Access to tuberculosis care: What did chronic cough patients experience in the way of healthcare-seeking?

Abstract

The directly observed treatment-short course (DOTS) has been adopted in China's modern tuberculosis (TB) control programme since 1992. However, the case detection rate of TB is far below the global 70% target. The aims of this study are to analyse the healthcare-seeking experiences and economic burden of potential TB patients with more than two weeks of cough in counties with and without a DOTS project and to explore the barriers to access for potential TB patients in rural China. A cross-sectional study using questionnaire interviews was conducted in a DOTS project county (Jianhu) and a non-DOTS county (Funing) in Jiangsu Province. A total of 1,204 chronic cough hospital patients were interviewed about their care-seeking experiences. The mean patient delays were 34 and 29 days respectively in Jianhu and Funing (p = 0.070). A shorter patient delay was associated with the availability of medical insurance (RR = 1.36, p<0.01). More than 97% of patients sought care in the general health system, rather than in the special TB dispensary. Only 1.8% (Jianhu) and 5.0% (Funing) of the subjects had been sputum smear tested (p<0.001). The average patient's expenditure was CNY346 in Jianhu and CNY256 in Funing (p>0.05). Potential TB patients' access to TB care needs improving under DOTS. The expenses for treatment of cough are a heavy burden for the poor. Since the low-income patients first seek care at village health stations or township hospitals for cough, it is vital to involve the general health system in the DOTS project.