It is important that people with TB start treatment as soon as possible but in many countries long delays are common between the onset of symptoms and the commencement of the recommended DOTS treatment. A research team in Indonesia examined the factors that might be responsible for delays.

They documented healthcare utilization pattern of smear positive TB patients prior to diagnosis and treatment by DOTS services in Yogyakarta province. The median delay between symptom onset and treatment was 8 weeks in urban areas and 12 for patients in the rural areas. Multivariate analysis suggested no confounding between individual factors and urban-rural setting remained as the main factor for total delay.

While there are many steps which could be take to reduce treatment delay, in this setting at least the most crucial need is to improve access to treatment services in the rural areas. The study, in BMC Public Health, may be read here.

Uzbekistan is one of many countries where extensively drug resistant tuberculosis (XDR-TB) has been reported. A letter in the New England Journal of Medicine describes how, of 87 patients receiving treatment with second-line TB drugs for multiple-drug resistant (MDR) TB, 18 (21%) developed ofloxacin resistance and 10 (11%) were classified as having XDR-TB.

The spread of XDR-TB is often blamed on failure to adequately diagnose and treat MDR-TB. Yet here we have a situation where a high proportion of MDR-TB patients, despite receiving appropriate care, nevertheless developed XDR-TB during their treatment.

This is a very worry finding. As the authors of report say, there are ’significant implications for the scale-up of multidrug-resistant tuberculosis treatment internationally’. The NEJM letter may be seen here.

As described in a TropIKA.net news story here, large-scale trials of the RTS,S malaria vaccine in which 16,000 children will participate are about to begin in Africa. An excelllent report from Reuters looks at the trials from the perspective of those on the front line.

The Reuters correspondent, Andrew Quinn begins with the comments of Dr Zena Mtajuka, ‘an exhausted warrior on the frontlines of the fight against one of the planet’s most devastating diseases’ at Bagamoyo District Hospital north of Tanzania’s capital Dar es Salaam. Bagamoyo is one of almost a dozen research sites where the RTS,S trials will take place. Scientists and health workers in Kilifi, Kenya were also interviewed for the report, which can be accessed here.