Factors influencing women’s decision choosing a public or private health facility for tuberculosis (TB) services: An analysis of Nepal demographic and health survey data 2016

Abstract

BACKGROUND: Nepal is committed to providing reliable and free Tuberculosis (TB) services through public health facilities, but a considerable number of TB cases seek services from the private sector. There have been no previously published studies investigating factors that influence women's decision to choose a public or private health facility for TB services. Therefore, we aimed to examine how women's socio-demographic characteristics influence this decision. METHODS: We conducted an analysis using data from the Nepal Demographic and Health Survey (NDHS) 2016. The NDHS 2016 was a nationally representative cross-sectional study. A descriptive, bivariate and multivariate logistic regression method was used in the analysis. RESULTS: Overall, 88% of women chose a public health facility as their preferred place for the diagnosis and treatment of TB. Women having good TB knowledge (aOR: 1.90, 95% CI: 1.52-2.39), women aged 45-49 years (aOR: 3.98, CI: 2.68-5.91), and women living in the mountain region (aOR: 3.16, CI: 1.78-5.61) were more likely to prefer a public health facility. Women belonging to the richest category (aOR: 0.54, CI: 0.38-0.78), and being of Muslim (aOR: 0.42, CI: 0.28-0.64) were less likely to choose a public health facility for diagnosis and treatment of TB. CONCLUSION: This study indicates a considerable number of women have an insufficient level of access to quality TB services from a public health facility in Nepal. Inadequate TB knowledge, younger age, unemployment, and social stigma were all associated with women not preferring the public health facilities for the diagnosis and treatment of TB. We believe the findings of the analysis will help policy makers and program managers to fine-tune an intervention plan focusing on these women who are less likely to prefer public health facilities for TB services.