Delays and barriers to early treatment initiation for childhood tuberculosis in India

C. Valvi, A. Chandanwale, S. Khadse, R. Kulkarni, D. Kadam, A. Kinikar, S. Joshi, R. Lokhande, G. Pardeshi, P. Garg, N. Gupte, D. Jain, N. Suryavanshi, J. E. Golub, A. Shankar, A. Gupta, G. Dhumal, A. Deluca, R. C. Bollinger

Research output: Contribution to journalArticle

Abstract

BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.

Original languageEnglish (US)
Pages (from-to)1090-1099
Number of pages10
JournalThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Volume23
Issue number10
DOIs
StatePublished - Oct 1 2019

Fingerprint

India
Tuberculosis
Health Personnel
Therapeutics
Private Sector
Hospital Records
Public Sector
Public Hospitals
Appetite
Early Diagnosis
Vaccination
Referral and Consultation
Cross-Sectional Studies

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Delays and barriers to early treatment initiation for childhood tuberculosis in India. / Valvi, C.; Chandanwale, A.; Khadse, S.; Kulkarni, R.; Kadam, D.; Kinikar, A.; Joshi, S.; Lokhande, R.; Pardeshi, G.; Garg, P.; Gupte, N.; Jain, D.; Suryavanshi, N.; Golub, J. E.; Shankar, A.; Gupta, A.; Dhumal, G.; Deluca, A.; Bollinger, R. C.

In: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, Vol. 23, No. 10, 01.10.2019, p. 1090-1099.

Research output: Contribution to journalArticle

@article{892d874dcf834f648945dfb54ed705fb,
title = "Delays and barriers to early treatment initiation for childhood tuberculosis in India",
abstract = "BACKGROUND: India accounts for 27{\%} of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75{\%}) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74{\%}) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Gu{\'e}rin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.",
author = "C. Valvi and A. Chandanwale and S. Khadse and R. Kulkarni and D. Kadam and A. Kinikar and S. Joshi and R. Lokhande and G. Pardeshi and P. Garg and N. Gupte and D. Jain and N. Suryavanshi and Golub, {J. E.} and A. Shankar and A. Gupta and G. Dhumal and A. Deluca and Bollinger, {R. C.}",
year = "2019",
month = "10",
day = "1",
doi = "10.5588/ijtld.18.0439",
language = "English (US)",
volume = "23",
pages = "1090--1099",
journal = "International Journal of Tuberculosis and Lung Disease",
issn = "1027-3719",
publisher = "International Union against Tubercul. and Lung Dis.",
number = "10",

}

TY - JOUR

T1 - Delays and barriers to early treatment initiation for childhood tuberculosis in India

AU - Valvi, C.

AU - Chandanwale, A.

AU - Khadse, S.

AU - Kulkarni, R.

AU - Kadam, D.

AU - Kinikar, A.

AU - Joshi, S.

AU - Lokhande, R.

AU - Pardeshi, G.

AU - Garg, P.

AU - Gupte, N.

AU - Jain, D.

AU - Suryavanshi, N.

AU - Golub, J. E.

AU - Shankar, A.

AU - Gupta, A.

AU - Dhumal, G.

AU - Deluca, A.

AU - Bollinger, R. C.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.

AB - BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.

UR - http://www.scopus.com/inward/record.url?scp=85073634121&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073634121&partnerID=8YFLogxK

U2 - 10.5588/ijtld.18.0439

DO - 10.5588/ijtld.18.0439

M3 - Article

C2 - 31627774

AN - SCOPUS:85073634121

VL - 23

SP - 1090

EP - 1099

JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

SN - 1027-3719

IS - 10

ER -