Case-finding -How to prevent patient's delay, especially in remote areas
Hidenori MASUYAMA,M.D., Dai-ich Dispensary, JATA
I. Introduction
Principally, one of the most important measures for tuberculosis (TB) is the interruption of transmission from newly occurring infectious cases of TB with appropriate chemotherapy as soon as possible after their occurrence. As shown in Figure 1, what stands between the onset of transmissibility and its arrest is the delay of the patient in seeking medical attention and the delay of health care providers in making the diagnosis and commencing appropriate chemotherapy. These delays are variably attribute to the patient's attitude towards symptoms and the health care provider's ability to rapidly diagnose TB. This line of action will reduce the incidence of infection.
The term "case finding" used in this refers to all activities that aim at reducing the interval between the onset of clinically and/or bacteriologically active TB and the arrest of transmission. Patient's and doctor's delay are thus the two major factors that determine the length of uncontrolled transmission of tubercle bacilli in the community and thus the incidence of infection
II. Identification of Sources of Transmission
To perform identification of sources of transmission, there are two methods for this identification. The one is "active case finding method", the other "passive case finding method". "Passive case finding method" is much more economical, provided it is properly done, and it is the standard method in the vast majority of national programmes.
The only way to make sure in passive case finding is to examine the sputum for TB in everyone who has had a cough for more than 3 weeks.
III. Factors Causing Patient's Delay
Factors causing patient's delay are considered as follows:
1. Not visiting health facilities in appropriate time after the appearance of symptoms.
2. Ignorance on TB symptoms
3. Neglect of symptoms
4. Inconvenient access to health facilities
5. Worry for cost of visiting doctors
6. Worry to be diagnosed as having TB
IV. Methods to Reduce Patient's Delay
Patients seek medical care when their symptoms are subjectively sufficiently sever too offset the difficulties involved (i.e., costs, interruption of normal activities). It is conceivable that in different societies, among different population segments, and between individuals, different forces are at work that influence a patient's delay from the first occurrence of symptoms to the seeking of medical attention.
In slides that evaluated the roll of mass miniature radiography, it has been shown that more than 90% of sputum smear-positive patients have symptoms, predominantly cough.
In industrialized countries with a dense network for health care provision, the distance between workplace and health facilities may be an unimportant factor in a patient's delay in seeking medical attention. In contrast, it is conceivable that in low-income countries the distance to the next health care provider may influence the patient's attitude towards seeking medical attention. In remote areas, increasing the health facilities (for example, sub health post) and the health care providers (such as primary health care trained persons in the community) convenient for the community people to visit is needed. Also, the home visit of the trained health care providers is recommended in order to facilitate TB patient's visit to health facilities.
