A cross sectional study to estimate delay in diagnosis and treatment of tuberculosis (TB) among patients attending urban health centre in an urban slum area

Abstract

Background: RNTCP (Revised National Tuberculosis Control Program) is an application in India of the (World Health Organisation) WHO recommended (Directly Observed Treatment Short Course) DOTS strategy. Early diagnosis and immediate initiation of treatment are essential for an effective TB control program. Delay under RNTC programme is of types: patients delay, health care systems delay, DOTS delay and total delay. Objectives: To determine average delay on part of patient and health system in diagnosis of tuberculosis, treatment delay in starting DOTS and total delay. Methodology: A cross-sectional descriptive study of 464 tuberculosis patients was conducted in an urban health center (UHC) of an urban slum area of Mumbai. Patients registered under RNTCP during 1 year i.e. from 1 st January to 31 st December 2016 were interviewed regarding their complaints and reporting to a health care facility (time taken and type-private or government), time taken for diagnosis and starting treatment. Thus, four types of delay were calculated. Results: Among 464 patients, mean patient’s delay, health system delay and total delay were 21.09 days (median 15), 14.41 days (median 6) and 35.50 days (median 21) respectively. Almost 60% of total delay was constituted from patient’s delay. Mean treatment delay was 2.84 days (median 3.19). Total delay was significantly longerin females. Almost, 40% of the patients reported to a health facility within 15 days of onset of symptoms. Conclusion: Patient delay was significantly more among sputum negative pulmonary TB patients than sputum positive patients. Health system delay to diagnose TB was more if private practitioners were approached first. Only 11% (35) pulmonary TB patients were advised sputum examination as the first investigation by private practitioners.