Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Kerala

Paramasivam, Selvam; Bina, Thomas; Chandran, Priya; Thayyil, Jayakrishnan; George, Biju; Sivakumar, Chaamanti

doi:10.4103/2249-4863.222052

Cited by 55 publications

(42 citation statements)

References 16 publications

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“…Paramasivam et al in their study in India indicate that inadequate knowledge contributes to diagnosis delay [30] this augury contrasts with our study where by participants were knowledgeable but still delayed in seeking for treatment. Also, on health literacy- most of our participants knew signs and symptoms of tuberculosis (p = 0.005; AOR 0.31; 95% CI 14–70) but produced unsatisfactory specimens (salivary).…”

Section: Discussioncontrasting

confidence: 96%

Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients

et al. 2019

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BackgroundSputum remains the most preferred specimen for detection of Mycobacterium tuberculosis due to its non-invasive method of production. Good quality sputum specimen is essential for accurate diagnosis of pulmonary tuberculosis (PTB). It is therefore imperative to assess factors that are related to the production of sputum that is of the best quality.ObjectiveWe assessed the intrinsic and extrinsic characteristics of presumed tuberculosis patients and the quality of sputum they produced.MethodsThis was a cross-sectional study in which consenting enrolled presumed tuberculosis patients were subjected to medical examination and a structured questionnaire administered to collect clinical history, demographic information, environmental and behavioral characteristics. The enrolled participants were instructed on how to collect spot and morning sputum specimens for macroscopic and microscopic assessment to determine any association.ResultsA total of 309 patients were enrolled into the study with an even distribution on gender (50.5% males). Of these, 202 (65.3%) submitted both a spot and a morning specimen for analysis. On macroscopic examination, 70% spot and 68% morning sputum were characterized as good quality (Purulent/mucoid). The factors associated (p<0.05) with quality specimen included both intrinsic and extrinsic factors. The intrinsic factors included: difficulty in breathing, presence of conjunctivitis and knowledge of the disease whereas the only extrinsic factor associated with production of good quality sputum for tuberculosis diagnosis was time taken by patient to seek tuberculosis treatment after occurrence of any of the TB symptoms.ConclusionBoth intrinsic and extrinsic factors affected the quality of sputum produced by presumed tuberculosis patients. Clinical and behavioral characteristics including conjunctivitis, difficulty in breathing and delay in seeking treatment were important factors that determined the production of good quality sputum specimens, while knowledge of tuberculosis disease did not compel presumed tuberculosis patients to produce good quality sputum for diagnosis of the disease.

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Section: Discussioncontrasting

confidence: 96%

Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients

et al. 2019

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“…[28][29][30] Those who had chronic diseases like diabetes, hypertension, etc had less patient delay probably because of frequent consultation because of other illnesses, however, this was statistically not significant (p=0.081). This finding was contrary to that of Paramsivam et al 19…”

Section: Patient's Delaycontrasting

confidence: 97%

“…17 Delays were reported from other countries, which ranged from 22 days (Spain) to 120 days (Tanzania). 18 Patient delay was higher in males, older persons and Christians which is similar to findings by Paramasivam et al 19 Patient delays can occur during the process of noticing symptoms, determining if one is ill, assessing the need for professional care, and overcoming social, personal, and physical barriers to obtaining that care. 20,21 In the present study, factors significantly associated with patient delay were having poor knowledge about TB, smoking, perception that symptoms were not serious, the first action patient took on having suggestive symptoms, and the mode of transport the patient used to reach the nearest public health facility.…”

Section: Patient's Delaysupporting

confidence: 73%

Patient and health provider factors affecting diagnostic delays of pulmonary tuberculosis in Jabalpur district of Madhya Pradesh, India: a cross-sectional study

Sahu

Verma

Kasar

2019

Int J Community Med Public Health

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Background: Delay in diagnosis of pulmonary tuberculosis (PTB) causes patients to have more severe disease, more complications and lead to higher mortality with disease spread. The aim of the study was to estimate patient proportion having delayed diagnosis of PTB and to estimate patient’ and health providers’ delay and associated factors.Methods: This cross sectional study was conducted on sample of 135 new sputum positive PTB patients from nine designated microscopy centres of Jabalpur district. Data collected on modified world health organization questionnaire. The criterion for defining delay was formulated keeping in mind the Revised TB Control Programme algorithm for diagnosis of PTB in PTB suspects. Mann Whitney U and Kruskal Wallis tests were used (α=5%).Results: Mean age was 33.87 (14.3) years. Males constituted 66.7%. Proportion of diagnostic delay was 87.4%. Median patient and health care personnel (HCP) interval were 39 days (IQR 22-75) and 34 days (IQR 12-79) respectively. Factors significantly associated with patient delay were poor knowledge about TB, smoking, symptoms perceived non serious, first action with symptom onset, and mode of transport patient used to reach the nearest public health facility. Stigma didn’t affected patient interval. Factors significantly associated with health providers’ delay were first consultations with; a non-formal HCP, private health facility, non-allopathic practitioner; consultation with multiple HCP’s; living more than half an hour away from public health facility.Conclusions: Unacceptable high delay in diagnosis, more from patient side. More attempts at increasing awareness are needed.

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“…Diagnostic delays resulted in patients not getting their laboratory TB test results, not returning for their follow-up clinic visit, and at times delaying treatment initiation, as also seen elsewhere [22, 23]. Continuous training of health staff on screening patients for TB and treating patients is necessary and needs to be improved.…”

Section: Discussionmentioning

confidence: 99%

Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique

et al. 2019

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Introduction Tuberculosis (TB) continues to be a leading cause of death in Sub-Saharan Africa, including Mozambique. While diagnostic methods and total notifications are improving, significant gaps remain between total numbers of TB cases annually, and the number that are notified. The purpose of this study was to elicit Mozambican patients with drug sensitive TB (DS-TB), TB/HIV and Multi drug resistant tuberculosis (MDR-TB) understanding and assessment of the quality of care for DS-TB, HIV/TB and MDR-TB services in Mozambique, along with challenges to effectively preventing, diagnosing and treating TB. Materials and methods Qualitative data was collected via separate focus group discussions consisting of patients with DS-TB, TB/HIV and MDR-TB at four health centers in Sofala and Manica Province, Mozambique, to describe knowledge on TB, HIV and MDR-TB, and identify barriers to access and adherence to services and their recommendations for improvement. A total of 51 patients participated in 11 discussions. Content analysis was done and main themes were identified. Results Focus groups shared a number of prominent themes. Respondents identified numerous challenges including delays in diagnosis, stigma related with diagnosis and treatment, long waits at health facilities, the absence of nutritional support for patients with TB, the absence of a comprehensive psychosocial support program, and the lack of overall knowledge about TB or multi drug resistant TB in the community. Discussion TB patients in central Mozambique identified many challenges to effectively preventing, diagnosing and treating tuberculosis. Awareness strengthening in the community, continuous quality monitoring and in-service training is needed to increase screening, diagnosis and treatment for TB, HIV/TB and MDR-TB.

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Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Kerala

Cited by 55 publications

References 16 publications

Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients

Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients

Patient and health provider factors affecting diagnostic delays of pulmonary tuberculosis in Jabalpur district of Madhya Pradesh, India: a cross-sectional study

Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique

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