Pattern and magnitude of treatment delay among TB patients in five states in southern Nigeria

Abstract

Prompt diagnosis and early treatment of Tuberculosis (TB) cases is an important strategy in TB prevention and control. Thus, passive case finding of TB suspects, sputum examination for diagnosis, and prompt treatment using Directly Observed Treatment Short Course (DOTS) are key elements in the national guideline for TB control programme. The aim of this study is to determine the time interval between diagnosis of smear-positive TB cases and the commencement of treatment in DOTS facilities in southern Nigeria. The study was carried out in 20 healthcare facilities supported by TB Control Assistance Program (TB-CAP) involved in TB management in southern Nigeria, which comprised tertiary, secondary, and primary healthcare facilities including public and private facilities. Data were collected through review of clients' and facility records covering July-September 2009. Data collected were sociodemographic characteristics, sputum-smear result, date of diagnosis, and date of commencement of treatment. Data were analyzed using SPSS version 15.0 software. Of the total 2,507 TB suspects examined for Acid-Fast Bacillus (AFB), 323 were diagnosed to be Sputum-Smear-Positive (SS+ve), However, 269 new smear positive cases were commenced on treatment within the period, thus 54 (17.0%) of the new SS+ve cases defaulted initially. One hundred and two (38%) of them commenced TB treatment within 3 days of smear examination for diagnosis, while 59 (22%) commenced 4-6 days after diagnosis. The study revealed significant delay in commencement of TB treatment for most new smear positive TB cases in southern Nigeria and underlines the need to further explore factors responsible for delay in commencement of TB treatment following diagnosis.The journal issue has a unique new feature for reaching to the journal's website without typing a single letter. Each article on its first page has a "Quick Response Code". Using any mobile or other hand-held device with camera and GPRS/other internet source, one can reach to the full text of that particular article on the journal's website. Start a QR-code reading software (see list of free applications from http://tinyurl.com/ yzlh2tc) and point the camera to the QR-code printed in the journal. It will automatically take you to the HTML full text of that article. One can also use a desktop or laptop with web camera for similar functionality. See

Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis

“…29,30 In some studies smear positivity was defined as at least 1 25,27,28,30,35,41,42 or at least 2 [22][23][24]34 positive smears, whereas others did not provide any definition. 10,21,26,[31][32][33][36][37][38][39][40] A study from South Africa stratified rates of reported pre-treatment loss to followup by smear status (smear-positive or smear-negative but culture-positive), 23 whereas another study, also from South Africa, reported on pre-treatment loss to follow-up in tuberculosis patients whose diagnosis was established clinically and/ or bacteriologically. 29 …”

“…In the remaining 4 studies, patients with a diagnosis of tuberculosis were identified as part of ongoing epidemiological surveillance 30 or were prospectively recruited for follow-up from a chest clinic 33,40 or from primary-health-care centres. 41 The recruitment periods ranged from 3 months 24,34,36 to 90 months. 30 Only 9 studies [22][23][24][25]27,29,31,36,37 applied a cut-off for time since diagnosis -ranging from 1 month to 3 months -to define pretreatment loss to follow-up.…”

“…41 The recruitment periods ranged from 3 months 24,34,36 to 90 months. 30 Only 9 studies [22][23][24][25]27,29,31,36,37 applied a cut-off for time since diagnosis -ranging from 1 month to 3 months -to define pretreatment loss to follow-up.…”

“…Studies that reported on data from a single clinical site 21,22,26,29,31,33,35,40 had higher rates of pre-treatment loss to follow-up (range: 14-38%) than studies reporting on national or regional data (range: 4-25%). 10,[23][24][25]27,28,30,32,34,[36][37][38][39]41,42 In total, 10 studies 10,24,25,[30][31][32][33][34]38,40 attempted to trace tuberculosis patients with pre-treatment loss to follow-up (Table 4). One of them did not detail the tracing method used.…”

Interferon-gamma treatment kinetics among patients with active pulmonary tuberculosis

“…In 2011, there were an estimated 8.7 million new cases of TB (13% coinfected with HIV) and 1.4 million people died from TB, including almost one million deaths among HIV-negative individuals and 430, 000 among people who were HIV-positive 1. The high prevalence of TB in the world and especially in developing countries is attributed to a number of factors, including significant delays in diagnosis and treatment initiation 23. Diagnosis still depends largely on the conventional methods i.e., acid-fast staining of sputum which has a low sensitivity of 50-60% and Mycobacterial culture that usually requires 6-8 weeks to be interpretable 456…”