Is physical access an impediment to tuberculosis diagnosis and treatment? A study from a rural district in North India
OBJECTIVE: To study the association of distance (physical access) to DMCs with loss to follow-up (LTFU) of presumptive tuberculosis (TB) cases while undergoing diagnostic sputum examination and failure to initiate treatment among smear-positive TB patients after diagnosis.
DESIGN: A cross-sectional, record-based study was undertaken to analyse patient records from routine laboratory registers in all DMCs from January to June 2012.
RESULT: More than 50% of presumptive TB cases had to travel >7 km to reach the DMC, totalling >28 km for two sputum examinations for the evaluation of an episode. The distance (>10 km) to the diagnostic facility was found to be significantly associated (P < 0.01), both with LTFU during diagnosis and with a delay (>7 days) in initiating treatment after diagnosis. There was a significant correlation (r < 0.7) between distance to the DMC and time to initiate treatment among smear-positive TB cases.
CONCLUSION: Distance from the nearest facility represents a significant risk for LTFU during diagnosis and delayed initiation of treatment after diagnosis. Further decentralisation of TB care services to the community level is required by expanding the network of DMCs or by organising sputum collection and transportation.
Keywords: India; RNTCP; TB diagnosis; physical access
Document Type: Research Article
Affiliations: 1: School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India 2: International Union Against Tuberculosis and Lung Disease, New Delhi, India 3: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa 4: REACH, Chennai, India 5: Revised National Tuberculosis Control Programme, District Fatehgarh Sahib, Punjab, India
Publication date: September 21, 2013
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