The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #63314

Ashutosh Tamhane, MD, DPH, Department of Epidemiology and International Health, University of Alabama at Birmingham, AL, 1146 16th Avenue South, Summit Apartments, Apt J, Birmingham, AL 35205, 205-322-0421, artamhane@yahoo.com, Nalini Sathiakumar, MD, DrPH, Epidemiology and International Health, University of Alabama at Birrmingham, 523, Ryals Building, 1665 University Blvd., School of Public Health, Birmingham, AL 35294, Sten Vermund, MDPhD, geographic medicine, University of Alabama at Birmingham School of Public Health, bevill buiding, 19th street, birmingham, AL 35205, Connie L. Kohler, DrPH, Department of Health Behavior School of Public Health, University of Alabama at Birmingham, RPHB 227, 1530 3rd Ave S, Birmingham, AL 35294-0022, Alka Karande, MBBS, DPH, Health Department, Brihan-Mumbai Municipal Corporation, F-South BMC Office, 4th floor, Parel, Mumbai, India, and Girish Ambe, MPH, DPH, Mumbai District Tuberculosis Control Society, Brihan-Mumbai Municipal Corporation, New Muni Stores Bldg, Room 111, Dr. E. Moses Rd., Worli Naka, Mumbai, India.

OBJECTIVES: The purpose of this cross-sectional study was to determine factors responsible for “patient delay” (seeking care after 20 days of onset of symptoms) and “treatment delay” (initiating treatment after 14 days of first consultation) in newly diagnosed sputum smear-positive pulmonary tuberculosis (TB) patients attending the health centers of Mumbai, India; and to compare gender differences in these delays. METHODS: The subjects, 75 men and 75 women, were randomly selected from 29 of 243 health centers. Medical records and in person interview elicited information about the length of time entailed for seeking care and initiating treatment; symptoms and knowledge about TB; health care access and other factors. Analysis included the use of non-parametric test to evaluate differences in continuous measures and chi-square test for proportions. Crude and adjusted prevalence odds ratios were computed for patient and treatment delays. RESULTS: Overall, 29% (43/150) subjects had patient delay and 81% (122/150) had treatment delay. Women were more likely to experience delays than men. Patients consulting non-allopathic health care provider on their first visit were more (POR = 14.3, 95% CI: 1.9 – 110.6) likely to experience treatment delay than those who first sought allopathic care. Most (63%) of the patients acquired knowledge about TB from other TB patients and from the community (66%); media played a small role in educating the patients. CONCLUSIONS: An intervention program using peer leaders to educate the community, and education of health care providers to provide early diagnosis and management of TB patients would be crucial.

Learning Objectives:

• List some crucial factors responsible for “patient delay” and “treatment delay” in pulmonary tuberculosis (TB) patients in a developing country and to learn about gender differences with regard to these factors and delays. 2)Be able to plan an intervention that seeks to enhance optimal management of TB patients, thereby reducing the spread of the disease.

Keywords: Tuberculosis,

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: 1) University of Alabama at Birmingham (UAB) , AL, USA 2) Health Department, Brihan-Mumbai Municipal Corporation (BMC), Mumbai, India
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.