Here is why tuberculosis (TB) transmission in Mumbai should be a cause for concern. A person infected with the TB bacilli in the city remains untreated for an average of 66 days, according to a study conducted among patients by The Foundation for Medical Research (FMR).
A major factor responsible for delay in diagnosis was the fact that most patients sought medication for symptoms from chemists and non-allopathic doctors.
The findings are alarming because an untreated TB patient can spread the infection to about 10-15 people annually, said doctors.
Going by these estimates, every newly infected TB patient in Mumbai ends up infecting two to three healthy individuals before even accessing treatment.
Experts said even after a patient is started on anti-TB treatment (DOTS - Directly Observed Treatment Short Course, the anti-TB treatment provided free of cost), he or she takes at least two to three weeks to reach a stage that doctors call sputum negative, when he or she is no longer at risk of spreading the infection.
The study said delay in diagnosis of the disease is a major hurdle in breaking the TB transmission chain in the city. “Once the disease is diagnosed, it does not take much time in starting the medication [after diagnosis a patient is put on anti-TB medication within five days]. The concern is that the diagnosis is delayed either because of the patient doesn’t go to the doctor; sometimes, even the physician could be the cause,” said Dr Yatin Dholakia, co-investigator of the study. “Most patients were initially treated as cases of pneumonia, typhoid or malaria”.
The study looked at the medical history of randomly selected respondents. The patients were self-reported ones living in 15 high-burden municipal wards. A population of about 50,000 was covered to identify 83 TB patients who participated in the study.
Researchers found that the patients took at least an average of 24 days to approach a medical practitioner from the day of the onset of
the symptoms. A person who has contracted TB complains of persistent cough with pain in chest, fever, chills and blood in sputum.
Researchers said some delay is unavoidable because TB symptoms are similar to other ailments. “But once the patient approaches a healthcare provider, it takes an average of another 40 days to get diagnosed. This period needs to be shortened,” said, Akshaya Patil public health researcher with FMR.
Experts said that the Revised National TB Control Program (RNTCP), the government TB control programme, is effective when it comes to putting patients on DOTS, but there is no mechanism for ensuring early diagnosis.