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Wardani DWSR, Pramesona BA, Septiana T, Soemarwoto RAS. Risk factors for delayed sputum conversion: A qualitative case study from the person-in-charge of TB program's perspectives. J Public Health Res 2023; 12:22799036231208355. [PMID: 37901194 PMCID: PMC10605690 DOI: 10.1177/22799036231208355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Background One of the indicators to determine the success of TB treatment is the conversion of sputum from smear positive to negative. However, several factors can lead to this failure of sputum conversion. Objectives To investigate the risk factors for delayed sputum conversion from the person-in-charge (PIC) of the TB program's perspective. Design and methods This qualitative case study was conducted on September 7th, 2022. Thirty-one PICs of the TB program from 31 public health centers (Puskesmas) in Bandar Lampung, Indonesia, were recruited purposively. All participants were grouped into three FGDs. Developed semi-structured interview questions were used for data collection. Thematic analysis was used to synthesize and cross-reference emerging topics. Results Three themes emerged in our study: (1) individual factors with the sub-themes of medication adherence, education, initial laboratory examination, comorbid disease, nutrition, and lifestyle; (2) environmental factors with the sub-themes of types of support, sources of support, environmental conditions and stigma; and (3) health service factors with the sub-theme of access to health service facilities. Conclusions Problems related to TB management are not only the individual's responsibility but need to strengthen support from the environment and health services.
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Affiliation(s)
| | - Bayu Anggileo Pramesona
- Department of Public Health, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia
| | - Trisya Septiana
- Department of Informatics Engineering, Faculty of Engineering, Universitas Lampung, Bandar Lampung, Indonesia
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Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 2021; 22:251. [PMID: 34556113 PMCID: PMC8459488 DOI: 10.1186/s12931-021-01841-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world's TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. METHODS We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. RESULTS This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were-patient delay (LIC/LMIC: 28 (95% CI 20-30); UMIC: 10 (95% CI 10-20), health system delay (LIC/LMIC: 14 (95% CI 2-28); UMIC: 4 (95% CI 2-4), and treatment delay (LIC/LMIC: 14 (95% CI 3-84); UMIC: 0 (95% CI 0-1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. CONCLUSIONS This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
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Bashar MA, Aggarwal A, Bhattacharya S. Overcoming the health system barriers to early diagnosis and management of multidrug-resistant tuberculosis in a rural setting in North India. BMJ Case Rep 2020; 13:13/1/e231009. [PMID: 31969399 DOI: 10.1136/bcr-2019-231009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
India contributes a quarter of the global burden of multidrug-resistant tuberculosis (MDR-TB) and has inadequate diagnostic infrastructure and institutional capacities for drug susceptibility testing. Subsequently, this leads to a large number of undetected and untreated cases of MDR-TB. In this report, we describe a case of a 55-year-old man from rural North India presenting with complaints of continued symptoms of chronic cough, fever and dyspnoea despite being recently diagnosed with recurrent tuberculosis and receiving treatment from the local community health centre. MDR-TB was suspected, but confirmatory diagnostic capabilities were not available in the local setting. The patient was finally diagnosed with MDR-TB. Treatment was coordinated by the district tuberculosis programme officer. Through this case, we describe the various barriers to detecting MDR-TB in the rural regions of India. Prompt identification of patients with presumptive MDR-TB, diagnosis of the disease and initiation of treatment are crucial to preventing disease transmission and reducing morbidity and mortality.
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Affiliation(s)
- Mohammad Abu Bashar
- Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Aggarwal
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Arroyo LH, Ramos ACV, Yamamura M, Berra TZ, Alves LS, Belchior ADS, Santos DT, Alves JD, Campoy LT, Arcoverde MAM, Bollela VR, Bombarda S, Nunes C, Arcêncio RA. Predictive model of unfavorable outcomes for multidrug-resistant tuberculosis. Rev Saude Publica 2019; 53:77. [PMID: 31553380 PMCID: PMC6752648 DOI: 10.11606/s1518-8787.2019053001151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB). METHODS Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated. RESULTS Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure. CONCLUSIONS The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.
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Affiliation(s)
- Luiz Henrique Arroyo
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Mellina Yamamura
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Thais Zamboni Berra
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Luana Seles Alves
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Danielle Talita Santos
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Josilene Dália Alves
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Laura Terenciani Campoy
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Valdes Roberto Bollela
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Sidney Bombarda
- Secretaria de Estado da Saúde de São Paulo. São Paulo, SP, Brasil
| | - Carla Nunes
- Universidade NOVA de Lisboa. Escola Nacional de Saúde Pública. Lisboa, Portugal
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Tefera KT, Mesfin N, Reta MM, Sisay MM, Tamirat KS, Akalu TY. Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia. BMC Infect Dis 2019; 19:489. [PMID: 31151423 PMCID: PMC6544973 DOI: 10.1186/s12879-019-4112-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia. Methods An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p-value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay. Results The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3–37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48–8.98], Culture [AOR = 5.15; 95% CI: 2.53–10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41–3.19] were associated with treatment delays. Conclusion Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.
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Affiliation(s)
| | - Nebiyu Mesfin
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mebratu Mitiku Reta
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ehsanul Huq KATM, Moriyama M, Zaman K, Chisti MJ, Long J, Islam A, Hossain S, Shirin H, Raihan MJ, Chowdhury S, Rahman MM. Health seeking behaviour and delayed management of tuberculosis patients in rural Bangladesh. BMC Infect Dis 2018; 18:515. [PMID: 30314453 PMCID: PMC6186095 DOI: 10.1186/s12879-018-3430-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022] Open
Abstract
Background Early diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB. Patients need to receive proper treatment through the National Tuberculosis Control Programme (NTP). This study describes various predictors for health seeking behaviour of TB patients and health system delay made by the different health care providers. Methods A cross-sectional study was conducted in a public health facility of a rural area in Bangladesh. Newly diagnosed smear positive pulmonary TB (PTB) patients who were ≥ 15 years of age were sequentially enrolled in this study. The socio-demographic characteristics and proportion of health care utilization by the patients, and health system delay made by the health care providers were calculated. Multivariate analysis was conducted to determine the independent association of the risk factors with the time to seek medical care. Results Two hundred and eighty patients were enrolled in this study. Among them, 73.6% were male and 26.4% were female. A hundred percent of patients primarily sought treatment for their cough, 170 (60.7%) first consulted a non-qualified practitioner while 110 patients (39.3%) first consulted with qualified practitioners about their symptoms. Pharmacy contact was the highest (27.9%) among the non-qualified practitioners, and 58.9% non-qualified practitioners prescribed treatment without any laboratory investigation. The average health system delay was 68.5 days. Multiple logistic regressions revealed a significant difference between uneducated and educated patients (OR 2.33; CI 1.39–3.92), and qualified and non-qualified practitioners (OR 2.34; CI 1.38–3.96) to be independent predictors of health system delay. Conclusions Compared to men, fewer women sought TB treatment. Uneducated patients and questionably qualified practitioners made for a longer delay in detecting TB. Increasing public health awareness and improving health seeking behavior of females and uneducated patients, and greater participation of the qualified practitioners in the NTP are highly recommended. Electronic supplementary material The online version of this article (10.1186/s12879-018-3430-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K A T M Ehsanul Huq
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8553, Japan.
| | - Michiko Moriyama
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8553, Japan
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Shahed Hossain
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Habiba Shirin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Sajeda Chowdhury
- Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8553, Japan
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Billah SM, Hoque DE, Rahman M, Christou A, Mugo NS, Begum K, Tahsina T, Rahman QSU, Chowdhury EK, Haque TM, Khan R, Siddik A, Bryce J, Black RE, El Arifeen S. Feasibility of engaging "Village Doctors" in the Community-based Integrated Management of Childhood Illness (C-IMCI): experience from rural Bangladesh. J Glob Health 2018; 8:020413. [PMID: 30202517 PMCID: PMC6125986 DOI: 10.7189/jogh.08.020413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Informal health care providers particularly "village doctors" are the first point of care for under-five childhood illnesses in rural Bangladesh. We engaged village doctors as part of the Multi-Country Evaluation (MCE) of Integrated Management of Childhood Illness (IMCI) and assessed their management of sick under-five children before and after a modified IMCI training, supplemented with ongoing monitoring and supportive supervision. Methods In 2003-2004, 144 village doctors across 131 IMCI intervention villages in Matlab Bangladesh participated in a two-day IMCI training; 135 of which completed pre- and post-training evaluation tests. In 2007, 38 IMCI-trained village doctors completed an end-of-project knowledge retention test. Village doctor prescription practices for sick under-five children were examined through household surveys, and routine monitoring visits. In-depth interviews were done with mothers seeking care from village doctors. Results Village doctors' knowledge on the assessment and management of childhood illnesses improved significantly after training; knowledge of danger signs of pneumonia and severe pneumonia increased from 39% to 78% (P < 0.0001) and from 17% to 47% (P < 0.0001) respectively. Knowledge on the correct management of severe pneumonia increased from 62% to 84% (P < 0.0001), and diarrhoea management improved from 65% to 82% (P = 0.0005). Village doctors retained this knowledge over three years except for home management of pneumonia. No significant differences were observed in prescribing practices for diarrhoea and pneumonia management between trained and untrained village doctors. Village doctors were accessible to communities; 76% had cell phones; almost all attended home calls, and did not charge consultation fees. Nearly all (91%) received incentives from pharmaceutical representatives. Conclusions Village doctors have the capacity to learn and retain knowledge on the appropriate management of under-five illnesses. Training alone did not improve inappropriate antibiotic prescription practices. Intensive monitoring and efforts to target key actors including pharmaceutical companies, which influence village doctors dispensing practices, and implementation of mechanisms to track and regulate these providers are necessary for future engagement in management of under-five childhood illnesses.
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Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Muntasirur Rahman
- School of Public Health, University of Queensland, Herston, Australia
| | - Aliki Christou
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Ngatho Samuel Mugo
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Khadija Begum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tazeen Tahsina
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Enayet K Chowdhury
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Rasheda Khan
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Ashraf Siddik
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Jennifer Bryce
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Nathavitharana RR, Daru P, Barrera AE, Mostofa Kamal SM, Islam S, Ul-Alam M, Sultana R, Rahman M, Hossain MS, Lederer P, Hurwitz S, Chakraborty K, Kak N, Tierney DB, Nardell E. FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up. Int J Tuberc Lung Dis 2018; 21:1020-1025. [PMID: 28826452 DOI: 10.5588/ijtld.16.0794] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
SETTING National Institute of Diseases of the Chest and Hospital, Dhaka; Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka; and Chittagong Chest Disease Hospital, Chittagong, Bangladesh. OBJECTIVE To present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a tuberculosis (TB) transmission control strategy. DESIGN FAST was implemented sequentially at three hospitals. RESULTS Using Xpert® MTB/RIF, 733/6028 (12.2%, 95%CI 11.4-13.0) patients were diagnosed with unsuspected TB. Patients with a history of TB who were admitted with other lung diseases had more than twice the odds of being diagnosed with unsuspected TB as those with no history of TB (OR 2.6, 95%CI 2.2-3.0, P < 0.001). Unsuspected multidrug-resistant TB (MDR-TB) was diagnosed in 89/1415 patients (6.3%, 95%CI 5.1-7.7). Patients with unsuspected TB had nearly five times the odds of being diagnosed with MDR-TB than those admitted with a known TB diagnosis (OR 4.9, 95%CI 3.1-7.6, P < 0.001). Implementation challenges include staff shortages, diagnostic failure, supply-chain issues and reliance on external funding. CONCLUSION FAST implementation revealed a high frequency of unsuspected TB in hospitalized patients in Bangladesh. Patients with a previous history of TB have an increased risk of being diagnosed with unsuspected TB. Ensuring financial resources, stakeholder engagement and laboratory capacity are important for sustainability and scalability.
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Affiliation(s)
- R R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - P Daru
- University Research Co., Washington DC
| | - A E Barrera
- Faculty of Nursing Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S M Mostofa Kamal
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - S Islam
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - M Ul-Alam
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - R Sultana
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - M Rahman
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - Md S Hossain
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - P Lederer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - S Hurwitz
- Division of Biostatistics, Brigham and Women's Hospital Center for Clinical Investigation, Boston, Massachusetts
| | | | - N Kak
- University Research Co., Washington DC
| | - D B Tierney
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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9
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Saqib SE, Ahmad MM, Amezcua-Prieto C, Virginia MR. Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program. Am J Trop Med Hyg 2018; 99:143-149. [PMID: 29761768 DOI: 10.4269/ajtmh.18-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among pulmonary TB patients in Pakistan. A cross-sectional study was conducted among 269 pulmonary TB patients in the district. Binary and multivariate logistic regressions were used to explore the factors associated with delay in TB treatment. Results reveal that most patients were from low socioeconomic backgrounds. For example, 74.7% were living in kacha houses, 54.7% were from lowest the income group (< 250 US$/month), 60.2% married, 54.3% illiterate, 62.5% rural, 56.1% had no house ownership, and 56.5% had insufficient income for daily family expenditures. Significant delays were revealed by this study: 160 patients had experienced a delay of more than 4 weeks, whereas the median delay was 5 weeks. Results show that the most important reason for patient delay was low income and poverty (42.0%) followed by unaware of TB center (41.6), stigma (felt ashamed = 38.7%), and treatment from local traditional healers. Old age (adjusted odds ratio [AOR] = 6.6; 95% confidence interval [CI] = 1.63-26.95); and rural areas patients (AOR = 2.1; 95% CI = 1.15-3.71) were more likely to have experienced delay. However, the higher income and sufficient income category (AOR = 0.5; 95% CI = 0.31-0.95) were associated factors and less likely to experience delay in patient treatment. Integrative prevention interventions, such as those involving community leaders, health extension workers such as lady health workers, and specialized TB centers, would help to reduce delay and expand access to TB-care facilities.
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Affiliation(s)
- Shahab E Saqib
- Department of Development and Sustainability, Regional and Rural Development Planning, Asian Institute of Technology, Pathum Thani, Thailand
| | - Mokbul Morshed Ahmad
- Department of Development and Sustainability, Regional and Rural Development Planning, Asian Institute of Technology, Pathum Thani, Thailand
| | - Carmen Amezcua-Prieto
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada (CTS-137) (CIBER), Granada, Spain
| | - Martínez-Ruiz Virginia
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada (CTS-137) (CIBER), Granada, Spain
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Chimbatata NBW, Zhou C, Chimbatata CM, Mhango L, Diwan VK, Xu B. Barriers to prompt TB diagnosis-a comparative study between northern Malawi and eastern rural China. Trans R Soc Trop Med Hyg 2017; 111:504-511. [PMID: 29425379 DOI: 10.1093/trstmh/try002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/07/2018] [Indexed: 11/12/2022] Open
Abstract
Background Tuberculosis (TB) case detection in China has improved remarkably, partly benefiting from the reducing delay to TB care, whereas the timeliness of TB care in Malawi remains problematic. Methods This study investigates barriers hindering timely TB diagnosis in Malawi and China, and attempts to share the experience in high burden countries. A cross-sectional study on TB diagnostic delay was conducted among 254 Malawian and 146 Chinese TB patients. Results The medians of patient's delays were 22 and 20 days (p>0.05), and provider delays were 12 and 11.5 days (p>0.05) in Malawi and China, respectively. Malawian patients had a higher proportion (72.05% vs 67.12%) of patient's delay longer than 14 days (p=0.042), which was significantly associated with initial visits to lower-level health providers in the villages (aOR=1.989, 95% CI: 1.075-3.682), and patients conducting casual/piece work (aOR=3.318, 95% CI: 1.228-8.964). Initial healthcare visits at village level also led to longer provider delay in both Malawi (aOR=2.055, 1.211-3.487) and China (aOR=5.627, 2.218-14.276). Conclusion Establishing a good communication and referral mechanism between different levels of health facilities is crucial to timely TB diagnosis. China's experience on pro-poor interventions could be useful to its Malawian counterpart and other similar settings with high TB burden.
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Affiliation(s)
- Nathan B W Chimbatata
- School of Public Health, Fudan University, Shanghai.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.,Mzuzu University, Mzuzu
| | - Changming Zhou
- School of Public Health, Fudan University, Shanghai.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China
| | | | | | - Vinod K Diwan
- Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.,Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden
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11
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Islam S, Hirayama T, Islam A, Ishikawa N, Afsana K. Treatment referral system for tuberculosis patients in Dhaka, Bangladesh. Public Health Action 2016; 5:236-40. [PMID: 26767176 DOI: 10.5588/pha.15.0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the referral system in an urban DOTS-based programme in Dhaka, Bangladesh, including the peri-urban area, and to identify opportunities to strengthen the system. DESIGN This was a retrospective cohort study in which diagnosed tuberculosis (TB) patients and health providers from DOTS centres were interviewed. Research tools included pre-tested structured questionnaires and the TB patients' referral records. RESULTS Of 4974 TB patients who were referred to the different treatment centres, only 1756 (35%) of the counterfoils of the referral slips were returned. Of 250 patients randomly selected for interview, 165 reported to a DOTS centre, 69 did not and 16 could not be traced. Variations in educational qualification, residence and the identification of DOTS centres after counselling were statistically significant (P < 0.05). Lower monthly income (RR = 7.84, RR = 5.03), distance from the centre (RR = 36.21) and those receiving treatment from pharmacies (RR = 3) or non-governmental organisations (RR = 28.48) have more risk of irregular treatment. CONCLUSION A high proportion of referred patients were registered and initiated treatment, but many did not report to the referral treatment centre. Proper counselling and taking into account the patients' preferences during referral are essential to address access barriers to treatment adherence and improved treatment outcome.
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Affiliation(s)
- S Islam
- Tuberculosis Control Programme, BRAC, BRAC Centre, Dhaka, Bangladesh
| | - T Hirayama
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - A Islam
- Tuberculosis Control Programme, BRAC, BRAC Centre, Dhaka, Bangladesh
| | - N Ishikawa
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - K Afsana
- Tuberculosis Control Programme, BRAC, BRAC Centre, Dhaka, Bangladesh
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12
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Rifat M, Hall J, Oldmeadow C, Husain A, Milton AH. Health system delay in treatment of multidrug resistant tuberculosis patients in Bangladesh. BMC Infect Dis 2015; 15:526. [PMID: 26573825 PMCID: PMC4647619 DOI: 10.1186/s12879-015-1253-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022] Open
Abstract
Background Bangladesh is one of the 27 high burden countries for multidrug resistant tuberculosis listed by the World Health Organization. Delay in multidrug resistant tuberculosis treatment may allow progression of the disease and affect the attempts to curb transmission of drug resistant tuberculosis. The main objective of this study was to investigate the health system delay in multidrug resistant tuberculosis treatment in Bangladesh and to explore the factors related to the delay. Methods Information related to the delay was collected as part of a previously conducted case–control study. The current study restricts analysis to patients with multidrug resistant tuberculosis who were diagnosed using rapid diagnostic methods (Xpert MTB/RIF or the line probe assay). Information was collected by face-to-face interviews and through record reviews from all three Government hospitals providing multidrug resistant tuberculosis services, from September 2012 to April 2013. Multivariable regression analysis was performed using Bootstrap variance estimators. Definitions were as follows: Provider delay: time between visiting a provider for first consultation on MDR-TB related symptom to visiting a designated diagnostic centre for testing; Diagnostic delay: time from date of diagnostic sample provided to date of result; Treatment initiation delay: time between the date of diagnosis and date of treatment initiation; Health system delay: time between visiting a provider to start of treatment. Health system delay was derived by adding provider delay, diagnostic delay and treatment initiation delay. Results The 207 multidrug resistant tuberculosis patients experienced a health system delay of median 7.1 weeks. The health system delay consists of provider delay (median 4 weeks), diagnostic delay (median 5 days) and treatment initiation delay (median 10 days). Health system delay (Coefficient: 37.7; 95 %; CI 15.0–60.4; p 0.003) was associated with the visit to private practitioners for first consultation. Conclusions Diagnosis time for multidrug resistant tuberculosis was fast using the rapid tests. However, some degree of delay was present in treatment initiation, after diagnosis. The most effective way to reduce health system delay would be through strategies such as engaging private practitioners in multidrug resistant tuberculosis control.
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Affiliation(s)
- Mahfuza Rifat
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia. .,BRAC, Dhaka, Bangladesh.
| | - John Hall
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Christopher Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Ashaque Husain
- National Tuberculosis Control Programme, Directorate General of Health Services, Dhaka, Bangladesh.
| | - Abul Hasnat Milton
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
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13
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Lin Y, Enarson DA, Chiang CY, Rusen ID, Qiu LX, Kan XH, Yuan YL, Du J, Zhang TH, Li Y, Li XF, Du CT, Zhang LX. Patient delay in the diagnosis and treatment of tuberculosis in China: findings of case detection projects. Public Health Action 2015; 5:65-9. [PMID: 26400603 DOI: 10.5588/pha.14.0066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE 1) To assess patient delay among new smear-positive pulmonary tuberculosis (PTB) patients in accessing health services in seven FIDELIS (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) projects from 2003 to 2008 in China; 2) to compare treatment delay by province; and 3) to assess factors associated with delay. METHOD Records of new smear-positive PTB patients were reviewed. Data sources were the consultation book, laboratory register, patient record, treatment card and the PWLAHS (people with limited access to health services) evaluation form. Data were collected using a standard questionnaire, cross-checked by staff from the sites and by the International Union Against Tuberculosis and Lung Disease (The Union) and analysed by The Union. RESULTS Of the 75 401 new smear-positive PTB patients included in the study, 63-89% were PWLAHS. The average gross domestic product of the project sites and at national level were respectively US$557 and US$998. The median patient delay was 93 days (range 68-128). Delays were longer among females, older patients, rural residents and PWLAHS. Delayed access to health services was significantly associated with a greater number of symptoms. CONCLUSION Patient delay in accessing health care in China was lengthy; TB care and control needs to be improved.
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Affiliation(s)
- Y Lin
- International Union Against Tuberculosis and Lung Disease (The Union), Beijing, China
| | | | | | | | - L-X Qiu
- Jiangxi Provincial Tuberculosis Institute, Nanchang, China
| | - X-H Kan
- Anhui Provincial Tuberculosis Institute, Hefei, China
| | - Y-L Yuan
- Jilin Provincial Tuberculosis Institute, Changchun, China
| | - J Du
- Beijing Tuberculosis and Thoracic Tumour Research Institute, Beijing, China
| | - T-H Zhang
- Shaanxi Provincial Tuberculosis Institute, Xian, China
| | - Y Li
- Guizhou Provincial Tuberculosis Institute, Guiyang, China
| | - X-F Li
- Xianyang Center for Disease Control and Prevention, Xianyang, China
| | - C-T Du
- Chongqing Tuberculosis Institute, Chongqing, China
| | - L-X Zhang
- International Union Against Tuberculosis and Lung Disease (The Union), Beijing, China
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14
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Bissell K, Harries AD, Reid AJ, Edginton M, Hinderaker SG, Satyanarayana S, Enarson DA, Zachariah R. Operational research training: the course and beyond. Public Health Action 2015; 2:92-7. [PMID: 26392960 DOI: 10.5588/pha.12.0022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/10/2012] [Indexed: 11/10/2022] Open
Abstract
Insufficient operational research (OR) is generated within programmes and health systems in low- and middle-income countries, partly due to limited capacity and skills to undertake and publish OR in peer-reviewed journals. To address this, a three-module course was piloted by the International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières in 2009-2010, with 12 participants. Five received mentorship and financial support as OR Fellows. Eleven of 12 participants submitted a paper to a peer-reviewed journal within 4 weeks of the end of the course. Evaluation shows that participants continued OR activities beyond the course. During the subsequent year, they submitted and/or published 19 papers, made 10 posters and/or presentations, and many participated in training, mentoring and/or paper reviewing. Some described changes in policy and practice influenced by their research, and changes in their organisation's approach to OR. They provided recommendations for improving and expanding OR. We conclude that participants can, with certain enabling conditions, take research questions through to publication, use skills gained to undertake and promote OR thereafter and contribute to improvement in policy and practice. An internet-based network will provide participants and graduates with a platform for collection of course outcomes and ongoing mentor- and peer-based support, resources and incentives.
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Affiliation(s)
- K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - A J Reid
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Centre for International Health, University of Bergen, Bergen, Norway
| | | | - D A Enarson
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - R Zachariah
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
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Hossain S, Zaman K, Quaiyum A, Banu S, Husain A, Islam A, Borgdorff M, van Leth F. Factors associated with poor knowledge among adults on tuberculosis in Bangladesh: results from a nationwide survey. J Health Popul Nutr 2015; 34:2. [PMID: 26825614 PMCID: PMC5465564 DOI: 10.1186/s41043-015-0002-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/08/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In 2012, Bangladesh continues to be one of the 22 high tuberculosis (TB) burden countries in the world. Although free diagnosis and management for TB is available throughout the country, case notification rate/100,000 population for new smear positive (NSP) cases under the national TB control programme (NTP) remained at around 70/100,000 population and have not changed much since 2006. Knowledge on TB disease, treatment and its management could be an important predictor for utilization of TB services and influence case detection under the NTP. Our objective is to describe knowledge of TB among newly diagnosed TB cases and community controls to assess factors associated with poor knowledge in order to identify programmatic implications for control measures. METHODS Embedded in TB prevalence survey 2007-2009, we included 240 TB cases from the TB registers and 240 persons ≥ 15 years of age randomly selected from the households where the survey was implemented. All participants were interviewed using a structured, pre-tested questionnaire to evaluate their TB knowledge. Regression analyses were done to assess associations with poor knowledge of TB. RESULTS Our survey documented that overall there was fair knowledge in all domains investigated. However, based on the number of correct answers to the questionnaires, community controls showed significantly poorer knowledge than the TB cases in the domains of TB transmission (80% vs. 88%), mode of transmission (67% vs. 82%), knowing ≥ 1 suggestive symptoms including cough (78% vs. 89%), curability of TB (90% vs. 98%) and availability of free treatment (75% vs. 95%). Community controls were more likely to have poor knowledge of TB issues compared to the TB cases even after controlling for other factors such as education and occupation in a multivariate model (OR 3.46, 95% CI: 2.00-6.09). CONCLUSIONS Knowledge on various aspects of TB and TB services varies significantly between TB cases and community controls in Bangladesh. The overall higher levels of knowledge in TB cases could identify them as peer educators in ongoing communication approaches to improve care seeking behavior of the TB suspects in the community and hence case detection.
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Affiliation(s)
- Shahed Hossain
- Centre for Equity and Health Systems (CEHS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Ashaque Husain
- National TB Control Programme (NTP), DGHS, Dhaka, Bangladesh
| | | | - Martien Borgdorff
- Department of Clinical Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Infection and Immunity Amsterdam, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Public Health Service, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
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Cai J, Wang X, Ma A, Wang Q, Han X, Li Y. Factors associated with patient and provider delays for tuberculosis diagnosis and treatment in Asia: a systematic review and meta-analysis. PLoS One 2015; 10:e0120088. [PMID: 25807385 PMCID: PMC4373856 DOI: 10.1371/journal.pone.0120088] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/19/2015] [Indexed: 11/18/2022] Open
Abstract
Background Delays in tuberculosis (TB) diagnosis and treatment is a major barrier to effective management of the disease. Determining the factors associated with patient and provider delay of TB diagnosis and treatment in Asia may contribute to TB prevention and control. Methods We searched the PubMed, EMBASE and Web of Science for studies that assessed factors associated with delays in care-seeking, diagnosis, or at the beginning of treatment, which were published from January 1992 to September 2014. Two reviewers independently identified studies that were related to our meta-analysis and extracted data from each study. Independent variables were categorized in separate tables for patient and provider delays. Results Among 45 eligible studies, 40 studies assessed patient delay whereas 30 assessed provider delay. Cross-sectional surveys were used in all but two articles, which included 17 countries and regions. Socio-demographic characteristics, TB-related symptoms and medical examination, and conditions of seeking medical care in TB patients were frequently reported. Male patients and long travel time/distance to the first healthcare provider led to both shorter patient delays [odds ratio (OR) (95% confidence intervals, CI) = 0.85 (0.78, 0.92); 1.39 (1.08, 1.78)] and shorter provider delays [OR (95%CI) = 0.96 (0.93, 1.00); 1.68 (1.12, 2.51)]. Unemployment, low income, hemoptysis, and positive sputum smears were consistently associated with patient delay [ORs (95%CI) = 1.18 (1.07, 1.30), 1.23 (1.02, 1.49), 0.64 (0.40, 1.00), 1.77 (1.07, 2.94), respectively]. Additionally, consultation at a public hospital was associated with provider delay [OR (95%CI) = 0.43 (0.20, 0.91)]. Conclusions We propose that the major opportunities to reduce delays involve enabling socio-demographic factors and medical conditions. Male, unemployed, rural residence, low income, hemoptysis, positive sputum smear, and long travel time/distance significantly correlated with patient delay. Male, long travel time/distance and consultation at a public hospital were related to provider delay.
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Affiliation(s)
- Jing Cai
- The College of Public Health, Qingdao University, Qingdao, Shandong Province, PR China
| | - Xianhua Wang
- The College of Public Health, Qingdao University, Qingdao, Shandong Province, PR China
| | - Aiguo Ma
- The College of Public Health, Qingdao University, Qingdao, Shandong Province, PR China
- * E-mail:
| | - Qiuzhen Wang
- The College of Public Health, Qingdao University, Qingdao, Shandong Province, PR China
| | - Xiuxia Han
- The College of Public Health, Qingdao University, Qingdao, Shandong Province, PR China
| | - Yong Li
- The College of Public Health, Beijing University, Beijing, PR China
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Abstract
OBJECTIVES To explore systematically the care seeking trajectories of tuberculosis (TB) cases up to four subsequent places of care and to assess the type of services provided at each place. METHODS TB cases detected actively during the 2007-2009 national TB prevalence survey and passively under the routine programme in the same period were interviewed by administering a standardised questionnaire. Care seeking and services provided up to four subsequent points were explored. Care seeking was further explored by categorising the providers into formal, informal and 'self-care' groups. RESULTS A total of 273 TB cases were included in this study, of which 33 (12%) were detected during the survey and 240 (88%) from the TB registers. Out of the 118 passively detected cases who first sought care from an informal provider, 52 (44.1%) remained in the informal sector at the second point of care. Similarly, out of the 52, 17 (32.7%) and out of the 17, 5 (29.4%) remained in the informal sector at the third and fourth subsequent points of care, respectively. All the 33 actively detected cases had 'self-care' at the first point, and 27 (81.8%) remained with 'self-care' up to the fourth point of care. Prescribing drugs (59-99%) was the major type of care provided by the formal and informal care providers at each point and was limited to the non-existent practice of investigation or referrals. CONCLUSIONS Free TB services are still underutilised by TB cases and informal caregivers remained the major care providers for such cases in Bangladesh. In order to improve case detection, it is necessary that the National Tuberculosis Programme immediately takes effective initiatives to engage all types of care providers, particularly informal providers who are the first point of care for the majority of the TB suspects.
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Affiliation(s)
- Shahed Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashaque Husain
- National TB Control Programme (NTP), DGHS, Dhaka, Bangladesh
| | | | - Martien Borgdorff
- Department of Clinical Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Infection and Immunity Amsterdam, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Public Health Service, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
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Htike W, Islam MA, Hasan MT, Ferdous S, Rifat M. Factors associated with treatment delay among tuberculosis patients referred from a tertiary hospital in Dhaka City: a cross-sectional study. Public Health Action 2013; 3:317-22. [PMID: 26393054 DOI: 10.5588/pha.13.0067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/04/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING A tertiary medical college hospital in Dhaka City Corporation area, Dhaka, Bangladesh. OBJECTIVES To identify factors associated with treatment delay among tuberculosis (TB) patients referred from a public diagnostic centre to various DOTS treatment centres in Dhaka City Corporation area, Bangladesh. METHODS A cross-sectional study was conducted among 123 patients referred from the Dhaka Medical College Hospital to different DOTS treatment centres during July-October 2012. Factors associated with treatment delay (>1 day between referral and initiation of DOTS treatment) were identified. RESULTS Among the 123 patients referred from the hospital, treatment delay was found to range between 2 and 17 days (median 2). In bivariate analysis, treatment delay was found to be significantly associated with the patient's diagnostic category. In multivariate analysis, World Health Organization ( WHO) Category II patients were found to be four times more likely to have treatment delay than WHO Category I patients, and married patients were much more likely to have treatment delays than unmarried patients. CONCLUSION The study findings suggest that the main factors contributing to treatment delay among TB patients were history of previous anti-tuberculosis treatment, marital status and age. Patients should be given extensive information about the dangers of treatment delay before referring them to DOTS treatment centres.
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Affiliation(s)
- W Htike
- World Health Organization, Myanmar, Yangon, Myanmar
| | - M A Islam
- BRAC Health, Nutrition and Population Programme, Dhaka, Bangladesh
| | - M T Hasan
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - S Ferdous
- BRAC Health, Nutrition and Population Programme, Dhaka, Bangladesh
| | - M Rifat
- BRAC Health, Nutrition and Population Programme, Dhaka, Bangladesh ; University of Newcastle, Newcastle, New South Wales, Australia
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Chiang CY, Van Weezenbeek C, Mori T, Enarson DA. Challenges to the global control of tuberculosis. Respirology 2013; 18:596-604. [DOI: 10.1111/resp.12067] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 01/22/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease; Paris; France
| | - Catharina Van Weezenbeek
- Stop TB and Leprosy Elimination Unit; World Health Organization; Western Pacific Regional Office, Manila; Philippines
| | - Toru Mori
- Research Institute of Tuberculosis; Japan Anti-Tuberculosis Association; Tokyo; Japan
| | - Donald A. Enarson
- International Union Against Tuberculosis and Lung Disease; Paris; France
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Dowdy DW, Basu S, Andrews JR. Is passive diagnosis enough? The impact of subclinical disease on diagnostic strategies for tuberculosis. Am J Respir Crit Care Med 2012; 187:543-51. [PMID: 23262515 DOI: 10.1164/rccm.201207-1217oc] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Tuberculosis (TB) is characterized by a subclinical phase (symptoms absent or not considered abnormal); prediagnostic phase (symptoms noticed but diagnosis not pursued); and clinical phase (care actively sought). Diagnostic capacity during these phases is limited. OBJECTIVES To estimate the population-level impact of TB case-finding strategies in the presence of subclinical and prediagnostic disease. METHODS We created a mathematical epidemic model of TB, calibrated to global incidence. We then introduced three prototypical diagnostic interventions: increased sensitivity of diagnosis in the clinical phase by 20% ("passive"); early diagnosis during the prediagnostic phase at a rate of 10% per year ("enhanced"); and population-based diagnosis of 5% of undiagnosed prevalent cases per year ("active"). MEASUREMENTS AND MAIN RESULTS If the subclinical phase was ignored, as in most models, the passive strategy was projected to reduce TB incidence by 18% (90% uncertainty range [UR], 11-32%) by year 10, compared with 23% (90% UR, 14-35%) for the enhanced strategy and 18% (90% UR, 11-28%) for the active strategy. After incorporating a subclinical phase into the model, consistent with population-based prevalence surveys, the active strategy still reduced 10-year TB incidence by 16% (90% UR, 11-28%), but the passive and enhanced strategies' impact was attenuated to 11% (90% UR, 8-25%) and 6% (90% UR, 4-13%), respectively. The degree of attenuation depended strongly on the transmission rate during the subclinical phase. CONCLUSIONS Subclinical disease may limit the impact of current diagnostic strategies for TB. Active detection of undiagnosed prevalent cases may achieve greater population-level TB control than increasing passive case detection.
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Affiliation(s)
- David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Hossain S, Quaiyum MA, Zaman K, Banu S, Husain MA, Islam MA, Cooreman E, Borgdorff M, Lönnroth K, Salim AH, van Leth F. Socio economic position in TB prevalence and access to services: results from a population prevalence survey and a facility-based survey in Bangladesh. PLoS One 2012; 7:e44980. [PMID: 23028718 PMCID: PMC3459948 DOI: 10.1371/journal.pone.0044980] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/15/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Bangladesh DOTS has been provided free of charge since 1993, yet information on access to TB services by different population group is not well documented. The objective of this study was to assess and compare the socio economic position (SEP) of actively detected cases from the community and the cases being routinely detected under National Tuberculosis Control Programme (NTP) in Bangladesh. METHODS AND FINDINGS SEP was assessed by validated asset item for each of the 21,427 households included in the national tuberculosis prevalence survey 2007-2009. A principal component analysis generated household scores and categorized in quartiles. The distribution of 33 actively identified cases was compared with the 240 NTP cases over the identical SEP quartiles to evaluate access to TB services by different groups of the population. The population prevalence of tuberculosis was 5 times higher in the lowest quartiles of population (95.4, 95% CI: 48.0-189.7) to highest quartile population (19.5, 95% CI: 6.9-55.0). Among the 33 cases detected during survey, 25 (75.8%) were from lower two quartiles, and the rest 8 (24.3%) were from upper two quartiles. Among TB cases detected passively under NTP, more than half of them 137 (57.1%) were from uppermost two quartiles, 98 (41%) from the second quartile, and 5 (2%) in the lowest quartile of the population. This distribution is not affected when adjusted for other factors or interactions among them. CONCLUSIONS The findings indicate that despite availability free of charge, DOTS is not equally accessed by the poorer sections of the population. However, these figures should be interpreted with caution since there is a need for additional studies that assess in-depth poverty indicators and its determinants in relation to access of the TB services provided in Bangladesh.
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Affiliation(s)
- Shahed Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh.
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