Delays in Diagnosis and Initiation of Treatment among Adult Tuberculosis Patients Registered Under Ntep in Urban Visa Khapatnam - A Mixed Method Study
DOI:
https://doi.org/10.37506/a2fsb288Keywords:
Tuberculosis, Diagnostic delay, NTEP, Patient pathway, Stigma.Abstract
INTRODUCTION: Our understanding of the health system and patient factors responsible for the time delay in diagnosis and treatment is limited. Further research is needed to analyze the health system factors responsible for delay in diagnosis of TB and to identify key factors related to delay in initiation of treatment, in particular the pathways involving health care providers and patients contributing to the complexity and long delays. Hence the current study was undertaken to identify the magnitude of the problem and reasons for delays in diagnosis and treatment using a mixed-method approach.
MATERIALS & METHODS: A Mixed –method study was conducted between November 2019 to December 2021 in 8 selected Tuberculosis units (TUs) of Urban Visakhapatnam district, Andhra Pradesh. It comprised of a cross sectional study of 102 people with tuberculosis followed by a series of Focus group discussions (FGD), In-depth interviews (IDI) & Key informant interviews (KII) with patients & health care workers associated with T.B service delivery.
RESULTS: The study findings suggested that out of a total 102 study population, the median age of study population was 39 years. Majority (59.8%) were males and 40.2% were females. The median patient care seeking delay was found to be 30 days (IQR 60-1) with a mean delay of 43 days. The mean diagnostic delay duration of 1±1.1 days with no treatment delay was observed in present study population. The mean total patient pathway duration was 44.3±50.2 days. Lack of awareness, fear and stigma derived qualitatively further explained the quantitative findings.
CONCLUSION: There were minimal delays observed in the study population in terms of diagnosis and treatment initiation, but a significant proportion of delays were seen in seeking medical care in patient’s pathway to healthcare system. Increasing public awareness about TB and consciousness regarding stigma, engaging the private health care providers could further improve early detection of TB and narrow the gap of missing cases.
References
References:
Global tuberculosis report 2020 [Internet]. [cited 2022 Jan 29]. Available from: https://www.who.int/publications-detail-redirect/9789240013131
India TB Report 2020.pdf [Internet]. [cited 2022 Jan 29]. Available from: https://tbcindia.gov.in/WriteReadData/l892s/India%20TB%20Report%202020.pdf
TBFacts - TB Statistics, India [Internet]. TBFacts. [cited 2022 Jan 29]. Available from: https://tbfacts.org/tb-statistics-india/
Uys PW, Warren RM, Helden PD van. A Threshold Value for the Time Delay to TB Diagnosis. PLOS ONE. 2007 Aug 22;2(8):e757.
Lestari BW, McAllister S, Hadisoemarto PF, Afifah N, Jani ID, Murray M, et al. Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia. Lancet Reg Health - West Pac. 2020 Dec;5:100059.
Goel K, Nagaraj K, Shashi J, Soans, Althur R, Bairy, et al. Goel K et al: Reasons for patient delays & health system delays for tuberculosis in South India REASONS FOR PATIENT DELAYS & HEALTH SYSTEM DELAYS FOR TUBERCULOSIS IN SOUTH INDIA. Indian J Community Health. 2011 Dec 1;23.
Schoonenboom J, Johnson RB. How to Construct a Mixed Methods Research Design. Kolner Z Soziol Sozialpsychologie. 2017;69(Suppl 2):107–31.
Patki G, Raut A, Datar S. Delay in initiation of treatment of tuberculosis: A cross-sectional study from rural Wardha. CHRISMED J Health Res. 2019 Jan 1;6:12.
Mistry N, Rangan S, Dholakia Y, Lobo E, Shah S, Patil A. Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India. PLOS ONE. 2016 Mar 28;11(3):e0152287.
Belay M, Bjune G, Ameni G, Abebe F. Diagnostic and treatment delay among Tuberculosis patients in Afar Region, Ethiopia: A cross-sectional study. BMC Public Health. 2012 May 23;12:369.
India TB Report 2021 :: Ministry of Health and Family Welfare [Internet]. [cited 2022 Jan 30]. Available from: https://tbcindia.gov.in/showfile.php?lid=3587
Mistry N, Lobo E, Shah S, Rangan S, Dholakia Y. Pulmonary tuberculosis in Patna, India: Durations, delays, and health care seeking behaviour among patients identified through household surveys. J Epidemiol Glob Health. 2017 Dec 1;7(4):241–8.
Roberts DJ, Mannes T, Verlander NQ, Anderson C. Factors associated with delay in treatment initiation for pulmonary tuberculosis. ERJ Open Res. 2020 Mar 16;6(1):00161–2019.
Belkina TV, Khojiev DS, Tillyashaykhov MN, Tigay ZN, Kudenov MU, Tebbens JD, et al. Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a cross-sectional study. BMC Infect Dis. 2014 Nov 25;14(1):624.
Paynter S, Hayward A, Wilkinson P, Lozewicz S, Coker R. Patient and health service delays in initiating treatment for patients with pulmonary tuberculosis: retrospective cohort study. Int J Tuberc Lung Dis. 2004 Feb 1;8(2):180–5.
Sreeramareddy CT, Panduru KV, Menten J, Van den Ende J. Time delays in diagnosis of pulmonary tuberculosis: a systematic review of literature. BMC Infect Dis. 2009 Jun 11;9(1):91.
Rajeswari R, Chandrasekaran V, Suhadev M, Sivasubramaniam S, Sudha G, Renu G. Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India. Int J Tuberc Lung Dis. 2002 Sep 1;6(9):789–95.
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