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Gupta P, Singh P, Das A, Kumar R. Determinants of tuberculosis: an example of high tuberculosis burden in the Saharia tribe. Front Public Health 2023; 11:1226980. [PMID: 37920577 PMCID: PMC10619692 DOI: 10.3389/fpubh.2023.1226980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Tuberculosis (TB) is a significant public health problem among the Saharia community, an underprivileged tribal group in the west-central part of India. There are several challenges for India's TB control program to curtail TB in the Saharia tribe. Malnutrition, poor health sector facilities, lower socio-economic status, and substance abuse are interconnected and synergistic factors contributing to a high burden of TB in the Saharia tribe. In this review, efforts are made to collate the findings of previous studies discussing the causes of high burden of TB in the Saharia tribe, social gaps for mitigating these preventable risk factors of TB in the Saharia tribe, and the plausible solutions for closing these gaps. The concept of Health in All Policies and intersectoral co-ordination is needed for the reduction of TB in the Saharia tribe and to make India TB-free by the year 2025.
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Affiliation(s)
| | | | | | - Ravindra Kumar
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
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Varughese M, Heffernan C, Li MY, Long R. Time to diagnosis and treatment of pulmonary tuberculosis in indigenous peoples: a systematic review. BMC Infect Dis 2023; 23:131. [PMID: 36882707 PMCID: PMC9989566 DOI: 10.1186/s12879-023-08098-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Time to diagnosis and treatment is a major factor in determining the likelihood of tuberculosis (TB) transmission and is an important area of intervention to reduce the reservoir of TB infection and prevent disease and mortality. Although Indigenous peoples experience an elevated incidence of TB, prior systematic reviews have not focused on this group. We summarize and report findings related to time to diagnosis and treatment of pulmonary TB (PTB) among Indigenous peoples, globally. METHODS A Systematic review was performed using Ovid and PubMed databases. Articles or abstracts estimating time to diagnosis, or treatment of PTB among Indigenous peoples were included with no restriction on sample size with publication dates restricted up to 2019. Studies that focused on outbreaks, solely extrapulmonary TB alone in non-Indigenous populations were excluded. Literature was assessed using the Hawker checklist. Registration Protocol (PROSPERO): CRD42018102463. RESULTS Twenty-four studies were selected after initial assessment of 2021 records. These included Indigenous groups from five of six geographical regions outlined by the World Health Organization (all except the European Region). The range of time to treatment (24-240 days), and patient delay (20 days-2.5 years) were highly variable across studies and, in at least 60% of the studies, longer in Indigenous compared to non-Indigenous peoples. Risk factors associated with longer patient delays included poor awareness of TB, type of health provider first seen, and self-treatment. CONCLUSION Time to diagnosis and treatment estimates for Indigenous peoples are generally within previously reported ranges from other systematic reviews focusing on the general population. However among literature examined in this systematic review that stratified by Indigenous and non-Indigenous peoples, patient delay and time to treatment were longer compared to non-Indigenous populations in over half of the studies. Studies included were sparse and highlight an overall gap in literature important to interrupting transmission and preventing new TB cases among Indigenous peoples. Although, risk factors unique to Indigenous populations were not identified, further investigation is needed as social determinants of health among studies conducted in medium and high incidence countries may be shared across both population groups. Trial registration N/a.
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Affiliation(s)
- Marie Varughese
- Department of Mathematics and Statistical Sciences, School of Public Health, University of Alberta, 632 Central Academic Building, Edmonton, AB, T6G2G1, Canada.
| | - Courtney Heffernan
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G2R7, Canada
| | - Michael Y Li
- Department of Mathematics and Statistical Sciences, University of Alberta, Edmonton, AB, T6G2G1, Canada
| | - Richard Long
- Faculty of Medicine and Dentistry, School of Public Health, University of Alberta, Edmonton, AB, T6G2R7, Canada
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Jiang Y, Luo L, Gui M, Liu L, Lin Y, Deng G, Chen J, Zhang P. Duration and Determinants of Delayed Diagnosis with Tuberculosis in Shenzhen, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2022; 15:1473-1481. [PMID: 35937967 PMCID: PMC9346302 DOI: 10.2147/rmhp.s367998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Early diagnosis and timely treatment of tuberculosis are critical for disease control and management. However, diagnostic delay remains severe around the world. We aim to evaluate the duration and factors associated with diagnostic delay of tuberculosis in Shenzhen, China. Methods We conducted a face-to-face interview to collect the whole care-seeking process of patients diagnosed with active TB in Shenzhen, China, from April 1 to September 30, 2021. The duration from symptom onset to confirmed diagnosis was recorded. The risk factors of diagnostic delay were identified by binary stepwise logistic regression analysis. Results Among 288 confirmed TB cases, 170 (59.0%) were delayed diagnosis. The median diagnostic delay was 39.5 days. Median patient delay was 23 days and health system delay was 7 days. Income ≤315USD/month (OR = 2.97 [95% CI: 1.15–7.69]), cough (OR = 3.00 [95% CI: 1.16–7.76]), weight loss (OR = 15.59 [95% CI: 1.85–131.56]), use of traditional Chinese Medicine (OR = 5.03 [95% CI: 1.04–24.31]) and over-the-counter cough syrup (OR = 2.73 [95% CI: 1.10–6.76]) were significant risk factors for patient delay. Fever (OR = 0.13[95% CI: 0.04–0.48]) and hemoptysis (OR = 0.06 [95% CI0.01–0.30]) were protective factors for patient delay. Cough (OR = 2.85 [95% CI: 1.49–5.49]) and availability of chest X-ray (OR = 0.21[CI: 0.11–0.39]) were factors associated with health system delay. Conclusion Delayed diagnosis of tuberculosis remains an unresolved problem. Patients with low income, self-treatment with over-the-counter medicine and accepting TCM suffered from a higher risk of patient delay. It is important to give more help to the vulnerable people and strengthen tuberculosis knowledge among primary health providers. Keeping all health providers alert to TB symptoms can facilitate earlier TB diagnosis and better disease control.
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Affiliation(s)
- Youli Jiang
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Lan Luo
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Min Gui
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Linlin Liu
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Yi Lin
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Guofang Deng
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Jingfang Chen
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Correspondence: Jingfang Chen; Peize Zhang, Email ;
| | - Peize Zhang
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
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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] [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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Thomas BE, Thiruvengadam K, S. R, Rani S, S. V, Gangadhar Rao V, Yadav R, J. B, Paluru V, Jacob Purthy A, Hussain T, Indira Krishna AK, Joseph A, Kumar Bansal A, Anand P, Das P, R. John K, K. RD, P. S, Moral R, S. A, V. C, G. S. T, Das M, Khan AM, Kaur H. Understanding health care-seeking behaviour of the tribal population in India among those with presumptive TB symptoms. PLoS One 2021; 16:e0250971. [PMID: 34014938 PMCID: PMC8136700 DOI: 10.1371/journal.pone.0250971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/17/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Understanding the drivers for care-seeking among those who present with symptoms of TB is crucial for early diagnosis of TB and prompt treatment, which will in turn halt further TB transmission. While TB is a challenge among the tribal population, little is known about the care-seeking behaviour and the factors influencing care-seeking behaviour among the tribal population across India. METHODOLOGY This community-based descriptive study was carried out in 17 states of India across 6 zones, covering 88 villages from tribal districts with over 70% tribal population. The sample population included individuals ≥15 years old who were screened through an interview for symptoms suggestive of pulmonary TB (PTB), currently and/or previously on anti-TB treatment. Those with symptoms were then assessed on their health-seeking behavior using a semi-structured interview schedule. RESULTS Among 74532 eligible participants screened for symptoms suggestive of TB, 2675 (3.6%) were found to be presumptive TB cases. Of them, 659 (24.6%) sought care for their symptoms. While 48.2% sought care after a week, 19.3% sought care after one month or more, with no significant difference in the first point of care; 46.9% approaching a private and 46.7% a public facility. The significant factors influencing care-seeking behaviour were knowledge on TB (OR: 4.64 (3.70-5.83), p < 0.001), age<35 years (OR: 1.60 (1.28-2.00), p < 0.001), co-morbidities like asthma (OR: 1.80 (1.38-2.35), p < 0.001) and blood pressure (OR: 2.59 (1.75-3.85), p < 0.001), symptoms such as blood in sputum (OR: 1.69 (1.32-2.16), p < 0.001), shortness of breath (OR: 1.43 (1.19-1.72), p < 0.001) and weight loss (OR: 1.59 (1.33-1.89), p < 0.001). The cough was the most often reported symptom overall. There were gender differences in symptoms that prompted care-seeking: Males were more likely to seek care for weight loss (OR: 1.78 (1.42-2.23), p<0.001), blood in the sputum (OR: 1.69 (1.25-2.28), p<0.001), shortness of breath (OR: 1.49 (1.18-1.88), p<0.001) and fever (OR: 1.32 (1.05-1.65), p = 0.018). Females were more likely to seek care for blood in sputum (OR: 1.68 (1.10-2.58), p = 0.018) and shortness of breath (OR = 1.35, (1.01-1.82), p = 0.048). The cough did not feature as a significant symptom that prompted care-seeking. CONCLUSION Delayed healthcare-seeking behaviour among those with symptoms presumptive of TB in the tribal population is a major concern. Findings point to differences across gender about symptoms that prompt care-seeking in this population. Gender-sensitive interventions with health system strengthening are urgently needed to facilitate early diagnosis and treatment among this population.
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Affiliation(s)
- Beena E. Thomas
- Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Kannan Thiruvengadam
- Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Raghavi S.
- Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Sudha Rani
- Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Vetrivel S.
- Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Vikas Gangadhar Rao
- Indian Council of Medical Research–National Institute for Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Rajiv Yadav
- Indian Council of Medical Research–National Institute for Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Bhat J.
- Indian Council of Medical Research–National Institute for Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Vijayachari Paluru
- Indian Council of Medical Research–Regional Medical Research Centre, Port Blair, Andaman and Nicobar Islands, India
| | | | - Tahziba Hussain
- Indian Council of Medical Research–Regional Medical Research Centre, Bhubaneshwar, Odisha, India
| | | | - Alex Joseph
- School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu
| | - Avi Kumar Bansal
- National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | | | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - K. R. John
- Apollo Institute of Medical Sciences & Research, Chittoor, India
| | | | - Sunish P.
- Indian Council of Medical Research–Regional Medical Research Centre, Port Blair, Andaman and Nicobar Islands, India
| | - Rony Moral
- Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Azhagendran S.
- Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Chandrasekaran V.
- Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Madhuchhanda Das
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - A. M. Khan
- Indian Council of Medical Research, New Delhi, India
| | - Harpreet Kaur
- Indian Council of Medical Research, New Delhi, India
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Datiko DG, Jerene D, Suarez P. Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study. BMC Public Health 2020; 20:1126. [PMID: 32680489 PMCID: PMC7368783 DOI: 10.1186/s12889-020-08967-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/20/2020] [Indexed: 01/16/2023] Open
Abstract
Background Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia. Methods This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. Results Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10–45), 4 (2–10) and 2 (1–3) days respectively. The median (IQR) of total delay was 33 (19–67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay. Conclusion TB patients’ delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.
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Affiliation(s)
- Daniel G Datiko
- Challenge TB Ethiopia /Management Sciences for Health Ethiopia, box 1157, code 1250, Addis Ababa, Ethiopia.
| | - Degu Jerene
- Challenge TB Ethiopia /Management Sciences for Health Ethiopia, box 1157, code 1250, Addis Ababa, Ethiopia
| | - Pedro Suarez
- Management Sciences for Health, Senior Director Infectious Disease Cluster, Arlington, USA
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Mallick G, Nagaraja SB, Sagili KD, Khaparde K, Satyanarayana S, Chadha S. Revised National Tuberculosis Control Programme (RNTCP) Tribal Action Plan Fund Utilisation: How Does Chhattisgarh State in India Fare? ACTA ACUST UNITED AC 2019. [DOI: 10.4236/jtr.2019.71001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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