Patient and health system delays among adult smear-positive tuberculosis patients diagnosed at medical colleges of Puducherry in south India

Abstract

Early diagnosis and prompt initiation of treatment are essential for an effective tuberculosis (TB) control program. This study was done to assess the extent of various delays among TB patients diagnosed at medical colleges of Puducherry. A cross-sectional study involving retrospective medical record review and prospective patient interviews was conducted in and around the union territory of Puducherry during the period 2009-10. Various delays and adjusted odds ratios (ORs) were calculated. Level of significance was determined at 95% confidence interval (CI) (P value <0.05) and all tests were two-sided. Among 216 new sputum smear-positive TB patients, 11.1% and 10.6% were smokers and alcohol users, respectively. The median patient delay, health system delay, and total delay was 37 days, 28 days, and 65 days respectively. Being a resident of Puducherry (OR = 0.39, 95% CI = 0.18-0.87) and family size of ≤5 (OR = 0.45, 95% CI = 0.21-0.97) were found as the determinants of patient delays and total delays, respectively.

Prevalence and determinants of delay in diagnosis of pulmonary tuberculosis in Darjeeling district of West Bengal

“…As seen in most other studies, the present study also elicited that patient delay was the main contributor to the total diagnostic delay,[ 13 14 15 16 17 18 19 20 21 22 ] although few studies[ 23 24 ] found health system delay as the main contributor. In our setting, the ratio of patient delay and health system delay was 5:1; the corresponding figures were 3:1 in Sikkim;[ 13 ] 2.8:1 in Nepal;[ 14 ] 4.3:1 in Angola;[ 15 ]; 1.5:1 in Navi Mumbai;[ 16 ] 1.1:1 in Mandi;[ 17 ] 1.7:1 in Oromia;[ 18 ] 3.1:1 in Puducherry;[ 19 ]; 1.4:1 in Brazil;[ 21 ] and 2.5:1 in Argentina. [ 22 ]; 0.5:1 in Mumbai;[ 23 ]; and 0.6:1 in Indian literature;[ 24 ]…”

“…Patient delay represented 83.3% of total delay in our study; 75% in Sikkim;[ 13 ] 73% in Nepal;[ 14 ] 81% in Angola;[ 15 ] 59.5% in Navi Mumbai;[ 16 ] 53.6% in Mandi;[ 17 ] 64.4% in Oromia;[ 18 ] 75% in Puducherry;[ 19 ] 59% in Brazil;[ 21 ] 71.3% in Argentina. [ 22 ] and32.6% in Mumbai;[ 23 ]…”

“…(30 days);[ 18 ] Puducherry by Purty et al . (37 days);[ 19 ] Rio De Jenero, Brazil by Machado et al . (30 days)[ 21 ] and four provinces of Argentina by Zerbini et al .…”

“…Some previous study's definition of patient delay was matched with our definition: the time interval between the onset of first symptom of TB and the first contact with “any health-care facility”[ 15 17 20 23 ] whereas some references defined it as “any formal health-care facility” (health centers, hospitals or DOTS centers, etc.). [ 13 14 16 18 19 21 22 ] We and some studies included “new sputum smear-positive pulmonary TB patients” only[ 16 17 19 20 21 22 23 ] whereas some studies included “suspected TB cases”;[ 13 ] some considered “both new sputum smear-positive pulmonary TB, and sputum smear-negative pulmonary TB”;[ 14 ] and very few studies included “all types of new TB”(NSP, new sputum negative and new extrapulmonary) TB patients;[ 14 15 ] and Oromia study included all types of TB (new and retreatment). [ 18 ]…”

The identification of risk factors associated with patient and healthcare system delays in the treatment of tuberculosis in Tabriz, Iran

“…Even though this region is not considered as having a high rate of incidence for TB, we found that the median of HSD in this region of Iran is higher than national value (52 vs. 42 days) [ 1 ]. Based on previous studies, there is a wide range of median HSD values, from 2 to 120 days, in industrialized and developing countries [ 15 , 17 , 23 , 61 – 63 ]. In this study, the median HSD was almost similar to studies in Malaysia (49 days), Vietnam (53 days), and New Zealand (49 days) [ 49 , 62 , 64 ]; lower than Mozambique (62 days), Pakistan (87 days), and Columbia (> 60 days) [ 1 , 39 , 52 , 65 ]; and higher than Taiwan (29 days), India (28 days), Nigeria (7 days), and Angola (7 days) [ 63 , 66 – 68 ].…”