TITLE

What 'outliers' tell us about missed opportunities for tuberculosis control: a cross-sectional study of patients in Mumbai, India

AUTHOR(S)
Pradhan, Anagha; Kielmann, Karina; Gupte, Himanshu; Bamne, Arun; Porter, John D. H.; Rangan, Sheela
PUB. DATE
January 2010
SOURCE
BMC Public Health;2010, Vol. 10 Issue 1, p263
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: India's Revised National Tuberculosis Control Programme (RNTCP) is deemed highly successful in terms of detection and cure rates. However, some patients experience delays in accessing diagnosis and treatment. Patients falling between the 96th and 100th percentiles for these access indicators are often ignored as atypical 'outliers' when assessing programme performance. They may, however, provide clues to understanding why some patients never reach the programme. This paper examines the underlying vulnerabilities of patients with extreme values for delays in accessing the RNTCP in Mumbai city, India. Methods: We conducted a cross-sectional study with 266 new sputum positive patients registered with the RNTCP in Mumbai. Patients were classified as 'outliers' if patient, provider and system delays were beyond the 95th percentile for the respective variable. Case profiles of 'outliers' for patient, provider and system delays were examined and compared with the rest of the sample to identify key factors responsible for delays. Results: Forty-two patients were 'outliers' on one or more of the delay variables. All 'outliers' had a significantly lower per capita income than the remaining sample. The lack of economic resources was compounded by social, structural and environmental vulnerabilities. Longer patient delays were related to patients' perception of symptoms as nonserious. Provider delays were incurred as a result of private providers' failure to respond to tuberculosis in a timely manner. Diagnostic and treatment delays were minimal, however, analysis of the 'outliers' revealed the importance of social support in enabling access to the programme. Conclusion: A proxy for those who fail to reach the programme, these case profiles highlight unique vulnerabilities that need innovative approaches by the RNTCP. The focus on 'outliers' provides a less resource- and time-intensive alternative to community-based studies for understanding the barriers to reaching public health programmes.
ACCESSION #
52038664

 

Related Articles

  • Evaluation of the Burden of Unsuspected Pulmonary Tuberculosis and Co-Morbidity with Non-Communicable Diseases in Sputum Producing Adult Inpatients. Bates, Matthew; O'Grady, Justin; Mwaba, Peter; Chilukutu, Lophina; Mzyece, Judith; Cheelo, Busiku; Chilufya, Moses; Mukonda, Lukundo; Mumba, Maxwell; Tembo, John; Chomba, Mumba; Kapata, Nathan; Rachow, Andrea; Clowes, Petra; Maeurer, Markus; Hoelscher, Michael; Zumla, Alimuddin // PLoS ONE;Jul2012, Vol. 7 Issue 7, p1 

    Background: A high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many cases of active TB and drug-resistant TB remain undiagnosed. Tertiary care hospitals provide an opportunity to study TB co-morbidity with noncommunicable and other communicable diseases (NCDs/CDs). We...

  • Characteristics of tuberculosis patients with positive sputum smear in Catalonia, Spain. Godoy, P.; Domínguez, A.; Alcaide, J.; Camps, N.; Jansà, J. M.; Minguell, S.; Pina, J. M.; Díez, M. // European Journal of Public Health;Mar2004, Vol. 14 Issue 1, p71 

    Background: Patients with positive sputum smears are those with the capacity to spread infection. The objective of this study was to describe the incidence of tuberculosis in Catalonia (an autonomous community in the northeast of Spain which includes Barcelona) and to determine risk factors...

  • Profile and Outcome of Unilateral Tuberculous Lung Destruction in Ilorin, Nigeria. Fawibe, A. E.; Salami, A. K.; Oluboyo, P. O.; Desalu, O. O.; Odeigha, L.O. // West African Journal of Medicine;Mar/Apr2011, Vol. 30 Issue 2, p131 

    BACKGROUND: Unilateral tuberculous lung destruction is a serious chronically disabling and often fatal complication of pulmonary tuberculosis. A few previous studies have dealt with some aspects of this entity among Nigerians with pulmonary tuberculosis but these studies may not truly reflect...

  • PLEUROPULMONARY PARAGONIMIASIS MIMICKING PULMONARY TUBERCULOSIS -- A REPORT OF THREE CASES. Singh, T. N.; Kananbala, S.; Devi, K. S. // Indian Journal of Medical Microbiology;Apr2005, Vol. 23 Issue 2, p131 

    Paragonimiasis is an important cause of pulmonary disease worldwide. Infection in humans mainly occurs by ingestion of raw or undercooked freshwater crabs or crayfishes. The disease is well known in endemic regions of Asian countries, where culturally based methods of food preparation foster...

  • PREVALENCE OF PULMONARY TUBERCULOSIS IN FAR WESTERN NEPAL. Joshi, Y. P.; Mishra, P. N.; Joshi, D. D. // Journal of the Nepal Medical Association;Apr-Jun2005, Vol. 44 Issue 158, p47 

    Keeping in view of high prevalence of tuberculosis in far western development region in different reports, a door to door survey of 125 household was carried out randomly in Mahendra Nagar municipality ward no 13 of Kanchanpur district to pick up symptomatics suggestive of pulmonary tuberculosis...

  • CHAPTER 8: STANDARDIZED TUBERCULOSIS CASE DEFINITIONS AND TREATMENT CATEGORIES.  // TB/HIV: A Clinical Manual;2004, p105 

    The article presents the standardized tuberculosis (TB) case definitions and treatment categories. When a patient is diagnosed with TB, it means that the patient has symptomatic disease due to lesions caused by Mycobacterium tuberculosis. It is critical to know the type of TB before starting...

  • THE EXPERIENCE OF SURGICAL TREATMENT OF PATIENTS WITH PULMONARY EXTENSIVELY RESISTANT TUBERCULOSIS. Yerimbetov, Kulakhmet; Abildaev, Thleukhan; Alenova, Arike; Zetov, Askar // Medical & Health Science Journal;Apr2011, Vol. 5 Issue 1, p84 

    Analysis of outcomes in 59 patients treated from extensively resistant tuberculosis (XDR TB) with anti-TB drugs of the reserve line was conducted. Implementation of surgical methods of treatment allowed to obtain the sputum smear conversion in 65.5% of cases; while conventional therapy, without...

  • Failure to complete the TB diagnostic algorithm in urban Perú: a study of contributing factors. Ouyang, Helen; Chepote, Felipe; Gilman, Robert H.; Moore, David A. J. // Tropical Doctor;Apr2005, Vol. 35 Issue 2, p120 

    The article focuses on the study which aims to determine why tuberculosis patients keep failing to return with their second sample after they entered the first diagnostic algorithm of two sputum specimens for acid-fast bacillus smear. To test, a survey was conducted with the use of...

  • Diagnosis of TB from smear & culture negative sputum specimens by IS 6110 based PCR. Abraham, Philip Raj; Sharma, V. D.; Shivannavar, C. T. // Indian Journal of Medical Research;Feb2012, Vol. 135 Issue 2, p249 

    The article presents a letter about the diagnosis of tuberculosis (TB) from smear and culture negative sputum specimens by IS 6110-based polymerase chain reaction (PCR) methods. Despite its low specificity and variable sensitivity, the use of smear microscopy to diagnose TB still remains in...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics