Delay in diagnosis of tuberculosis in Rawalpindi, Pakistan

Abstract

BackgroundDelay in diagnosis and treatment of tuberculosis (TB) may enhance the chances of morbidity and mortality and play a key role in continuous transmission of the bacilli. The objective of this study was to describe health care seeking behavior of suspected TB patients and initial diagnostic work up prior to consultation and diagnosis at National TB Center (NTC).FindingsInterviews of 252 sputum smear positive patients were taken from NTC, Rawalpindi. The duration between on-set of symptoms and start of treatment was considered as the total delay and correlated with general characteristics of TB patients. The proportion of males and females were 49.6% and 50.4% with median age of 25 and 24 years respectively. A median delay of 56 days (8 weeks) was observed which was significantly associated with age, cough and fever. More than 50% of the current patients had a history of contact with previously diagnosed TB patients. The majority of patients (63%) visited health care providers within three weeks of appearance of symptoms but only thirty five percent were investigated for TB diagnosis.ConclusionCough and fever are being ignored as likely symptoms of TB by patients as well as health care providers resulting in delay. Engaging private practitioners through public private mix (PPM) approach for expansion of TB diagnosis and increasing public awareness could be more beneficial to reduce delay.

Delay in Diagnosis of Tuberculosis among Under Treatment Patients in Rajshahi City, Bangladesh

“…Many authors have found higher diagnostic delay among pulmonary patients. 1,5,30 But, in accordance with some other studies 10,11,16 extra-pulmonary TB patients were significantly more likely to have experienced diagnostic delay. However, it is not surprising because, patients with extra-pulmonary TB may have diffuse or non-specific symptoms and are likely to experience longer delays than patients with pulmonary TB in both low and highendemic settings.…”

“…13,14 In several studies, it has been documented that health seeking behavior, low access to health care facilities, poverty, rural residence, education, female sex, old age are in significant relation with delays in diagnosis. 1,5,15,16 Therefore, the authors have tried to find out the association between the various socio-demographic factors and delay in diagnosis among TB patients in Bangladesh context. In Bangladesh no recent study was available in this regard.…”

“…Reemergence and association with acquired immunodeficiency syndrome (AIDS) have made TB a global threat. 1 Currently, one third of world's population is infected with MTB resulting in annually approximately 1.8 million deaths worldwide. 2 TB remains a one of the major causes of morbidity and mortality in Bangladesh.…”

“…10 The magnitude and risk factors for diagnostic delays have been well documented in a number of studies. 1,11,12 Patient's decision on seeking healthcare depends on different factors. 13,14 In several studies, it has been documented that health seeking behavior, low access to health care facilities, poverty, rural residence, education, female sex, old age are in significant relation with delays in diagnosis.…”

Alarming rates of attrition among tuberculosis patients in public-private facilities in Lahore, Pakistan

“…21,22 We may thus have overestimated the extent of pre-treatment LTFU. There is no electronic database of patient records in the country and it was not feasible to manually review the treatment registers maintained in the hundreds of public sector facilities.…”