Tempo entre o início dos sintomas e o tratamento de tuberculose pulmonar em um município com elevada incidência da doença

Abstract

Objective: To estimate the time elapsed between the onset of symptoms and the initiation of treatment of pulmonary tuberculosis among treatment-naïve patients with positive results in sputum smear microscopy, and to evaluate the variables associated with delays in diagnosis and in treatment initiation. Methods: This was a descriptive exploratory study involving 199 treatment-naïve tuberculosis patients ≥ 12 years of age with AFB-positive sputum smear microscopy results between 2006 and 2008. At their first (treatment initiation) visit to a primary health care clinic in the city of Nova Iguaçu, Brazil, the patients were interviewed and their ancillary test results were reviewed. Results: The medians (and respective interquartile ranges) of the time from symptom onset to the initiation of treatment of pulmonary tuberculosis, from symptom onset to seeking medical attention, from entry into care to diagnosis, and from entry into care to treatment initiation, in weeks, were 11 (6-24), 8 (4-20), 2 (1-8), and 1 (1-1), respectively. The variables gender, age, level of education, previous use of antibiotics, HIV status, site of first medical visit, and radiological extent of tuberculosis showed no associations with the time from entry into care to diagnosis or to treatment initiation. The main reason for the delay in seeking medical attention reported by the patients was their inability to recognize their symptoms as indicators of a disease. Conclusions: Among the patients studied, there was an unacceptably long delay between the onset of symptoms and the initiation of tuberculosis treatment.

Atraso na procura pelo primeiro atendimento para o diagnóstico da tuberculose

“…In this study, the possibility that TB patients have undervalued the symptoms of the disease corroborated with the severity perceived of the symptoms for the demand for health services (13)(14)(15) . The fact that one of the first symptoms of pulmonary TB (5) (cough) initially presented in a milder manner (7,16) and be considered as a consequence of smoking (17) could remove the suspicion of TB or other severe disease among patients, leading them to not feel the need to search care in a health facility.…”

“…However, in this study 50 to 59 years old patients took more time to seek care and it can be explained by the coexistence of other diseases that could have masked the TB symptoms, making complex the perception of the disease. Furthermore, TB symptoms are often attributed to other diseases related to the respiratory system, contributing to the worsening of the delay of the clinical diagnosis (7,(12)(13) .…”

“…Difficult access, assumption of inability and lack of confidence in the resolution of the problem, and inexistence of vacancies for obtaining care in primary care services are possible causes that can induce the direct demand for the Emergency Care Units, corroborating with the delay found among patients who sought primary services within this study. Such behavior is not conducive to organization of the demand and the care of chronic conditions such as TB, since Emergency Care units do not have a role in care coordination (7,13,(21)(22) .…”

Desempeño laboratorial de las unidades de atención primaria en el diagnóstico de tuberculosis en Pelotas, Brasil

“…Este tiempo amplio puede contribuir al retardo del inicio del tratamiento y a la propagación de la enfermedad entre los contactos, dificultando el control de la TB. De acuerdo con un estudio realizado en Nova Iguaçu, Brasil, el tiempo entre la entrada del paciente en el sistema de salud (primera atención en una unidad) y el inicio del tratamiento para TB fue considerado como excesivo, lo que sugiere la necesidad de estrategias para la reducción de este tiempo (19) .…”

Profile Of Elderly Diagnosed With Tuberculosis In A Reference Hospital In Brazil

“…The first problem intertwines factors inherent to therapy and the work process of the teams that make up the Family Health Strategy (FHS). As an example of the challenges related to the treatment, the following is observed: side effects caused by medication, size of the tablets, the time of treatment, the improvement of symptoms after starting it and often the difficulties in dealing with problems of social nature experienced by patients [11]. The second problem stems from both the user`s delay in seeking health facilitieswhich occurs routinely from the lack of understanding regarding the symptoms of the disease -and the barriers of access to the service [12].…”