A cross sectional study to estimate delay in diagnosis and treatment of tuberculosis (TB) among patients attending urban health centre in an urban slum area
Abstract
Background: RNTCP (Revised National Tuberculosis Control Program) is an application in India of the (World Health Organisation) WHO recommended (Directly Observed Treatment Short Course) DOTS strategy. Early diagnosis and immediate initiation of treatment are essential for an effective TB control program. Delay under RNTC programme is of types: patients delay, health care systems delay, DOTS delay and total delay.
Objectives: To determine average delay on part of patient and health system in diagnosis of tuberculosis, treatment delay in starting DOTS and total delay.
Methodology: A cross-sectional descriptive study of 464 tuberculosis patients was conducted in an urban health center (UHC) of an urban slum area of Mumbai. Patients registered under RNTCP during 1 year i.e. from 1st January to 31st December 2016 were interviewed regarding their complaints and reporting to a health care facility (time taken and type-private or government), time taken for diagnosis and starting treatment. Thus, four types of delay were calculated.
Results: Among 464 patients, mean patient’s delay, health system delay and total delay were 21.09 days (median 15), 14.41 days (median 6) and 35.50 days (median 21) respectively. Almost 60% of total delay was constituted from patient’s delay. Mean treatment delay was 2.84 days (median 3.19). Total delay was significantly longerin females. Almost, 40% of the patients reported to a health facility within 15 days of onset of symptoms.
Conclusion: Patient delay was significantly more among sputum negative pulmonary TB patients than sputum positive patients. Health system delay to diagnose TB was more if private practitioners were approached first. Only 11% (35) pulmonary TB patients were advised sputum examination as the first investigation by private practitioners.
Downloads
References
2. World Health Organization. Diagnosis and treatment delay in tuberculosis. An in-depth analysis of the health seeking behavior of patients and health system response in seven countries of the Eastern Mediterranean Region. Available from: http://www.emro.who.int/dsaf/dsa710.pdf [Last accessed on 2016 May 25].
3. Srinath S, Sreenivas AN, Sarabjit SC, Roopa S, Geetanjali S, Subhash Y. et al., From where are Tuberculosis patients accessing treatment in India? Results from a cross-sectional community-based survey of 30 districts. PLoS ONE. 2011; 6(9): e24160. doi:10.1371/journal.pone.0024160.
4. Definitions and reporting framework for tuberculosis-2013 revision (updated December 2014)(WHO/HTM/TB/2013.2). Geneva: WHO;2013. www.who.int/iris/bitstream/10665/79199//1/9789241505345_eng.pdf. Accessed 1 July2017).
5. International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-4), 2015–16: India. http://rchiips.org/NFHS/NFHS-4Reports/India.pdf.
6. Olumuyiwa O, Babafemi J. Patterns of delay among pulmonary tuberculosis patients attending a Lagos Chest clinic, Lagos Nigeria. BMC Pub Health 2004;4:18.
7. Karim F, Islam MA, Chowdhury AM, Johansson E, Diwan VK. Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan. 2007 Sep;22(5):329-34.
8. Rajeswari R, Chandrasekaran V, Suhadev M, Sivasubramaniam S, Sudha G, Renu G. Factorsassociated with patient and healthsystemdelays in the diagnosis of tuberculosis in SouthIndia. Int J Tuberc Lung Dis. 2002 Sep;6(9):789-95.
9. Chang CT, Esterman A. Diagnosticdelay among pulmonary tuberculosispatients in Sarawak, Malaysia: a cross-sectional study. Rural Remote Health. 2007 Apr-Jun;7(2):667. Epub 2007 May 11.
10. Long NH, Johansson E, Lönnroth K, Eriksson B, Winkvist A, Diwan VK. Longer delays in tuberculosis diagnosis among women in Vietnam. Int J Tuberc Lung Dis. 1999 May;3(5):388-93. [PubMed]
11. Solomon Y, Gunnar B, Getu A. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: A cross sectional study. BMCInfec Dis2005;5:112.
12. Zerbini E, Chirico MC, Salvadores B, Amigot B, Estrada S, Algorry G. Delay in tuberculosisdiagnosis and treatment in fourprovinces of Argentina. Int J Tuberc Lung Dis. 2008 Jan;12(1):63-8. [PubMed]
13. Wandwalo ER, Mørkve O. Delay in tuberculosiscase-finding and treatment in Mwanza, Tanzania. Int J Tuberc Lung Dis. 2000 Feb;4(2):133-8.
14. Mesfin MM, Newell JN, Walley JD, Gessessew A, Madeley RJ. Delayedconsultation among pulmonary tuberculosispatients: a cross sectional study of 10DOTSdistricts of Ethiopia. BMC Public Health. 2009 Feb 9;9:53. doi: 10.1186/1471-2458-9-53. [PubMed]
15. Yeshiwork AM, Lakew A, Netsanet F, Shegaon AB, Addisu WK. Delay for first consultation and associated factors among tuberculosis patients in Bahir Dar Town administration, North West Ethiopia. Amer J Health Res2014;2:140-5.
16. Demissie M, Lindtjorn B, Berhane Y. Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health. 2002 Sep 25;2:23. Epub 2002 Sep 25.
17. Fatiregun AA,Ejeckam CC. Determinants of patient delay in seeking treatment among pulmonary tuberculosis cases in a government specialist hospital in Ibadan, Nigeria. Tan J Health Res2010;12:2.
18. Chiang CY, Chang CT, Chang RE, Li CT, Huang RM. Patient and healthsystemdelays in the diagnosis and treatment of tuberculosis in SouthernTaiwan. Int J Tuberc Lung Dis. 2005 Sep;9(9):1006-12.
19. Mpungu SK, Karamagi C, Mayanja KH. Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital. BMC Pub Health 2005;5:122.
20. Sherman LF, Fujiwara PI, Cook SV, Bazerman LB, Frieden TR. Patient and health care systemdelays in the diagnosis and treatment of tuberculosis. Int J Tuberc Lung Dis. 1999 Dec;3(12):1088-95.
Copyright (c) 2018 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
OAI - Open Archives Initiative
