 2 shows the distribution of patient delay and related psychosocial and access factors. A substantial proportion of participants (59.8%) delayed seeking care for more than two months. High levels of perceived stigma (96.9%) and fear (66.9%) were reported. Distance to health facilities varied, with nearly one-third of participants living more than 10 km away.
| Variable | Category | Delayed (%) | Not Delayed (%) | p-value |
|---|---|---|---|---|
| Sex | Male | 60.0 | 40.0 | 0.210 |
| Female | 63.1 | 36.9 | ||
| Age Group | 15–29 | 52.0 | 48.0 | 0.032 |
| 30–39 | 58.8 | 41.2 | ||
| 40–49 | 70.7 | 29.3 | ||
| Distance | <5 km | 50.0 | 50.0 | 0.015 |
| >5 km | 68.0 | 32.0 | ||
| Education | Primary or less | 65.5 | 34.5 | 0.041 |
| Secondary+ | 55.2 | 44.8 |
Table 3: Bivariate Analysis of Factors Associated with Delay
Table 3 summarizes the bivariate associations between selected variables and delay in seeking care. Age group, distance to health facility, and education level showed statistically significant associations with delay (p < 0.05), while sex was not significantly associated.
| Variable | Category | Adjusted OR | 95% CI | p-value |
|---|---|---|---|---|
| Sex | Female vs Male | 1.21 | 0.65–2.25 | 0.540 |
| Age Group | 40–49 vs others | 1.48 | 0.78–2.81 | 0.210 |
| Distance | >5 km vs <5 km | 1.72 | 0.89–3.31 | 0.103 |
| Education | Low vs High | 1.36 | 0.72–2.56 | 0.330 |
Table 4: Multivariable Logistic Regression Analysis
Table 4 presents the multivariable logistic regression analysis of factors associated with delay. Although some variables showed increased odds of delay, none were statistically significant (p > 0.05). This indicates that no independent predictors of delay were identified after adjusting for confounding variables.
Figures
The persistence of these delays suggests that TB control strategies must adopt a multi-sectoral approach, combining:
Figure 1: Age distribution of study participants (n = 127). Figure 1 Shows highest concentration in 40–49 age group, indicating TB burden among middle-aged adults. The age distribution indicates that the highest proportion of participants were in the 40–49-year age group. This pattern is consistent with global tuberculosis epidemiology, where TB predominantly affects economically productive age groups. Individuals in this age range are often at increased risk due to cumulative exposure, occupational risks, and potential immunological compromise.
Studies have shown that TB burden is disproportionately high among adults in their productive years, which contributes to sustained transmission within communities and significant socioeconomic consequences (World Health Organization, 2023; Furin et al., 2019). In high-burden settings, similar age distributions have been reported, reinforcing the importance of targeting TB control interventions toward working-age populations.
Figure 2: Distribution of patient delay in seeking care. Figure 2 shows Highlights prolonged delays, with many patients seeking care after more than two months. The findings reveal that a substantial proportion of participants experienced prolonged patient delay, with many seeking care after more than two months of symptom onset. This delay is consistent with evidence indicating that patient delay remains a major challenge in tuberculosis control, particularly in low- and middle-income countries.
According to the World Health Organization, delays in seeking care contribute significantly to ongoing transmission and increased morbidity (WHO, 2023). Factors such as low awareness of TB symptoms, stigma, and reliance on self-medication have been widely documented as contributors to delayed care-seeking (Storla et al., 2008; Sreeramareddy et al., 2014). Prolonged patient delay increases the risk of disease progression and community transmission, highlighting the need for early detection strategies.
Figure 3: Reported barriers to timely care-seeking. Figure 3: Shows Stigma and fear are dominant barriers, followed by distance to health facilities. The high prevalence of perceived stigma among participants reflects a critical barrier to timely TB diagnosis and treatment. Stigma has been consistently identified as a major determinant of delayed care-seeking behavior, as it influences patients’ willingness to disclose symptoms and seek formal medical care.
Fear of diagnosis and social consequences further compounds this delay, leading individuals to adopt concealment strategies or alternative care pathways (Courtwright & Turner, 2010; Craig et al., 2017). Additionally, geographic barriers such as distance to health facilities remain significant, particularly in resource-limited settings where access to healthcare services is uneven (Lönnroth et al., 2009).
These findings align with previous research demonstrating that TB-related stigma, fear, and structural barriers collectively contribute to diagnostic and treatment delays, ultimately sustaining transmission within communitie
Figure 4: Care-seeking pathway prior to TB diagnosis. Figures 4 Illustrates multiple steps before diagnosis, showing potential delay points. The care-seeking pathway illustrates multiple steps between symptom onset and treatment initiation, including self-medication and visits to informal providers before reaching formal health facilities. This pattern is widely documented in TB epidemiology and reflects fragmented healthcare-seeking behavior.
Research indicates that patients often first seek care from pharmacies, traditional healers, or through self-medication before accessing formal healthcare services (Sreeramareddy et al., 2014; Hoa et al., 2013). Each step in this pathway introduces delays that contribute to late diagnosis and continued transmission.
This multi-step pathway underscores systemic inefficiencies and highlights the need for strengthening primary healthcare systems, improving referral mechanisms, and increasing community awareness to reduce delays in diagnosis and treatment initiation.
Tuberculosis remains a significant public health challenge, with persistent delays in diagnosis and treatment driven by both patient-level and health system factors. A substantial proportion of participants in this study sought care more than two months after symptom onset, highlighting gaps in timely healthcare utilization and ongoing risks of transmission.
The findings indicate that tuberculosis disproportionately affects individuals in economically productive age groups, particularly those aged 40–49 years. This pattern is consistent with global epidemiological trends and has important implications for both disease transmission and socioeconomic burden. Delayed diagnosis within this population not only increases community spread but also contributes to loss of productivity and financial strain at household level.
Patient delay emerged as a major contributor to late diagnosis. This delay appears to be influenced by a combination of behavioral and structural factors, including limited awareness of tuberculosis symptoms, normalization of persistent cough, stigma, and barriers to accessing healthcare. These findings are consistent with previous studies conducted in similar high-burden settings, which highlight the role of patient behavior in delaying care-seeking.
Stigma and fear were prominent barriers affecting healthcare utilization. Fear of diagnosis, social exclusion, and discrimination may discourage individuals from seeking care early, leading to concealment of symptoms and prolonged delays. These findings reinforce the importance of addressing social determinants of health in tuberculosis control strategies.
Geographical access also played a role in influencing delay. Participants residing farther from health facilities were more likely to delay seeking care, reflecting ongoing inequities in access to health services. This underscores the need for decentralization of tuberculosis services and improved accessibility at community level.
The care-seeking pathways observed in this study were often complex and non-linear, with many participants initially engaging in self-medication or consulting informal providers before accessing formal healthcare services. Such fragmented pathways contribute to missed opportunities for early diagnosis and highlight inefficiencies within the health system. Strengthening referral systems and integrating informal providers into tuberculosis control efforts may help reduce these delays.
Although several factors were associated with delay at the bivariate level, no independent predictors were identified after adjustment. This suggests that delays in tuberculosis diagnosis are influenced by multiple interrelated factors rather than a single determinant, emphasizing the need for comprehensive and multi-sectoral interventions.
1. Age Distribution and Its Implications (Objective 1: Patient Characteristics and Risk Profile)
The predominance of participants within the 40–49-year age group highlights that tuberculosis disproportionately affects individuals in their economically productive years. This finding aligns with global evidence indicating that TB primarily impacts adults who contribute significantly to household income and national productivity (World Health Organization, 2023; Furin et al., 2019).
From a public health perspective, this age distribution has important implications for both transmission dynamics and socioeconomic burden. Adults in this age group are more likely to engage in social and occupational interactions that facilitate disease spread, while also facing competing responsibilities that may delay healthcare seeking. This reinforces the need for targeted TB screening and health education strategies focusing on working-age populations.
2.Patient Delay and Its Determinants (Objective 2: Health-Seeking Timeliness)
The study identified substantial patient delay, with many individuals seeking care more than two months after symptom onset. This delay is consistent with findings from systematic reviews showing that prolonged patient delay remains a major barrier to TB control in high-burden settings (Storla et al., 2008; Sreeramareddy et al., 2014).
Patient delay is often driven by a combination of low awareness of TB symptoms, normalization of chronic cough, reliance on self-care, and socioeconomic constraints. In addition, stigma and fear of diagnosis further discourage timely healthcare seeking (Courtwright & Turner, 2010).
These findings suggest that despite ongoing TB control efforts, early detection remains insufficient, allowing continued transmission within communities and increasing the risk of severe disease outcomes.
3. Barriers to Care (Objective 3: Health System and Socio-Cultural Barriers)
The high prevalence of stigma, fear of diagnosis, and geographical barriers underscores the multifaceted challenges affecting access to TB care. Stigma continues to be a significant social determinant of TB outcomes, influencing individuals’ willingness to disclose symptoms and seek formal medical services (Craig et al., 2017).
Fear of social isolation, discrimination, and loss of employment often leads to concealment of symptoms, which delays diagnosis and treatment initiation. Additionally, distance to health facilities remains a structural barrier, particularly in resource-limited settings, where healthcare access is unevenly distributed (Lönnroth et al., 2009).
These findings highlight that TB control requires not only clinical interventions but also strong community engagement and stigma reduction strategies. Without addressing these barriers, delays in diagnosis and treatment will persist, undermining TB control efforts.
Care-Seeking Pathways and Health System Inefficiencies (Objective 4: Patient Pathways to Care)
The observed care-seeking pathways reveal multiple points of delay, including self-medication, visits to informal providers, and eventual presentation to formal healthcare facilities. This fragmented pathway is widely documented in TB literature and reflects systemic inefficiencies in healthcare delivery (Hoa et al., 2013).
Patients often first seek care from pharmacies, traditional healers, or through informal channels before accessing formal diagnostic services. Each step introduces additional delays, contributing to disease progression and continued transmission (Sreeramareddy et al., 2014).
These findings emphasize the need for strengthening primary healthcare systems, improving referral systems, and integrating informal providers into TB detection and referral networks. Early detection strategies at community level could significantly reduce diagnostic delays and improve treatment outcomes.
Limitations
This study has several limitations. First, recall bias may have affected the accuracy of reported symptom onset, although efforts were made to validate timelines using clinical records. Second, the study was conducted in a single tertiary facility, which may limit generalizability to other settings. Third, the retrospective design may be subject to incomplete records and missing data. Finally, potential selection bias may have occurred, as only patients who accessed care at KNH were included.
Recommendations
Efforts to reduce tuberculosis delays should focus on strengthening early case detection, particularly among working-age populations. Community-based awareness programs are needed to improve recognition of TB symptoms and promote timely healthcare seeking. Addressing stigma through community engagement and psychosocial support is essential to reduce delays associated with fear and social barriers. Improving access to services through decentralization and strengthening referral systems, including engagement with informal providers, may further reduce diagnostic delays and improve treatment outcomes.
This study demonstrates that tuberculosis remains a significant public health challenge characterized by delays in diagnosis, persistent stigma, and fragmented care-seeking pathways. The predominance of cases among individuals in the 40–49-year age group underscores the continued impact of TB on economically productive populations, amplifying both health and socioeconomic consequences.
Patient delay was found to be a major contributor to late diagnosis, driven by low awareness, stigma, and reliance on informal care pathways. Barriers such as fear, stigma, and geographical inaccessibility further exacerbate these delays, while multiple care-seeking steps highlight inefficiencies within the health system.
Addressing these challenges requires a comprehensive, multi-sectoral approach that includes strengthening primary healthcare systems, enhancing community awareness, reducing stigma, and improving care integration. Such interventions are essential to achieving early diagnosis, reducing transmission, and ultimately advancing TB control and elimination efforts.
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Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
