Correspondence Address:
Madhavi Bhargava
Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka
India

Full Text

Sir,

I read with interest the article on delays at patient and health system level among smear-positive tuberculosis by Purty et al.[1] The authors have pointed out the extent of delays in the diagnosis and treatment in sputum positive patients. The fact that 40.7% patients were earning international normalized ratio ≤2000/month and another 35.2% did not have steady income source is very significant. It definitely reinforces the importance of addressing social determinants in any tuberculosis control program.[2] Further considering the prevalence of multidrug-resistant tuberculosis (MDR-TB) in India, as 3% in new cases and 12%–17% in retreatment cases,[3] the implications on transmission of MDR-TB in the community are worrisome. This calls for the strengthening of airborne infection control in India, which is far from ideal.[4]

As far as methodology is concerned, it needs to be pointed out that the sample size calculation should have taken into consideration the incidence of tuberculosis in Tamil Nadu and Puducherry (the states from which the patients were enrolled), as done in the Eastern Mediterranean Region study in seven countries.[5] This is especially because the delay is not in terms of prevalence but in terms of duration.

Nevertheless, the study is an important one paving way for operational research to explore important determinants of delays in diagnosis and treatment of tuberculosis in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References