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Online TB diagnosis picking up: study

May 28, 2011

A physician looking at the X-Ray of TB patient. – Photo by SINC via Eureka Alert.

KARACHI, May 28: A study conducted in the peri-urban and rural areas of Sindh has shown that an online diagnosis of difficult tuberculosis (TB) cases is as accurate as face-to-face diagnosis.

The online diagnosis of TB is one of the first few e-health initiatives in Pakistan that faces grave challenges in the fight against tuberculosis, though a national TB control programme has been in place in the country for over 15 years.

Tuberculosis, which is a curable disease, annually claims lives of between 80,000 and 100,000 people in Pakistan, ranking sixth among the high disease burden countries in the world.

The number of TB cases is estimated to be 171 per 100,000.

“The online diagnosis of TB has been proved to be accurate and efficient in terms of cost and the time it consumed. No professional is required to run the system either. Besides, it could easily work in rural areas where access to the internet is on the rise,” says Dr Zafar Fatmi, assistant professor and head of the division of Environmental Health Sciences at the department of Community Health Sciences, Aga Khan University (AKU).

The university collaborated with the City District Government Karachi and the Gambat Institute of Medical Sciences to conduct the research on over 100 patients in Orangi and Gambat, district Khairpur.

Dr Fatmi was assisted by Dr Shiraz Sheikh in the research: “Accuracy and Effectiveness of Electronic Diagnosis of difficult TB cases (sputum negative TB): Results from Pakistan.”

“The new diagnosis method needs to be incorporated in the national TB control programme so that the highly contagious disease could be effectively diagnosed and treated in remote areas,” Dr Fatmi further said.

Giving background information and the objectives of the research, Dr Fatmi said that tuberculosis claimed lives of two million people every year in the world. Forty-four per cent of the TB cases in the Eastern Mediterranean region, a regional division by the World Health Organisation (WHO), existed in Pakistan.

The TB symptoms included weight loss, persistent cough for over three weeks and malnutrition.

The TB-DOTS (tuberculosis directly observed short course) programme was adopted in the country in 1993 after TB was declared an emergency by WHO. The challenge, however, was seriously taken up as late as 2001.

“By year 2005-06, the government was able to provide a cover for TB control at all public sector hospitals in the country.

However, the issue remained that a large population sought treatment from private sector facilities,” he said, adding that the failure of private facilities to follow the WHO guidelines on TB or lack the expertise had contributed to the continued prevalence of TB.

Pointing out other major problems in battling tuberculosis, he said that though quality of drugs was an issue especially in rural areas, medicines for tuberculosis were generally available and the main obstacle was diagnosis in many cases.

“There are two types of TB cases; one in which the sputum test is positive and the other in which it is not. Pakistan has 55 per cent of TB cases in which the sputum test is negative because of various reasons that include improper sampling, poor sputum microscopy techniques and the lack of training among physicians.

“Because of these complications, TB cases were hugely being mismanaged and had given a rise to another challenge, multi-drug resistance tuberculosis, over the years.

“In cases whose sputum smear is negative, but the patient is showing the signs of TB, an X-ray is required. That needs to be examined by an expert and not a general physician. Unfortunately, in the rural and peri-urban areas, which are more affected by the disease, no specialist is generally available,” he explained.

It was to fill this huge gap in diagnosis that a research was conducted to check the accuracy of a diagnosis made by a specialist sitting far away from the patient, he said.

Under the study, only sputum smear negative cases were included at health facilities in Orangi and Gambat. A brief history of the patient was taken and a chest X-ray was done by a trained person and emailed to specialists at the AKU. To check the accuracy of the diagnosis, culture tests of patients were also carried out and patients were called for clinical follow-ups for two months.

“The results of online diagnosis were as accurate as face-to-face diagnosis. The mean response time at both sites was 29.7 hours despite power outages in these areas.

“As the availability of the internet in the rural areas is increasing, we believe that the role of online technology for diagnosis from specialists in urban centres could be instrumental for providing a quality healthcare,” he said.