Table 3 Summary of delay in diagnosis by study (n = 24) among indigenous populations
From: Time to diagnosis and treatment of pulmonary tuberculosis in indigenous peoples: a systematic review
Year of Study | Country (Total Sample Size)/Indigenous Population Group (Total) | Study Design/Primary Objective was to estimate delay (Yes/No) | Study Setting/Sampling Method/Description | Type of Data (Disaggregate/Single) | Definition of Event | Estimate, (Type) | Study |
|---|---|---|---|---|---|---|---|
2012–2014 | Canada/Inuit (n = 344) | Prospective pragmatic/No | Nunavut/Xpert MTB/RIF tests in patients with suspected TB | Single | TmD: Receipt of sputa by the laboratory to treatment (Tests: Xpert MTB/RIF & three smears) | GX (Smear+/Smear−): 1.8 days (Mean) Smear+: 7.7 days (Mean) Smear− (Culture): 37.1 days (Mean) | [27] |
2002–2006 | Taiwan (n = 78,118)/Aboriginal (n = 2,530) | Cross-sectional/Yes | Taiwan/Surveillance data | Disaggregate | DCD: First medical examination to diagnosis (positive smear /culture/clinical symptoms) TmD: Diagnosis to treatment initiation | DCD: 9 ± 23 days (Mean) TmD: 9 ± 38 days (Mean) | [33] |
1992–2001 | New Zealand (n = 244)†/Maori (n = 110) & Pacific Islanders (n = 4) | Descriptive (Quantitative)/No | The Waikato Health District/Surveillance data | Disaggregate | TDx: Onset of symptom to case notification: diagnosis date or treatment date/clinical signs (if bacteriological & histological evidence is absent) | 28 days (15th percentile)‡ | [28] |
2009–2010 | Ethiopia (n = 216)†/Pastoralists (n = 91) | Cross-sectional/Yes | Afar Region/Sampling of TB patients in two health facilities | Disaggregate | PD: Onset of symptom to first visit to health provider HD: Time between first visit to health provider and start of treatment TTm/TD: Onset of symptom to TB treatment | PD: 20 days (40th percentile) HD: 33.5 days (48th percentile) TD: 70.5 days (44th percentile) | [3] |
2007 | India/Tribal (n = 261)§ | Cross-sectional/Yes | Mayurbhanj district, Odisha/Sampling of TB patients in four health units | Single | PD: Onset of symptom to first health facility visit HD: First health facility visit to start of TB treatment TTm/TD: Onset of symptom to start of TB treatment | PD: 24 days (Median)/36.5 days (Mean) HD: 3 days. (Median)/11.6 days (Mean) TD: 24 days (Median)/37.5 days (Mean) | [37] |
2011–2012 | Solomon Islands/Kwaio people (n = 16: n = 4, 1 focus group n = 12)†Note: Delay estimate based on n = 3 | Descriptive (Qualitative)/Yes | East Kwaio/Hospital records and focus groups | Single | PD: Duration between feeling unwell and presenting to hospital for diagnosis and treatment | 2–3 years (range) | [32] |
1998–2000 | Thailand (n = 557)§/Hill Tribe (n = 74) | Cross-sectional/Yes | Chiang Rai/Sampling of TB patients in one hospital | Disaggregate | PD: Onset of cough (or other symptom if cough not present) to first visit with doctor/health staff DCD: First visit with doctor/health staff to TB diagnosis | PD: 21 days (49th percentile) DCD: 7 days (53rd percentile) | [39] |
1985–1998 | Australia (N = 375)§/Aboriginal & Torres Strait Islanders (n = 47) | Cross-sectional/Yes | Queensland/Surveillance data | Disaggregate | PD: Onset of symptom to first visit to a medical practitioner HD: First visit to a medical practitioner to start of TB treatment | PD: 30 days (Median) HD: 10 days (Median) | [40] |
2000–2005 | United States/Marshall Islanders (n = 40)†| Cross-sectional/No [Abstract] | Arkansas/Surveillance data | Single | TDx: Onset of symptom to TB diagnosis | 60 days (35th percentile) | |
2006–2009 | United States/American Indian and/or Alaska Native (n = 111)†| Validation study/No | United States/Surveillance data and chart review | Single | TmD: Diagnosis (ICD-9 diagnostic codes for active TB) to TB treatment | 0 days (Median) (13.9% > 7 days) | [30] |
2004 | Ethiopia/(n = 243) | Cross-sectional/Yes | SNNPR/Samp-ling of TB patients in one health centre | Single | PD: Onset of symptom to first consultation (e.g. health centre) | 4.3 weeks (Median)/9.8 weeks (Mean) | [48] |
2010–2012 | Vanuatu/Melanesian (n = 35)†| Descriptive (Qualitative/Quantitative)/Yes | Vanuatu/Samp- ling of TB patients in four study areas | Single | TDx: Onset of symptom to TB diagnosis (defined as visit to hospital) | 8 weeks IQR: 20 weeks (Median) | [35] |
2006–2013 | China (n = 76,486)§/Hmong (n = 125) & Tujia (n = 211) | Cross-sectional/Yes | Yunnan/Surveillance data | Disaggregate | PD: Onset of symptom to first contact with a doctor in a CDC TB center (DOTS facility) | 90 days (63rd percentile) | [50] |
2011–2013 | India/Tribal (n = 580)§ | Cross-sectional/Yes [Abstract] | Rayagada district, Odisha/Samp- ling of TB patients in 20 microscopy centres | Single | PD: Onset of symptom to first visit at a Designated Microscopy Centre | 2 months (87th percentile)/1 month (63rd percentile) | [49] |
2011 | Ethiopia/Pastoralist (n = 129) | Cross-sectional/Yes | Bale Zone/Sampling of TB patients in four health facilities | Single | PD: Onset of symptoms to first visit at a health care facility HD: First health facility visit to start of TB treatment TTm/TD: Onset of symptoms to start of TB treatment | PD: 63 days (Median) HD: 34 days (Median) TTm/TD: 97 days (Median) | [41] |
2007 | Ethiopia/Pastoralist (n = 226)†| Cross-sectional/Yes | Jigjiga & Shinile Zones/Sampling of TB patients in TB management units from two zones | Single | PD: Onset of symptoms to first visit with a professional health provider DCD: First visit to a professional health provider to diagnosis TDx: Onset of symptoms to TB diagnosis | PD: 60 days (Median)/130 days (Mean) DCD: 6 days (Median)/9 days (Mean) TDx: 70 days (Median)/140 days (Mean) | [42] |
2012–2013 | Iran/Nomadic Tribes (Qashqai) (n = 4) | Community-based/No | Fars Province/Active surveillance of nomadic populations | Single | TDx: Onset of symptoms to TB diagnosis | 6 weeks–52 weeks (Range) | [31] |
2005–2006 | Malaysia (n = 272)/Kadazan-Dusun-Murut, Bajau, Rungus and Brunei (n = 249)§ | Cross-sectional/Yes | Sabah/Sampling of TB patients in 36 health centers | Disaggregate | PD: Onset of symptoms to first visit with a health provider (government and/or private) | 30 days (48th percentile) | [51] |
2003–2004 | Malaysia (n = 316)/Iban, Bidayuh, & Melanau (n = 185)§ | Cross-sectional/Yes | Sarawak/Sampling of TB patients in 10 TB clinics from three divisions | Disaggregate | PD: Onset of symptoms to first medical consultation DCD: First medical consultation to diagnosis | PD: 30 days (55th percentile) DCD: 22 days (56th percentile) | [38] |
2001 | India/Tribal (n = 37)†| Descriptive (Qualitative and Quantitative)/No | Andhra Pradesh/Snowball sampling of TB patients in four health centres from two mandals | Single | PD: onset of symptoms to first visit with a health provider (includes private, qualified/unqualified) TTm/TD: Onset of symptoms to start of TB treatment | PD: 4–7 months (range) TTm/TD: ≥ 8 months (max of 15 months) | [32] |
2017–2018 | Ethiopia (n = 442)/Pastoralist (n = 206) | Matched case–control/Yes | Somali Region/Sampling of TB patients in five health facilities | Disaggregate | PD: onset of symptoms to first visit with a health provider (in health center, hospital, and/or private facility with TB services) | 30 days (48th Percentile) | [54] |
2002 | Vietnam (n = 2093)/Ethnic Minority (n = 124)§ | Cross-Sectional Study/Yes | Vietnam/Sampling of TB units in 70 districts | Disaggregate | TTm/TD: Onset of symptoms to start of TB treatment | 5 weeks (Median)/8.4 weeks (Mean) | [52] |
1995 | West Africa (n = 100)/Akan tribe (n = 86)§ | Cross-Sectional Study/Yes | Ghana/Sampling of TB patients from one hospital | Disaggregate | TTm/TD: Onset of symptoms to start of TB treatment | 5 months (Median) | [34] |
2010–2014 | China (n = 1166)/Minority (n = 1061) | Cross-Sectional Study/Yes | Jinping County/Surveillance data | Disaggregate | PD: Onset of symptoms to first doctor’s visit | 30 days (51th Percentile) | [53] |