What 'outliers' tell us about missed opportunities for tuberculosis control: a cross-sectional study of patients in Mumbai, India.
What 'outliers' tell us about missed opportunities for tuberculosis control: a cross-sectional study of patients in Mumbai, India.
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DOI：
10.1186/1471-2458-10-263
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发表时间：
2010-05-20
影响因子：
4.5
通讯作者：
Rangan S
中科院分区：
文献类型：
--
作者：
Pradhan A;Kielmann K;Gupte H;Bamne A;Porter JD;Rangan S
印度修订后的国家结核病控制方案在发现率和治愈率方面被认为非常成功。然而，一些患者在获得诊断和治疗方面遇到了延误。在评估方案执行情况时，在这些准入指标中落在第96到第100个百分位数之间的患者通常被视为非典型的“异常值”而被忽视。然而，它们可能会提供线索，帮助我们理解为什么有些患者永远不会接受治疗。本文研究了印度孟买的患者在访问RNTCP时延迟的潜在脆弱性。我们对孟买RNTCP登记的266名新的痰阳性患者进行了横断面研究。如果患者、提供者和系统延迟超过各自变量的第95个百分位数，则患者被归类为“异常值”。患者、提供者和系统延迟的“离群值”的案例档案被检查，并与样本的其余部分进行比较，以确定导致延迟的关键因素。在一个或多个延迟变量上，有42名患者是“异常值”。所有“异常值”的人均收入都明显低于剩余样本。社会、结构和环境方面的脆弱性加剧了经济资源的缺乏。患者延误时间较长与患者认为症状不严重有关。由于私人提供者未能及时对结核病作出反应，造成了提供者的延误。诊断和治疗的延误微乎其微，然而，对“异常值”的分析揭示了社会支持在使人们能够获得该方案方面的重要性。这些案例是那些未能达到计划的人的代表，这些案例突出了需要RNTCP创新方法的独特脆弱性。对“离群值”的关注为了解实现公共卫生计划的障碍提供了一种不那么耗费资源和时间的替代方案，而不是基于社区的研究。
India's Revised National Tuberculosis Control Programme (RNTCP) is deemed highly successful in terms of detection and cure rates. However, some patients experience delays in accessing diagnosis and treatment. Patients falling between the 96th and 100th percentiles for these access indicators are often ignored as atypical 'outliers' when assessing programme performance. They may, however, provide clues to understanding why some patients never reach the programme. This paper examines the underlying vulnerabilities of patients with extreme values for delays in accessing the RNTCP in Mumbai city, India. We conducted a cross-sectional study with 266 new sputum positive patients registered with the RNTCP in Mumbai. Patients were classified as 'outliers' if patient, provider and system delays were beyond the 95th percentile for the respective variable. Case profiles of 'outliers' for patient, provider and system delays were examined and compared with the rest of the sample to identify key factors responsible for delays. Forty-two patients were 'outliers' on one or more of the delay variables. All 'outliers' had a significantly lower per capita income than the remaining sample. The lack of economic resources was compounded by social, structural and environmental vulnerabilities. Longer patient delays were related to patients' perception of symptoms as non-serious. Provider delays were incurred as a result of private providers' failure to respond to tuberculosis in a timely manner. Diagnostic and treatment delays were minimal, however, analysis of the 'outliers' revealed the importance of social support in enabling access to the programme. A proxy for those who fail to reach the programme, these case profiles highlight unique vulnerabilities that need innovative approaches by the RNTCP. The focus on 'outliers' provides a less resource- and time-intensive alternative to community-based studies for understanding the barriers to reaching public health programmes.
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DOI：
10.2471/blt.06.033167
发表时间：
2007-08-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Kemp, Julia R;Mann, Gillian;Squire, Stephen Bertel
通讯作者：
Squire, Stephen Bertel
影响因子：
3.3
作者：
Cambanis, A;Yassin, MA;Cuevas, LE
通讯作者：
Cuevas, LE
影响因子：
3.2
作者：
Kielmann, K;Bentley, M
通讯作者：
Bentley, M
影响因子：
3.2
作者：
Karim, Fazlul;Islam, Md. Akramul;Diwan, Vinod K.
通讯作者：
Diwan, Vinod K.
影响因子：
3.3
作者：
Jaiswal, A;Singh, V;Jain, RC
通讯作者：
Jain, RC