Abstract
Tuberculosis (TB) is a major health care burden in developing countries. With a high number of population living in an environment with high congestion, controlling TB in Bangladesh especially in urban areas has been a big challenge. The current study aims to identify the perception and treatment practice of formal and informal health service providers regarding TB in terms of treatment, referral system and to find out the partnership mechanism and also community perception and their health seeking behavior in two urban slums of Dhaka city. This is a cross-sectional study utilizing mixed methods approach and was conducted in two urban slums, namely, Slum A and Slum B of Dhaka city. Health service providers both formal and informal, community people and TB patients were selected as study population. In the quantitative part a survey was carried out where all the existing health service providers were interviewed. These health service providers were identified through 12 PRA (Participatory Rapid Appraisal) Social Mapping. Seven Focus Group Discussions (FGD) were conducted with this community. Popular Health service providers were identified through PRA matrix ranking during the FGDs and were selected for in-depth interview. TB patients were identified during FGD for in-depth interview. Community in urban slums is well aware of the infectious, contagious characteristics of TB. However, the long duration of DOTS program has been a major cause of high rate of drop-out. Generally drug sellers, traditional healers, homeopath and allopath (MBBS) practitioners are the primary point of contact of TB patients. They know where to refer to diagnosis and treatment. The referral system based on informal relationship sometimes leads to referring patients to wrong service providers. The mechanisms of TB programs in urban areas of Bangladesh should seriously consider arranging regular training and monitoring of health workforce, setting up formal partnership between formal and informal health service providers and generate information that policy-makers could use to scale up TB control program.
Highlights
Tuberculosis (TB) is a major health care burden in developing countries (Ravichandran, 2004)
During conducting social mapping, listing of all health service providers including both formal and informal who are delivering health services in the two selected slums were carried out. These providers range from qualified allopathic doctors gaining MBBS degree from different medical colleges, semi-qualified allopathic providers that include providers who have received training of varying duration from a formal institution in the public or private sector, drug sellers most of whom have had no training in dispensing drugs, traditional healers like Kabiraj whose practice is based on diet and herbs, faith healers mostly providing spiritual treatment etc
Community people are well aware of the infectious, contagious characteristics of TB which is absolutely curable by proper medication
Summary
Tuberculosis (TB) is a major health care burden in developing countries (Ravichandran, 2004). It is reported as the second highest cause of death from infectious disease after HIV/AIDS in the world. Sub-Saharan Africa has the highest incidence rate (290 per 100,000 population), the majority of patients with TB live in Bangladesh, China, India, Indonesia and Pakistan where it is concentrated among densely populated areas (Dye, 2006). The population of Dhaka city is approximately 12 million (Banglapedia, 2006) and about 30% of the population live in slums and temporary squatter settlements without any access to basic primary health care services ((DGHS, NTP, 2009; ICDDR, B WP 142, 2000).
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