Singapore: Urgent need for faster TB diagnoses: experts
Tuberculosis rates in Singapore are much higher than in developed countries in the West, and some experts here believe there is "an urgent need" to cut the time taken to diagnose infectious TB cases at healthcare facilities here.
Singapore's TB rates have crept up since 2008, from an
all-time low of 35 in every 100,000 people in 2007 to 41 in
every 100,000 people last year. The incidence rate in the
United States last year was 3.4 cases in every 100,000
people, according to its Centers for Disease Control and
Prevention.
While multiple factors like the
influx of immigrants from countries with a high incidence of
TB, the ageing population and prevalence of diabetes play a
role, TB experts here believe the delay in diagnosing
infectious cases is also a major factor contributing to the
increase in community transmission.
Writing in
last month's Singapore Medical Journal, they cited findings
of a 2009/2010 survey: Among patients with cough lasting
than more than eight weeks, there was a median delay of
three weeks by patients in seeking medical help, and a
healthcare system delay of eight weeks.
In
comparison, there was a median delay of two weeks in
patients seeking help,and a healthcare system delay of three
weeks in 2002.
The surveys were conducted by the
TB Control Unit of Tan Tock Seng Hospital, where Dr Cynthia
Chee, one of the authors of the journal article, is a senior
consultant.
Healthcare system delays may be "due
to a lack of availability of services or low awareness of TB
among healthcare workers", the authors wrote.
The decline in TB rates since 1997 - when the
Singapore Tuberculosis Elimination Programme was introduced
- may have "created an impression among our medical
community and the public that TB is no longer a health
threat in Singapore. Thus, this diagnosis has not been
considered often enough, especially among younger patients",
they wrote.
The Ministry of Health (MOH), which
announced in March that it is reviewing the TB elimination
programme, said enhanced measures will be announced "in due
course".
The MOH will also introduce clinical
practice guidelines for TB investigations, diagnosis and
treatment. It has convened a professional group to develop
these guidelines, said the MOH spokesperson.
Doctors
contacted by TODAY said it is not easy to detect TB, given
that cough is a common symptom. General practitioner
Jonathan Pang said he has encountered fewer than five cases
in 20 years of practice, with the last happening about six
years ago.
Asked if doctors needed to be better
equipped to diagnose TB, Dr Pang said: "I think every now
and then we need to be reminded, but ... I don't think
there's a way they can be better equipped to diagnose or
refer suspicious cases ... it's not something they can do to
come up with the diagnosis."
Another doctor, who
practises in a clinic in Little India, said he has
encountered two foreign TB patients and one local case in
more than 20 years. Foreigners who come here on employment
passes would have been screened via chest X-rays, but it is
difficult to screen other overseas visitors for TB, said the
doctor, who declined to be named.
He looks out
for patients whose coughs do not go away after being
treated, as well as those who display other TB symptoms like
blood in phlegm, night chills and gradual weight loss.
"Sometimes there are no symptoms, and it is only with time
that we can pick them up," he said.
Channel NewsAsia
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