A recent study of state think tank Philippine Institute for Development
Studies (PIDS) and the Department of Health (DOH) reveals that the leading
cause of high tuberculosis (TB) cases in urban poor communities is the
patient’s delaying to visit the doctor.
Titled
“Barriers of Early TB Diagnosis among the Poor in Highly Urbanized Areas in the
Philippines”, the study noted that although there is a significant drop of TB
prevalence over the last decade, TB remains the fourth leading cause of
mortality among Filipinos. The 2007 Philippine National Tuberculosis Prevalence
Survey revealed that there are approximately three TB cases in every 1,000
Filipinos. Moreover, the DOH confirmed that there is a prevalence of the
multidrug resistance TB in the country, a fatal form.
“Higher
risk of tuberculosis can be attributed to delayed diagnosis,” said Krishna
Reyes, study co-author and PIDS research consultant during a recent seminar
held at NEDA sa Makati Building, Makati City.
“Early
diagnosis is essential in the control and prevention of TB especially in the
urban poor population that has a higher risk of acquiring both infectious and
non-communicable diseases,” Reyes said. “Urban poor communities have 1.5 times
higher prevalence of disease than their non-poor counterparts.”
“Delay
in the diagnosis is a contributing factor of higher reproductive rate of TB
epidemic at the community level,” Reyes said. She explained that transmission
usually takes place between the period of occurrence of cough and initiation of
treatment.
Reyes
noted other factors contributing to delayed TB diagnosis at the patient level
such as lack of knowledge about tuberculosis, financial constraints,
inaccessibility of healthcare services and facilities, and stigma-related
factors.
From
focus group discussions of selected participants in Southern Philippines
Medical Center in Davao, Mandaue City Health Office in Cebu, and German Doctors
in Metro Manila, Reyes and her colleagues found that some patients did not
immediately relate their symptoms to TB. Instead, they thought of them as
pre-existing conditions like asthma or may be related to pneumonia, which led
them to forego or skip healthcare and rely on self-medication.
Lack
of money for transportation also hinders patients to seek immediate medical
attention. The choice of health facility is also a factor. “Some patients
delayed going to a health facility because they were waiting for money so they
can go to a private health facility for checkup or diagnosis instead of going
to a public health facility. This reflects their low regard for the healthcare
provided by government”, Reyes said.
The
stigma associated with TB remains a critical issue. According to Reyes,
tuberculosis is usually associated with other diseases as well as malnutrition
and low social stature (poverty). For
this reason, others would delay being diagnosed thus lowering their chances of
recovery from the disease.
Reyes
emphasized the urgency of looking into these factors and developing a strategy
to improve TB case detection rate, early diagnosis, and delivery of healthcare
service among the urban poor population. She added that it is important
to improve the country’s public health service as poor people tend to perceive
the public health system as unreliable and of poor quality. “Access to
health services has a significant impact on the timeliness of TB diagnosis,”
she said.
For
more information, you may download the full study athttp://dirp4.pids.gov.ph/webportal/CDN/PUBLICATIONS/pidsdps1418.pdf.
(PIDS)
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