Urgent need for faster TB diagnoses, say experts
SINGAPORE, Sept 13 — 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. — Today