%0 Journal Article
%T High mortality during tuberculosis treatment does not indicate long diagnostic delays in Vietnam: a cohort study
%A Marleen Vree
%A Nguyen T Huong
%A Bui D Duong
%A Nguyen V Co
%A Dinh N Sy
%A Frank G Cobelens
%A Martien W Borgdorff
%J BMC Public Health
%D 2007
%I BioMed Central
%R 10.1186/1471-2458-7-210
%X Follow-up of a patient cohort included in a survey of diagnostic delay in 70 randomly selected districts. Data on diagnosis and treatment were extracted from routine registers. Patients who had died during the course of treatment were compared to those with reported cure, completed treatment or failure (survivors).Complete data were available for 1881/2093 (89.9%) patients, of whom 82 (4.4%) had died. Fatality was 4.5% for patients with ¡Ü 4 weeks delay, 5.0% for 5- ¡Ü 8 weeks delay (aOR 1.11, 95%CI 0.67¨C1.84) and 3.2% for > 9 weeks delay (aOR 0.69, 95%CI 0.37¨C1.30). Fatality tended to decline with increasing delay but this was not significant. Fatality was not associated with median diagnostic delay at district level (Spearman's rho = -0.08, P = 0.5).Diagnostic delay is not associated with treatment mortality in Vietnam at individual nor district level, suggesting that high case fatality should not be used as an indicator of long diagnostic delay in national tuberculosis programmes.Worldwide around 2 million people die with tuberculosis each year [1]. Of all new smear-positive pulmonary tuberculosis patients treated in programmes applying the World Health Organization's (WHO) DOTS strategy, 4.6% died [1].It is generally assumed that delay in diagnosis and treatment initiation increases the severity of disease at the time of diagnosis and the risk of death [2,3]. This assumed relation is often reason to measure the length of delays before tuberculosis treatment [4-6]. Conversely, a high case fatality, i.e. death during the course of tuberculosis treatment, is often perceived to reflect long delays in low HIV-prevalence settings. In program evaluations high case fatality rates are thereby used as an indicator of low access to clinics [7].With time, tuberculosis disease progresses [8] and chances of survival will decline. With worsening and spreading of pulmonary tuberculosis lesions the bacillary load in the lungs generally increases [8]. Therefore, longer delays could
%U http://www.biomedcentral.com/1471-2458/7/210