Why delayed diagnosis leads to more TB cases


Posted at Apr 24 2014 11:26 PM | Updated as of Apr 25 2014 07:32 AM

MANILA -- Delayed diagnosis is the leading cause of high tuberculosis (TB) cases in urban poor communities, according to a recent study.

The "Barriers of Early TB Diagnosis among the Poor in Highly Urbanized Areas in the Philippines," done by the Philippine Institute for Development Studies (PIDS) and the Department of Health (DOH), showed that TB remains as the 4th leading cause of mortality among Filipinos, despite the significant drop in TB prevalence in the last decade.

The 2007 Philippine National Tuberculosis Prevalence Survey revealed that there are approximately 3 TB cases in every 1,000 Filipinos.

Moreover, the DOH confirmed that there is a prevalence of the multidrug-resistant TB in the country, which is fatal.

“Higher risk of tuberculosis can be attributed to delayed diagnosis,” said Krishna Reyes, study co-author and PIDS research consultant during a seminar held in Makati City.

She said early diagnosis is essential in the control and prevention of TB, especially in the urban poor population, as they are at higher risk of acquiring both infectious and non-communicable diseases.

“Urban poor communities have 1.5 times higher prevalence of disease than their non-poor counterparts," Reyes said.

She explained that transmission usually takes place between the period of occurrence of cough and initiation of treatment. Late diagnosis increases the reproductive rate of TB epidemic at the community level.

Reyes also explained the different factors contributing to delayed TB diagnosis at the patient level such as lack of knowledge about the disease, financial constraints, inaccessibility of healthcare services and facilities, and stigma-related factors.

The group, through focus group discussions held in different parts of the country, found out that some patients did not immediately relate their symptoms to TB.

Instead, patients thought of these symptoms as pre-existing conditions like asthma or symptoms of pneumonia, which led them to forego or skip healthcare and rely on self-medication.

Lack of money for transportation is also a factor that hinders patients to seek immediate medical attention.

Some patients also delay going to a health facility for lack of money to go to a private health facility, reflecting their low regard for the healthcare provided by the government.

The stigma associated with TB is also a critical issue. According to Reyes, most people associate tuberculosis with malnutrition and poverty. Others would delay being diagnosed, thus, lowering their chances of recovery from the disease.

Reyes emphasized the urgency of looking into these factors and developing a strategy to improve TB case detection rate, early diagnosis, and delivery of healthcare service among the urban poor population.

She added that it is important to improve the country’s public health service as poor people tend to perceive the public health system as unreliable and of poor quality.

“Access to health services has a significant impact on the timeliness of TB diagnosis,” she said.