Background
Timely
diagnosis and treatment initiation are critical to reduce the chain of
transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of
the inhabitants reside in overcrowded slums. This study documents the pathway
from the onset of symptoms suggestive of TB to initiation of TB treatment and
examines factors responsible for delay among uncomplicated pulmonary TB
patients in Mumbai.
Methods
A
population-based retrospective survey was conducted in the slums of 15 high TB
burden administrative wards to identify 153 self-reported TB patients.
Subsequently in-depth interviews of 76 consenting patients that fit the
inclusion criteria were undertaken using an open-ended interview schedule. Mean
total, first care seeking, diagnosis and treatment initiation duration and
delays were computed for new and retreatment patients. Patients showing defined
delays were divided into outliers and non-outliers for all three delays using
the median values.
Results
The
mean duration for the total pathway was 65 days with 29% of patients being
outliers. Importantly the mean duration of first care seeking was similar in
new (24 days) and retreatment patients (25 days). Diagnostic duration
contributed to 55% of the total pathway largely in new patients. Treatment
initiation was noted to be the least among the three durations with mean
duration in retreatment patients twice that of new patients. Significantly more
female patients experienced diagnostic delay. Major shift of patients from the
private to public sector and non-allopaths to allopaths was observed,
particularly for treatment initiation.
Conclusion
Achieving positive behavioural changes in providers
(especially non-allopaths) and patients needs to be considered in TB control
strategies. Specific attention is required in counselling of TB patients so
that timely care seeking is effected at the time of relapse. Prioritizing
improvement of environmental health in vulnerable locations and provision of
point of care diagnostics would be singularly effective in curbing pathway
delays.
Below: First Care Seeking; Duration and Delays
Full article at: http://goo.gl/xLp81X
By:
The Foundation for Medical Research, 84A, R. G. Thadani Marg, Worli, Mumbai, India
Maharashtra Association of Anthropological Sciences-Centre for Health Research and Development, Savitribai Phule University, Pune, Maharashtra, India
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