Delay in diagnosis of tuberculosis in Rawalpindi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Delay in diagnosis and treatment of tuberculosis (TB) may enhance the chances of morbidity and mortality and play a key role in continuous transmission of the bacilli. The objective of this study was to describe health care seeking behavior of suspected TB patients and initial diagnostic work up prior to consultation and diagnosis at National TB Center (NTC).</p> <p>Findings</p> <p>Interviews of 252 sputum smear positive patients were taken from NTC, Rawalpindi. The duration between on-set of symptoms and start of treatment was considered as the total delay and correlated with general characteristics of TB patients. The proportion of males and females were 49.6% and 50.4% with median age of 25 and 24 years respectively. A median delay of 56 days (8 weeks) was observed which was significantly associated with age, cough and fever. More than 50% of the current patients had a history of contact with previously diagnosed TB patients. The majority of patients (63%) visited health care providers within three weeks of appearance of symptoms but only thirty five percent were investigated for TB diagnosis.</p> <p>Conclusion</p> <p>Cough and fever are being ignored as likely symptoms of TB by patients as well as health care providers resulting in delay. Engaging private practitioners through public private mix (PPM) approach for expansion of TB diagnosis and increasing public awareness could be more beneficial to reduce delay.</p

Risk factors for treatment delay in pulmonary tuberculosis in Recife, Brazil

BACKGROUND: Tuberculosis is still a great challenge to public health in Brazil and worldwide. Early detection followed by effective therapy is extremely important in controlling the disease. Recent studies have investigated reasons for delays in treatment, but there is no agreed definition of what constitutes an "acceptable" delay. This study investigates factors associated with total delay in treatment of tuberculosis. METHODS: A cohort of adult cases of pulmonary tuberculosis diagnosed over a two-year period was studied. Patients were interviewed on entry, reporting the duration of symptoms before the start of treatment, and sputum and blood samples were collected. It was decided that sixty days was an acceptable total delay. Associations were investigated using univariable and multivariable analysis and the population attributable fraction was estimated. RESULTS: Of 1105 patients, 62% had a delay of longer than 60 days. Age, sex, alcoholism and difficulty of access were not associated with delays, but associations were found in the case of unemployment, having given up smoking, having lost weight and being treated in two of the six health districts. The proportion attributable to: not being an ex-smoker was 31%; unemployment, 18%; weight loss, 12%, and going to the two worst health districts, 25%. CONCLUSION: In this urban area, delays seem to be related to unemployment and general attitudes towards health. Although they reflect the way health services are organized, delays are not associated with access to care

A systematic review of delay in the diagnosis and treatment of tuberculosis

Background Early diagnosis and immediate initiation of treatment are essential for an effective tuberculosis (TB) control program. Delay in diagnosis is significant to both disease prognosis at the individual level and transmission within the community. Most transmissions occur between the onset of cough and initiation of treatment. Methods A systematic review of 58 studies addressing delay in diagnosis and treatment of TB was performed. We found different definitions of, for example, debut of symptoms, first appropriate health care provider, time to diagnosis, and start of treatment. Rather than excluding studies that failed to meet strict scientific criteria (like in a meta-analysis), we tried to extract the "solid findings" from all of them to arrive on a more global understanding of diagnostic delay in TB. Results The main factors associated with diagnostic delay included human immunodeficiency virus; coexistence of chronic cough and/or other lung diseases; negative sputum smear; extrapulmonary TB; rural residence; low access (geographical or sociopsychological barriers); initial visitation of a government low-level healthcare facility, private practitioner, or traditional healer; old age; poverty; female sex; alcoholism and substance abuse; history of immigration; low educational level; low awareness of TB; incomprehensive beliefs; self-treatment; and stigma. Conclusion The core problem in delay of diagnosis and treatment seemed to be a vicious cycle of repeated visits at the same healthcare level, resulting in nonspecific antibiotic treatment and failure to access specialized TB services. Once generation of a specific diagnosis was in reach, TB treatment was initiated within a reasonable period of time

IN VITRO BULBLET INDUCTION FROM BULB SCALES OF ENDANGERED ORNAMENTAL PLANT MUSCARI AZUREUM

Muscari azureum with beautiful white and sky blue flowers is an important endangered ornamental plant of Turkey and needs exploitation for commercial propagation. 2-4 bulb scale explants of M. azureum were cultured in basal media supplemented with 2 mg/l 2,4-D, 20 g/l mannitol, 20 g/l sucrose, 0.5 mg/l NAA and different concentrations of BAP KIN, 2iP and TDZ plus 2 g/l gelrite. The best regeneration on 2 or 4 scales and the highest mean number of bulblets per explants (mean 8.77 per explant)" was achieved on an Orchimax medium supplemented with 2.0 mg/l BAP, 2 mg/l 2,4-D, 20 g/l mannitol, 20 g/l sucrose and 0.5 mg/l NAA for 2-scales. Mature bulblets were excised and individually rooted on half strength MS medium supplemented with I mg/l IBA, 0.5 g/l activated charcoal, 20 g/l sucrose and 6 g/l agar Regenerated plants from 2 and 4 scales were acclimatized with a 14% survival rate after 3 weeks

Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Pulmonary tuberculosis continues to increase due to late patient presentation. The study was conducted at a chest clinic of a general hospital in Lagos, Nigeria, to investigate patterns of delays before treatment amongst tuberculosis patients.</p> <p>Methods</p> <p>Longitudinal recruitment using a health worker administered protocol to determine time interval from onset of symptoms to initiation of treatment. Presentation to a health facility after 30 days of the onset of symptoms was classified as patient delay. Doctor delay was when patients stayed for more than 15 days with the referring doctor.</p> <p>Results</p> <p>One hundred and forty-one patients were recruited. The mean age was 29.5 ± 11.0 years, 89 (63%) were males and 52 (37%) were females. One hundred and sixteen (82%) had positive smears. One hundred and seventeen (83%) delayed their seeking help from health facilities longer than one month after the onset of symptoms. The median patient delay was eight weeks; median doctor delay was one week, median treatment delay was one week and the median total delay was 10 weeks. Doctor delay was observed in 19 (13%) patients. Patient delay was the most frequent type of delay observed and was the major contributor to the overall total delay. Patient delay was not significantly associated with patients' socio-demographic characteristics such as age, gender and educational level.</p> <p>Conclusion</p> <p>Majority of TB patients at this centre did not present early to health facilities and continue to serve as reservoirs of infection. Patient education on the disease may help reduce delays in starting treatment.</p