There is considerable tuberculosis diagnostic delay in The Gambia and this is likely to be worsened by the COVID-19 pandemic. It’s the main finding from a scientific investigation in The Gambia by the International Society for Infectious Diseases (ISID) that works to control infectious disease outbreaks and improve the care of patients afflicted with these conditions.
The researchers of the ISID got their investigation approved by the Gambia Government/MRC joint ethics committee and published their findings in the International Journal of Infectious Diseases. 216 adult patients were recruited in The Gambia from October 2016 to March 2017, after they were all diagnosed positive with pulmonary tuberculosis (pTB) in either of three health centres (Brikama, Fajikunda and Serrekunda Health Centres) or the MRC Gambia TB clinic.
The TB diagnostic delay in The Gambia and Covid-19
Of the 216 tuberculosis patients aged between 23 to 39 years, 167 (77%) were males. A number of 110 (50.9%) patients in the group started care-seeking in the formal and informal private sector. The most striking observation to the team of researchers is that a considerable number of patients, 181 (83.8%) in the group, had tuberculosis diagnostic delay. This means that after a patient showed symptoms of tuberculosis, it took more than 21 days for health personnel to confirm that the patient is TB infected. Of these delays, some patients went as much as 34 to 56 days before they clearly confirm their tuberculosis infection status.
“It is very likely that the desire and efforts by potential TB patients to be attended and checked up by Health personnel and delays in TB diagnosis in The Gambia will be further impacted by the advent of the COVID-19 pandemic” according to the study. The likely grave consequences are real for existing and undiagnosed TB patients particularly in countries like The Gambia where health services are poorly equipped. Because delay in diagnosis of TB is impacts the quality of TB care to be given to the patients.
Why the delay in diagnosis of TB?
In The Gambia, The diagnosis of TB and provision of anti-TB drugs are only available in public health facilities. Sputum smear microscopy is still the first and only diagnostic test for TB in routine public health system. This requires that the patient returns days and days after at the Health centre. Some patients do not return for a second or third sputum smear because of many factors.
According to the team of researchers, passive tuberculosis case detection is influenced by several factors. The first problem is “the subject’s perception of the severity of his illness, his awareness of the likely cause of his symptoms, the stigma, his chances of access to health facilities and well-equipped to screen labs for TB. The second aspect lies on the level of TB symptoms recognition that will trigger investigation by the care provider” (Health Personnel) at the time of first presentation by the patients.
The team on this scientific research comprised among others Alieu Wurrie of The Gambia National Leprosy and Tuberculosis Control Programme, Momodou Jallow, Beate Kampmann, Jayne Sutherland, Gambia Sowe, Monica D. Genekah, Rohey Jallow, Olumuyiwa A. Owolabi of the Medical Research Council Unit in The Gambia of the London School of Hygiene and Tropical Medicine, Toyin Togun, Corresponding author atClinical Research Department, Faculty of Infectious and Tropical Diseases, London