Abstract
BackgroundHealth care seeking is a dynamic process that is influenced by socio-demographic, cultural and other factors. In Ethiopia, there are limited studies regarding the health seeking behaviour of tuberculosis (TB) suspects and TB patients. However, a thorough understanding of patients' motivation and actions is crucial to understanding TB and the treatment of disease. Such insights would conceivably help to reduce delay in diagnosis, improve treatment adherence and thereby reduce transmission of TB in the community. The objective of this study was to describe and analyze health care seeking among TB suspects and pulmonary TB (PTB) cases in a rural district of the Amhara Region in Ethiopia.MethodsStudy kebeles were randomly selected in a cross-sectional study design. House-to-house visits were conducted in which individuals aged 15 years and above in all households of the kebeles were included. Subjects with symptoms suggestive of TB were interviewed about their health seeking behaviour, socio-demographic and clinical factors using a semi-structured questionnaire. Logistics regression analysis was employed to assess associations between the independent and outcome variables.ResultsThe majority, 787 (78%), TB suspects and 33 (82.5%) PTB cases had taken health care actions for symptoms from sources outside their homes. The median delay before the first action was 30 days. In logistics regression, women (AOR 0.8, 95% CI 0.6, 0.9) were found to be less likely to visit a medical health provider than men. Those with a long duration of cough (AOR 1.5, 95% CI 1.03, 2.1) and those with a previous history of TB (AOR 1.5, 95% CI 1.03, 2.3) were more likely to visit a medical health provider compared to those with a shorter duration of cough and with no history of TB.ConclusionThe majority of TB suspects and PTB cases had already taken health care actions for their symptoms at the time of the survey. The availability of a simple and rapid diagnostic TB test for use at the lowest level of health care and the involvement of all health providers in case finding activities are imperative for early TB case detection.
Highlights
Health care seeking is a dynamic process that is influenced by socio-demographic, cultural and other factors
Duration of cough In this survey, a total of 1,006 (2.1%) individuals were identified as TB suspects of whom 40 were acid fast bacilli (AFB)-positives cases
Among the 40 patients identified with pulmonary TB (PTB) during the survey, 7 (17.5%) had a cough of one month's duration or less and 22 (55%) between 3 months and one year (Table 2)
Summary
Health care seeking is a dynamic process that is influenced by socio-demographic, cultural and other factors. Understanding the diagnostic process and health seeking behaviour of TB patients is necessary to improve case detection and provide timely treatment of TB. In this regard, a number of health facility-based studies have explored the duration of delay and factors related to health seeking among PTB patients [2]. Too few community-based studies have been conducted to provide an understanding of health seeking behaviour among TB suspects [3,4,5] As these groups of patients constitute pools from which infectious TB cases are detected, analysing their health seeking behaviour is very important to elucidate the magnitude and reasons for diagnostic delay in TB
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