Abstract
BackgroundChina is facing a significant tuberculosis epidemic among rural-to-urban migrants, which poses a threat to TB control. This study aimed to understand the health seeking behaviour of and health systems responses to migrants and permanent urban residents suffering from chronic cough, in order to identify the factors influencing delays for both groups in receiving a TB diagnosis in urban China.MethodsCombining a prospective cohort study of adult suspect TB patients and a qualitative study, the Piot model was used to analyze the health seeking behaviour of TB suspects among migrants and permanent urban residents, the factors influencing their decision and the responses by general health providers. Methods included a patient survey, focus group discussions with migrants in the general population, qualitative interviews with migrant and permanent resident TB suspects and TB patients as well as key stakeholders related to TB control and the management of migrants.ResultsSixty eight percent of migrants delayed for more than two weeks before seeking care for symptoms suggestive of TB, compared to 54% of residents (p < 0.01). When they first decided to seek professional care, migrants were 1.5 times more likely than residents to use less expensive, community-level health services. Only 5% were ultimately referred to a TB dispensary. Major reasons for both patient and provider delay included lack of knowledge and mistrust of the TB control programme, lack of knowledge about TB (patients), and profit-seeking behaviour (providers). In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care, with a statistically significant difference between the two groups (p < 0.05).ConclusionRural-to-urban migrants are more likely than permanent residents to delay in seeking care for symptoms suggestive of TB in urban Chongqing. 'Patient-' and 'provider-' related factors interact to pose barriers to TB diagnosis for migrants, including: low awareness, and poor knowledge among both the general public and TB suspects about TB as a disease and about the TB control programme; low financial capacity to pay for care and diagnostic tests; and inadequate use of diagnostic tests and referral to TB dispensaries by general health providers.
Highlights
China is facing a significant tuberculosis epidemic among rural-to-urban migrants, which poses a threat to TB control
The study reported in this paper aims to understand the health seeking behaviour of migrants for symptoms suggestive of TB, and to identify the factors influencing delays in receiving a TB diagnosis for this group in urban China
Knowledge and awareness of TB and the TB control programme Our study clearly shows that the knowledge and awareness of TB among the general public and in TB suspects was relatively poor
Summary
China is facing a significant tuberculosis epidemic among rural-to-urban migrants, which poses a threat to TB control. After two decades of comprehensive socio-economic reforms, a significant change in Chinese society is the rising population mobility, the movement from rural to urban areas due to ruralurban income disparity and rural labour surplus [4]. This has been identified as a major challenge facing TB control [5]. Available data show that whilst the incidence of pulmonary TB among permanent urban residents in major Chinese cities is relatively stable [6,7], incidence amongst rural-to-urban migrants is increasing annually. The number of active TB patients in this group has increased by 9.4% every year between 1997 and 2001
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
