{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:48:09Z","timestamp":1787032089044,"version":"build-2736575974"},"reference-count":0,"publisher":"International Union Against Tuberculosis and Lung Disease","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["int j tuberc lung dis"],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:p>\n                    <jats:bold>BACKGROUND:<\/jats:bold>\n                    India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.\n                    <jats:bold>METHODS:<\/jats:bold>\n                    A cross-sectional study was performed among 89 children initiated on anti-TB\n treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between\n onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as &gt;28 days.\n                    <jats:bold>RESULTS:<\/jats:bold>\n                    Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR]\n 27\u201386). Sixty-six (74%) children visited 1\u20138 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10\u201375). Bacille Calmette-Gu\u00e9rin vaccination (aOR 10.96,\n                    <jats:italic>P =<\/jats:italic>\n                    0.04) and loss of appetite (aOR 4.44,\n                    <jats:italic>P =<\/jats:italic>\n                    0.04)\n were associated with delayed TTI.\n                    <jats:bold>CONCLUSION:<\/jats:bold>\n                    The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation\n in childhood TB.\n                  <\/jats:p>","DOI":"10.5588\/ijtld.18.0439","type":"journal-article","created":{"date-parts":[[2019,10,19]],"date-time":"2019-10-19T00:55:51Z","timestamp":1571446551000},"page":"1090-1099","source":"Crossref","is-referenced-by-count":23,"title":["Delays and barriers to early treatment initiation for childhood tuberculosis in India"],"prefix":"10.5588","volume":"23","author":[{"given":"C.","family":"Valvi","sequence":"first","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Chandanwale","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Khadse","sequence":"additional","affiliation":[{"name":"Rajiv Gandhi Medical College and Chatrapati Shivaji Maharaj Hospital, Kalwa, Thane"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Kadam","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Kinikar","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Lokhande","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Pardeshi","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Garg","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Gupte","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College\/Johns Hopkins Clinical Trials Unit, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Jain","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College\/Johns Hopkins Clinical Trials Unit, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Suryavanshi","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College\/Johns Hopkins Clinical Trials Unit, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. E.","family":"Golub","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Environmental Health and Engineering"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College\/Johns Hopkins Clinical Trials Unit, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Dhumal","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College\/Johns Hopkins Clinical Trials Unit, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Deluca","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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