Delay in the diagnosis of pulmonary tuberculosis, London, 1998-2000: analysis of surveillance data

Rodger, Alison; Jaffar, Shabbar; Paynter, Stuart; Hayward, Andrew; Carless, Jacqui; Maguire, Helen

doi:10.1136/bmj.326.7395.909

Cited by 46 publications

(23 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding was also reported in other countries [18,22,26-28], usually without proper explanation. In some of these countries (Uganda, Bangladesh) [22,26], cultural factors which might not have been relevant for Croatian females were likely to be involved.…”

Section: Discussionsupporting

confidence: 87%

Health system delay in pulmonary tuberculosis treatment in a country with an intermediate burden of tuberculosis: a cross-sectional study

et al. 2013

View full text Add to dashboard Cite

BackgroundDelayed diagnosis and treatment of tuberculosis increase both the severity of the disease and the duration of infectivity. A number of studies have addressed the issue of health system delays in the treatment of tuberculosis, but mostly in countries with a high or low incidence of the disease. Our understanding of delay is quite limited in settings with an intermediate burden of tuberculosis. We explore the duration and factors associated with delays in the Croatian health system which has free health care and a sufficient network of health services providing tuberculosis diagnosis and care.MethodsA total of 241 consecutive adults with culture-confirmed pulmonary tuberculosis were interviewed in seven randomly selected Croatian counties and their medical records were evaluated. A health system delay was defined as the number of days from the first consultation with a physician to the initiation of anti-tuberculosis treatment. A long delay was defined as a period exceeding the median delay, while an extreme delay was considered to be above the 75th percentile delay.ResultsThe median health system delay was 15 days while the 75th percentile was 42 days (the 5th and 95th percentile being 1 and 105 days respectively). Almost 30% of tuberculosis patients remained undiagnosed for more than 30 days after the initial health care visit. Female patients (p = 0.005), patients with a negative sputum smear (p = 0.002) and patients having symptoms other than the usual ones (0.027) were found to be in significant correlation with a long delay. In a multivariate model, a long delay remained associated with the same variables (p = 0.008, p = 0.003, and p = 0.037, respectively).A significant association was demonstrated between both the female gender (p = 0.042) and a negative sputum smear (p < 0.001) and extreme delay, while only a negative sputum smear (p < 0.001) remained significant in the multivariate analysis.ConclusionsOur findings suggest that some groups of tuberculosis patients experienced a health system delay. In such a setting where tuberculosis incidence is decreasing, which leads to a lack of physician experience and expertise, training in tuberculosis is required. Such measure may be useful in reducing the number of missed opportunities for tuberculosis diagnosis.

show abstract

Section: Discussionsupporting

confidence: 87%

Health system delay in pulmonary tuberculosis treatment in a country with an intermediate burden of tuberculosis: a cross-sectional study

et al. 2013

View full text Add to dashboard Cite

show abstract

“…median duration of 93 days in Vietnamese women, and 136 days in Tanzania) 10,12 . A recent publication based on surveillance data in London reported a median duration of symptoms of 49 days among sputum smear‐positive patients 13 . The median duration of cough among the sputum smear‐positive patients in our patient cohort was comparable at 56 days (8 weeks).…”

Section: Discussionsupporting

confidence: 58%

Characteristics of patients with delayed diagnosis of infectious pulmonary tuberculosis

Phoa

Teleman

Wang³

et al. 2005

Respirology

View full text Add to dashboard Cite

show abstract

“…Our hypothesis is that this increase in patients on cART could have resulted in a higher percentage of patients with low vitamin D levels, which may be partly responsible. On the other hand, it should not be ruled out that a possible diagnostic delay due to tuberculosis symptoms being similar to other respiratory infections prevalent in winter [49] could result in PTB hospitalizations in the spring.…”

Section: Discussionmentioning

confidence: 99%

Environmental Factors Related to Pulmonary Tuberculosis in HIV-Infected Patients in the Combined Antiretroviral Therapy (cART) Era

et al. 2016

View full text Add to dashboard Cite

The aim of our study was to evaluate the seasonal variations and whether short-term exposure to environmental risk factors, such as climate and air pollution, is associated with PTB-related hospital admissions in human immunodeficiency virus (HIV)-infected patients in Spain during the era of combined antiretroviral therapy (cART). A retrospective study was carried out using data from the Minimum Basic Data Set (MBDS) and the State Meteorological Agency (AEMET) of Spain. The primary outcome variable was hospital admissions with PTB diagnosis. The environmental risk factors evaluated were season, temperature, humidity, NO2, SO2, O3, PM10, and CO. Overall, HIV-infected patients had a lower frequency of PTB-related hospital admissions in summer (22.8%) and autumn (22.4%), but higher values in winter (26.6%) and spring (28.2%). Using a Bayesian temporal model, PTB-related hospital admissions were less frequent in summer-autumn and more abundant in winter-spring during the first years of follow-up. During the later years of follow-up, the seasonal trends continued resulting in the lowest values in autumn and the highest in spring. When considering short-term exposure to environmental risk factors, lower temperatures at 1 week (odds ratio (OR) = 1.03; p = 0.008), 1.5 weeks (OR = 1.03; p<0.001), 2 weeks (OR = 1.04; p<0.001), and 3 weeks (OR = 1.03; p<0.001) prior to PTB admission. In addition, higher concentration of NO2 at the time of admission were significantly associated with higher likelihoods of PTB-related hospital admission in HIV-infected patients when 1.5 weeks (OR = 1.1; p = 0.044) and 2 weeks (OR = 1.21; p<0.001) were used as controls. Finally, higher concentration of SO2 at 1.5 weeks prior to PTB admission was significantly associated with a higher likelihood of PTB-related hospital admissions (OR = 0.92; p = 0.029). In conclusion, our data suggest an apparent seasonal variation in hospital admissions of HIV-infected patients with a PTB diagnosis (summer/autumn vs. winter/spring), as well as a link to short-term exposure to environmental risk factors, such as temperature and ambient NO2 and SO2.

show abstract

Delay in the diagnosis of pulmonary tuberculosis, London, 1998-2000: analysis of surveillance data

Cited by 46 publications

References 3 publications

Health system delay in pulmonary tuberculosis treatment in a country with an intermediate burden of tuberculosis: a cross-sectional study

Health system delay in pulmonary tuberculosis treatment in a country with an intermediate burden of tuberculosis: a cross-sectional study

Characteristics of patients with delayed diagnosis of infectious pulmonary tuberculosis

Environmental Factors Related to Pulmonary Tuberculosis in HIV-Infected Patients in the Combined Antiretroviral Therapy (cART) Era

Contact Info

Product

Resources

About