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'Lost' smear-positive pulmonary tuberculosis cases: where are they and why did we lose them?

Squire, Bertie, Belaye, A. K., Kashoti, A., Salaniponi, F. M. L., Mundy, Catherine, Theobald, Sally and Kemp, J. (2005) ''Lost' smear-positive pulmonary tuberculosis cases: where are they and why did we lose them?'. International Journal of Tuberculosis and Lung Disease, Vol 9, Issue 1, pp. 25-31.

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Abstract

SETTING: Ntcheu District, rural Malawi.
OBJECTIVES: 1) To locate smear-positive pulmonary tuberculosis patients who were identified during the first 6 months of 2000 but did not start treatment ('lost cases'); 2) to describe these patients' pathways to diagnosis, health status and socio-demographic characteristics; and 3) to explore why these patients did not start treatment. METHODS: Lost cases were traced from programme registers and interviewed using the qualitative research critical incidents narrative (CIN) interviews technique. Results were triangulated with responses from health care workers through focus group discussions.
RESULTS: The laboratory registered 157 new smear-positive patients. Twenty three (15%) of these were 'lost' (did not appear in the treatment register). CIN interviews were conducted with five lost patients and 14 carets of lost patients who had died. Long pathways to diagnosis were the norm. Health system structural barriers were the main factors behind these pathways, including requirement for hospital attendance, delays in symptom recognition and receipt of sputum results, and the misconception that negative smears excluded tuberculosis.
CONCLUSION: Some smear-positive cases experience very long pathways to diagnosis and are lost from this free public health system. The diagnostic process needs to become more responsive to patients' needs.

Item Type: Article
Uncontrolled Keywords: qualitative research pulmonary tuberculosis diagnostic delay poverty case finding malawi decentralization district outcomes program quality
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 85 Patients. Attitude and compliance
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 300 Pulmonary tuberculosis
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Groups (2002 - 2012) > International Health Group
Depositing User: Martin Chapman
Date Deposited: 06 Oct 2011 13:01
Last Modified: 06 Feb 2018 13:02
URI: http://archive.lstmed.ac.uk/id/eprint/1908

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