CORRELATES OF DELAYED INITIATION OF TREATMENT AFTER CONFIRMED DIAGNOSIS UNDER RNTCP: A CROSS SECTIONAL STUDY IN AHMEDABAD MUNICIPAL CORPORATION, INDIA (original) (raw)
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Socio-demographic profiles of the delayed diagnosed patients in RNTCP Anand District
Healthline, Journal of Indian Association of Preventive and Social Medicine, 2010
Background: It would be worth to consider socio-demographic characteristics of the patients on DOTS (Directly Observed Treatment Short course), as the therapy requires a long term adherence. Material & Methods: Design: Cross-sectional study, Participants: 100 diagnosed TB patients on DOTS, from all TB units (25 from each TU) of Anand District, who had reported 3 weeks or later to health care center, after the onset of symptoms of TB. Information was filled up in a pretested questionnaire and the data was analyzed. Results: Among 100 TB patients (68 males and 32 females), 75% of the subjects had an education below 9 th standard. 46% of subjects were laborer. 65% were self-dependent. Most of the respondents (75%) preferred government facility. Conclusion: The socio-demographic characteristics of DOTS patients are found to be of such levels that could have a pivotal role in the treatment success. They also need to be addressed under the program in such a manner that those characteristi...
IAR Consortium, 2022
Introduction: Tuberculosis (TB) has been a continuous major public health problem.The treatment delay affects an individual, the community, a country’s health and economy. In general, it is very difficult to quantify the crisis in country’s health and economy, especially in the era of MDR-TB, from suffering and death of economically productive individuals from such preventable and treatable disease because of delayed initiation of treatment.Understanding the causes behind delay in diagnosis and treatment is essential for all partners involved in tuberculosis control. Material and Methods: The cross-sectional study was conducted among the patients of tuberculosis diagnosed at I.G.M.C. Shimla from 1st August 2018 through 31st July 2019.A structured, validated and pre-tested questionnaire was adapted from the WHO multi country tuberculosis treatment delay survey. Questionnaire consists of basic demographic profile of patients, type of tuberculosis and associated co-morbidities, TB knowledge, attitude toward TB and regarding potential delays. Data was collected from patients at the time of their registration for treatment at DOTS centre. Results: The most common levels of delays identified in study participants were patient delay and health care provider delay.The mean delay at patient level was 66 days and delay at health care provider was 83 days. Total delay among participants was 130 days.Among all study participants, 31.03% thought that their symptoms would go at their own. The economic constraint was found in 22.41 %.Reason of delay among 41.42 % participants was Late diagnosis at level of health care provider. Out of total, 18.5% who visited private practitioner, were not diagnosed. Conclusion: There was a delay of 66 days for seeking treatment and 84 days for diagnosis of tuberculosis at health care provider level. A longer delay was revealed in smoker, residents of rural area and patients from low income group for seeking treatment.The delay at the level of health care provider was significantly associated in participants who travelled less than five kilometers to reach first health facility for seeking treatment.
American Journal of Nursing Science, 2014
Objectives: was to assess patient delay in health care seeking behavior and associated factors among women with Tuberculosis in Mekelle City Governmental health facilities, Ethiopia 2012.Methods: The study design was Cross-sectional study and systematic random sampling technique was used to select participants from all governmental health facilities in Mekelle City. The study periods were from May 2012 to December, 2012.Data collection procedure was by using interviewer administered questionnaire. After completing data collection, data was coded and entered into SPSS version 20 software for analysis. univariate, Bivariate and multivariate logistic regression was computed and data was presented in texts, tables and figure. Result: A total of 257 participants were interviewed using standardized structured questionnaire and included in the analysis. Of those 15 respondents were excluded from the analysis for gross incompleteness and inconsistency of responses, made a response rate of 94.16 %. The mean age of respondents was30.59+12.61 years ranging from 16-75 years old. Being in age group >55 (AOR: 0.23, 95% CI 0.006, 0.03) was at risk for delay. Marital status 79(75.2%)was also found to be significantly associated with patient delay to seeking care and was found to be at great risk delay in seeking care (AOR: 0.002, 95% CI 0.001, 0.32) than that of other (divorce& widowed). Educational status was also found to be significantly associated with patient delay, illiterate 63(98.4%) by adjacently (AOR: 27, 95% CI 1.30, 60.45) was at risk for patient delay. Conclusion and Recommendation In conclusion the finding of this result showed that from the total respondents the reason of patient delay for seeking care for more than two third of the respondents were lack of money, illiteracy and being married was significantly associated with patient delay Therefore, Delay in care seeking behavior among women with TB more specific and effective education and income improvement needs work on self-esteem development on care seeking behavior among women's with TB.
ABSTRACT Delay in seeking effective treatment for tuberculosis increase the level of disease morbidity and mortality rate well as the risk of its transmission in the community. A cross-sectinal study was conducted among new pulmonary tuberculosis patients for factors influencing delay in seeking treatment among tuberculosis patients in TB clinic, 200 bedded general hospital, Hlaingtharyar, Yangon Region during September to November 2017. The study aimed to study predisposing, enabling and need factors of TB among new pulmonary TB patients attending at TB clinic, 200 bedded general hospital, Hlaingtharyar, Yangon Region. A total of 110 new smear positive pulmonary TB patients were involved in this study. Face to face interview was performed by using pre-tested semi-structured questionnaire. Mean age of the respondents was 39 years. and male were 61.8 %. It was found that 67.3 % were married. Regarding occupation, 79.1% were general workers. Among the respondents, 46.3% of the patients delayed over 30 days from the first symptom of TB to seeking treatment at TB clinic with a median delay 30 day. Main reasons for the delayed seeking was financial problem. Home remedies and drug stores were the first place for seeking treatment accounting for 49% and 27.5% each. There was not significant association between sex, monthly family income and patient delay. Common sources of the information about TB clinic was health care persons and private clinic accounting for 29.1% and 28.2% each. Source of information about treatment course were 37.3% in healthcare persons and 29.1% in hospital doctors and staff . Knowledge on TB was significantly associated with delay. Overall perception on severity of disease and benefits of treatment were not associated with delay in seeking treatment. This study showed physical barriers was associated with delay in seeking treatment, mode of travel from home to TB clinic was associated with delay in seeking treatment. This study recommended to strengthen the health education regarding with TB and to strengthen the existing Public-Private partnership.
Knowledge and health seeking behaviour of tuberculosis patients in Kerala, India
International Journal of Community Medicine and Public Health, 2016
Tuberculosis (TB), the ancient scourge of man, continues to be a major global public health problem in the twentyfirst century. According to World Health Organization (WHO), one-third of the world's population is estimated to have Mycobacterium tuberculosis. The Revised National Tuberculosis Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, launched in 1997 has expanded across the country in a phased manner. Full nationwide coverage was achieved in March 2006. In spite of its impressive performance in terms of case detection and cure rates, the programme has many challenges due to the different health seeking pattern. Patients with undiagnosed pulmonary TB predominantly ABSTRACT Background: Patients confront several problems in timely and effective utilization of TB health facilities which have often delayed diagnosis of TB. It is hence the need of the hour to look beyond the case detection rates towards other factors that can promote early diagnosis. Methods: A community-based cross-sectional study was conducted among newly diagnosed smear positive pulmonary tuberculosis patients aged ≥15 years on the Intensive Phase of treatment. A pretested semi-structured questionnaire was used to study knowledge, stigma, health seeking behaviour and other factors. Results: The predominant symptom for seeking care was cough (93.0%). 45.7% of patients sought the services of a health care provider within 2 weeks. Modern medicine was the preferred system for 94.7% of the patients. The majority (58.6%) of the patients consulted a private health facility. Illiterates and Below Poverty Line patients preferred government facilities. The average number of consultations before diagnosis was 3.11±1.9. 34.1% had adequate knowledge about tuberculosis and women had a significantly higher knowledge score. low per capita income, smoking and alcohol use, cough alone, cough with other symptoms, history of TB in Family, distance more than ≥ 5 km to health facility showed significant association with delayed health-seeking action (>14 days). Conclusions: Private practitioners and private hospitals were the predominant health providers preferred by the study subjects for the first consultation. Delayed health seeking action was probably due to the presence of a cough alone and coughs with other symptoms, history of tuberculosis among the family members and increased distance to TB health facility.
PLoS ONE, 2012
Background: Excessive time between diagnosis and initiation of tuberculosis (TB) treatment contributes to ongoing TB transmission and should be minimized. In India, Revised National TB Control Programme (RNTCP) focuses on indicator start of treatment within 7 days of diagnosis for patients with sputum smear-positive PTB for monitoring DOTS implementation. Objectives: To determine length of time between diagnosis and initiation of treatment and factors associated with delays of more than 7 days in smear-positive pulmonary TB. Methods: Using existing programme records such as the TB Register, treatment cards, and the laboratory register, we conducted a retrospective cohort study of all patients with smear-positive pulmonary TB registered from July-September 2010 in two districts in India. A random sample of patients with pulmonary TB who experienced treatment delay of more than 7 days was interviewed using structured questionnaire. Results: 2027 of 3411 patients registered with pulmonary TB were smear-positive. 711(35%) patients had .7 days between diagnosis and treatment and 262(13%) had delays .15 days. Mean duration between TB diagnosis and treatment initiation was 8 days (range = 0-128 days). Odds of treatment delay .7 days was 1.8 times more likely among those who had been previously treated (95% confidence interval [CI] 1.5-2.3) and 1.6 (95% CI 1.3-1.8) times more likely among those diagnosed in health facilities without microscopy centers. The main factors associated with a delay .7 days were: patient reluctance to start a re-treatment regimen, patients seeking second opinions, delay in transportation of drugs to the DOT centers and delay in initial home visits. To conclude, treatment delay .7 days was associated with a number of factors that included history of previous treatment and absence of TB diagnostic services in the local health facility. Decentralized diagnostic facilities and improved referral procedures may reduce such treatment delays.
Predictors of delayed care seeking for tuberculosis in southern India: an observational study
Background: Reducing delay to accessing care is necessary to reduce the Tuberculosis (TB) burden in high incidence countries such as India. This study aimed to identify factors associated with delays in seeking care for TB in Southern India. Methods: We analyzed data from newly diagnosed, smear-positive, culture-confirmed, pulmonary TB patients in the Regional Prospective Observational Research for TB (RePORT) cohort in Puducherry and Tamil Nadu, India. Data were collected on demographic characteristics, symptom duration, and TB knowledge, among other factors. Delay was defined as cough ≥4 weeks before treatment initiation. Risky alcohol use was defined by the AUDIT-C score which incorporates information about regular alcohol use and binge drinking. TB knowledge was assessed by knowing transmission mode or potential curability. Results: Of 501 TB patients, 369 (73.7%) subjects delayed seeking care. In multivariable analysis, risky alcohol use was significantly associated with delay (aOR 2.20, 95% CI: 1.31, 3.68). Delay was less likely in lower versus higher income groups (<3000 versus >10,000 rupees/month, aOR 0.31, 95% CI: 0.12, 0.78). TB knowledge was not significantly associated with delay. Conclusions: Local TB programs should consider that risky alcohol users may delay seeking care for TB. Further studies will be needed to determine why patients with higher income delay in seeking care.
International Journal Of Community Medicine And Public Health, 2020
Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria spread by droplet infection.According to global TB report 2017, there were approximately 28 lakhs cases of TB in India accounting a quarter of the world TB cases. Today, it is the fastest-expanding and the largest program in the world in terms of patients initiated on treatment and the second largest in terms of population coverage. The objective of this study is to assess the socio-demographic profile of the patients attending revised national TB control programme (RNTCP) clinic, to determine the nature of disease, its co-morbidities, seasonal variability and treatment profile of the patients attending the RNTCP clinic during this study period.Methods: This was a retrospective record-based study conducted in RNTCP clinic of KPC Medical College and Hospital, Kolkata. Details of all the 684 patients who were enrolled under RNTCP from the year 2014 to 2018 were collected from RNTCP rec...
International Journal of Medical Science and Public Health, 2014
Background: The period of infectiousness of a new sputum smear-positive pulmonary tuberculosis case is important in determining the risk of exposure faced by the community. Early detection and effective treatment of TB case reduces the period of transmission and the risk of exposure of the community. It is for this reason that the delay in TB diagnosis and treatment should be minimal to control disease transmission and patient suffering. Aims & Objective: To measure delays in diagnosis and treatment of pulmonary tuberculosis, and to identify and assess the risk factors associated with these delays. Material and Methods: A cross-sectional study was conducted of all new smear-positive pulmonary TB patients diagnosed between January 2012 and June 2013 at RNTCP clinic. The time from the onset of symptoms to first health care consultation (patient delay) and the time from first health care consultation to the date of TB diagnosis (health system delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays. Results: A total of 122 patients with a mean age of 29.9 years were included in the study. Mean total delay between the onset of symptoms and treatment initiation was 53.42 days (median 50, range 14-128), with a mean patient delay of 29.24 days (median 25, range 5-94) and mean health system delay of 21.7 days (median 17, range 3-93). The mean treatment delay was 2.48 days (median 2, range 1-6). Factors independently associated with total delay were cough symptom (OR 3.36, P = 0.038), completed secondary school (OR 0.41, P = 0.018), good knowledge of TB symptoms (OR 0.39, P = 0.011), first visit to a public health facility (OR 0.45, P = 0.044), sputum testing at first health care consultation (OR 0.46, P = 0.048) and stigma attached to TB disease (OR 2.89, P = 0.021). Those associated with patient delay were male sex (OR 0.42, P = 0.020), large family size (OR 2.30, P = 0.027), completed secondary school (OR 0.43, P = 0.025) and good knowledge of TB symptoms (OR 0.45, P = 0.029); while those associated with health system delay were first visit to a public health facility (OR 0.31, P = 0.006), sputum testing at first health care consultation (OR 0.22, P = 0.001), number of health care consultations (OR 4.41, P < 0.001) and pre-diagnosis health care cost (OR 3.35, P = 0.001). Conclusion: Health system delay was an important problem in the area studied, with patient delay being of most concern.
Gender and socio-cultural determinants of delay to diagnosis of TB in Bangladesh, India and Malawi
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2008
Tuberculosis (TB) control programmes in Bangladesh, India and Malawi. To compare the interval from symptom onset to diagnosis of TB for men and women, and to assess socio-cultural and gender-related features of illness explaining diagnostic delay. Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Based on time from initial symptoms to diagnosis of TB, patients were classified with problem delay (>90 days), timely diagnosis (< or =30 days) or moderate delay. EMIC interview data were analysed to explain problem delay. The median interval from symptom onset to diagnosis was longest in India and shortest in Malawi. With adjustment for confounding, female sex (Bangladesh), and status of married woman (India) and housewife (Malawi) were associated with problem delay. Prominent non-specific symptoms--chest pain (Bangladesh) and breathlessn...