Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome

Evenden, Poppy; Roche, A.; Karo, Basel; Balasegaram, Sooria; Anderson, Charlotte

doi:10.1136/bmjresp-2019-000468

Cited by 11 publications

(9 citation statements)

References 22 publications

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“…We presume that TB could have been prevented in many exposed children through timely identification of the source case. Delayed diagnosis of pulmonary TB is frequently reported in high TB-incidence low-and middle-income countries [29], but also in low-incidence countries [30,31]. Furthermore, transmission prior to TB symptoms in subclinical source cases may occur [32]; thus, documented exposure times may be underestimated.…”

Section: Discussionmentioning

confidence: 99%

Pilot study to identify missed opportunities for prevention of childhood tuberculosis

et al. 2022

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Tuberculosis (TB) in exposed children can be prevented with timely contact tracing and preventive treatment. This study aimed to identify potential barriers and delays in the prevention of childhood TB in a low-incidence country by assessing the management of children subsequently diagnosed with TB. A pilot retrospective cohort study included children (< 15 years) treated for TB between 2009 and 2016 at a tertiary care hospital in Berlin, Germany. Clinical data on cases and source cases, information on time points of the diagnostic work up, and preventive measures were collected and analyzed. Forty-eight children (median age 3 years [range 0.25–14]) were included; 36 had been identified through contact tracing, the majority (26; 72.2%) being < 5 years. TB source cases were mostly family members, often with advanced disease. Thirty children (83.3%) did not receive prophylactic or preventive treatment, as TB was already prevalent when first presented. Three cases developed TB despite preventive or prophylactic treatment; in three cases (all < 5 years), recommendations had not been followed. Once TB was diagnosed in source cases, referral, assessment, TB diagnosis, and treatment were initiated in most children in a timely manner with a median duration of 18 days (interquartile range 6–60, range 0–252) between diagnosis of source case and child contact (information available for 35/36; 97.2%). In some cases, notable delays in follow-up occurred.Conclusion: Prompt diagnosis of adult source cases appears to be the most important challenge for childhood TB prevention. However, improvement is also needed in the management of exposed children. What is Known:• Following infection with Mycobacterium tuberculosis, young children have a high risk of progression to active and severe forms of tuberculosis (TB).• The risk of infection and disease progression can be minimized by prompt identification of TB-exposed individuals and initiation of prophylactic or preventive treatment. What is New:• We could show that there are avoidable time lags in diagnosis in a relevant proportion of children with known TB exposure.• Delayed diagnosis of adult source cases, losses in follow-up examinations, and delay in referral to a specialized TB clinic of TB-exposed children, especially among foreign-born children, appear to be the main issue in this German pediatric study cohort.

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Section: Discussionmentioning

confidence: 99%

Pilot study to identify missed opportunities for prevention of childhood tuberculosis

et al. 2022

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“…We also compared the health delay between males and females and individuals older and younger than 64. The literature seems to indicate that older age is associated with higher delays [ 26 , 27 ]. However, other studies found no association, which could be due to different classifications of age.…”

Section: Discussionmentioning

confidence: 99%

“…However, other studies found no association, which could be due to different classifications of age. Some considered age as above 60, 70, or distinct age groups [ 9 , 23 , 26 , 27 ]. We found that females had significantly higher health delays than males in most regions, which was replicated in other studies [ 23 , 25 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some considered age as above 60, 70, or distinct age groups [ 9 , 23 , 26 , 27 ]. We found that females had significantly higher health delays than males in most regions, which was replicated in other studies [ 23 , 25 – 27 ]. However, this finding is also inconsistent across the literature [ 9 , 25 ] and several studies also include extrapulmonary TB.…”

Section: Discussionmentioning

confidence: 99%

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A temporal analysis on patient and health service delays in pulmonary tuberculosis in Portugal: inter and intra‑regional differences and in(equalities) between gender and age

et al. 2022

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Background Tuberculosis (TB) diagnosis and treatment delays increase the period of infectiousness, making TB control difficult and increasing the fatality rates. This study aimed to determine the evolution of health care service delay (time between the patient’s first contact with the health service and the diagnosis/start of treatment) and patient delay (time between onset symptoms date and the date of first contact with health services) for Pulmonary Tuberculosis (PTB) in Portugal between 2008 and 2017 across different regions, age groups and gender. Methods An exploratory analysis was performed, trends of both delays were studied, and 36 months forecasts were generated. We used the permutation test to test differences between groups and the Seasonal and Trend decomposition using Loess (STL) method and Autoregressive Integrated Moving Average (ARIMA) models for forecasting for both Health and Patient delays. We used data from notified PTB cases in mainland Portugal between 2008 and 2017, provided by the national surveillance system. Results Health delays remained relatively constant while patient delays increased. Females had significantly higher health delays in some regions. Individuals older than 64 had higher health delays than younger individuals, while patient delay for working-age individuals between 15 and 64 years old, presents higher patient delay. Conclusions Forecasts presage that the upward trend of the delays is unlikely to fall in the coming years. It is important to understand the evolution of the delays and predict how these will evolve. Our understanding of the delays behaviours will contribute to better health policies and resources allocation.

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“…(7) The results of a relevant study in London also showed that social factors affected the delay in the diagnosis and treatment of TB. (8) On the other hand, a person with TB expects psychological support and guidance from his caregiver. In patient's view, home is a proper place for rest and recovery.…”

Section: Introduction Dmentioning

confidence: 99%

Lived Experience of Iranian Family Caregivers of Tubercular Patients: A Qualitative Study

Mohebbi¹,

Dehbozorgi²,

Setoodeh³

et al. 2022

Invest. Educ. Enferm.

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Objective. To investigate the lived experience of family caregivers of persons with tuberculosis. Methods. In this study, the method of hermeneutic phenomenology. Data were collected through online in-depth semi-structured interviews with nine family caregivers of TB patients. The obtained data were thematically analyzed to explain the concept of home care for TB patients through van Manen's 6-step methodology. Results. After the thematic analysis, three main themes of caregivers'; mental distresses, quality care stasis, andfacilitated care were obtained from 944 primary codes and 11 categories. Conclusion. Family caregivers of these patients suffer from mental distress. This issue affects the quality and ease of caregiving for these patients. Therefore, policymakers of this area should pay attention to the family caregivers of these patients and attempt to provide support; they should try to improve their quality of life.

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Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome

Cited by 11 publications

References 22 publications

Pilot study to identify missed opportunities for prevention of childhood tuberculosis

Pilot study to identify missed opportunities for prevention of childhood tuberculosis

A temporal analysis on patient and health service delays in pulmonary tuberculosis in Portugal: inter and intra‑regional differences and in(equalities) between gender and age

Lived Experience of Iranian Family Caregivers of Tubercular Patients: A Qualitative Study

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