Tuberculosis patients of the country who seek help from private sector face a delay in getting diagnosed correctly-the delay could be as long as two months. And that is if the diagnosis happens at all. This sobering reality was brought out by systematic reviews of Indian studies.
The reasons of delay need to be tackled and two recent studies- published by medical anthropologist Andrew McDowell and TB expert, Madhur Pai of the McGill University, Canada shed more light to the causes for delay.
Experimenting with drugs
Experimenting with antibiotics could be one reason for the delay.
A study that encompassed 175 practitioners of Indian medicine was published in the ‘Transactions of the Royal Society of Tropical Medicine and Hygiene’ in March 2016. The study involved 400 interviews and 208 hours of observation. 2,000 observed patient interactions in 10 clinics in Mumbai were also part of the study.
All the physicians reported seeing at least one patient who had typical TB symptoms for over two weeks in the year before. But the patient had to repeatedly visit the doctor before they were diagnosed. In the meantime they would be treated with different antibiotics-this experimentation went on for some 10 to 14 days.
Lab investigation wasn’t asked by any of the physicians on the first visit. Also, just 31 practitioners asked for sputum smear, after conducting blood tests and a chest X-ray. Sputum smear or geneXpert could be used as confirmatory tests.
164 of the 175 AYUSH practitioners, rather than treating the TB patients themselves preferred referring them to the public sector. On the other hand, some AYUSH practitioners treated the patients who left the public sector.
Dr. McDowell states the key problem as the low testing for resistance, adding that it’d be unfair to say the issue exists only with AYUSH practitioners. About 5 percent of the practitioners used at least one second-line TB drug. Dr.Pai says that second-line anti-TB drugs shouldn’t be used for treatments.
Not enough diagnostic tests
The second study which was published in the International Journal of Tuberculosis and Lung Disease in April 2016 looked at 110 private doctors-both MBBS and AYUSH practicing in Mumbai and Patna. The study incorporated 143 interviews as well as 150 clinical observations from seven clinics, the participating doctors were from all systems of medicine.
It was noted that even though when suspected of TB, patients were asked for a chest X-ray and other lab tests, it happened “often after months of fever.” even if the patient comes with a history of cough, no practitioner of alternative medicine suspected TB on the first visit.
The process of observing an issue persisting for long to come to suspect TB naturally leads to delay in diagnosis and also raises the spread of TB. Then there’s the issue of exposing the patient to an array of antibiotics. Adding to the problem is the use of drugs such as quinolones and amoxicillin-clayulanante since they temporarily stops such symptoms as cough and fever.
Since the patients are mostly poor and in need of immediate relief, the experimentation with antibiotics is only possible with reducing the cost of TB diagnostic tests.
The study shows that the use of sputum smear testing is low in the private sector-because it can only confirm what the X-ray has already revealed. Also, an X-ray gives a broader picture of what happens in the patients’ lungs.
Three reasons were found for why the doctors opted for treating with antibiotics and waiting.
- A compulsion to provide symptom relief fast or risk losing the patients
- Lack of unique TB symptoms
- Doctors have the perception that many TB patients come in without cough or without producing sputum.
The studies bring forth the necessity for both allopathic and AYUSH practitioners to change the empirical approach in diagnosing RB.
With Inputs from The Hindu
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