Health-care seeking among people with cough of 2 weeks or more in India. Is passive TB case finding sufficient?

Abstract

Thirty districts of India. To estimate 1) the proportion of people with cough of ≥2 weeks, 2) those who did not seek care from a health care provider for cough, and 3) their characteristics. A cross-sectional community-based survey in which 4562 people (aged ≥18 years) were interviewed. Of the 4562 individuals interviewed, 437 (9.5%, 95%CI 7.2-11.8) had cough ≥2 weeks; this was more frequent in those >55 years of age (14%) and in those from districts in eastern (12%) and northern (11%) states of India. Of those with cough, 300 (69%, 95%CI 60-77) had not sought care from any health care provider. Not seeking care was more frequent in people residing in rural areas (73%) compared with urban areas (53%), and in the districts of eastern (82%) and northern (74%) states compared to districts from the southern (46%) and western (54%) states. Nearly a tenth of those interviewed aged ≥18 years had cough of ≥2 weeks. About two thirds, especially those from rural areas, had not visited a health care provider for the cough. This finding has huge implications for India's current mostly passive case-finding strategy for detecting and controlling tuberculosis.