Health seeking behaviour and delayed management of tuberculosis patients in rural Bangladesh

K A T M Ehsanul Huq,Habiba Shirin,Akramul Islam,Julie Long,Michiko Moriyama,Shahed Hossain,Sajeda Chowdhury,Mohammod Jobayer Chisti,Mohammad Jyoti Raihan,Md Moshiur Rahman,Khalequ Zaman

doi:10.1186/s12879-018-3430-0

Abstract

BackgroundEarly diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB. Patients need to receive proper treatment through the National Tuberculosis Control Programme (NTP). This study describes various predictors for health seeking behaviour of TB patients and health system delay made by the different health care providers.MethodsA cross-sectional study was conducted in a public health facility of a rural area in Bangladesh. Newly diagnosed smear positive pulmonary TB (PTB) patients who were ≥ 15 years of age were sequentially enrolled in this study. The socio-demographic characteristics and proportion of health care utilization by the patients, and health system delay made by the health care providers were calculated. Multivariate analysis was conducted to determine the independent association of the risk factors with the time to seek medical care.ResultsTwo hundred and eighty patients were enrolled in this study. Among them, 73.6% were male and 26.4% were female. A hundred percent of patients primarily sought treatment for their cough, 170 (60.7%) first consulted a non-qualified practitioner while 110 patients (39.3%) first consulted with qualified practitioners about their symptoms. Pharmacy contact was the highest (27.9%) among the non-qualified practitioners, and 58.9% non-qualified practitioners prescribed treatment without any laboratory investigation. The average health system delay was 68.5 days. Multiple logistic regressions revealed a significant difference between uneducated and educated patients (OR 2.33; CI 1.39–3.92), and qualified and non-qualified practitioners (OR 2.34; CI 1.38–3.96) to be independent predictors of health system delay.ConclusionsCompared to men, fewer women sought TB treatment. Uneducated patients and questionably qualified practitioners made for a longer delay in detecting TB. Increasing public health awareness and improving health seeking behavior of females and uneducated patients, and greater participation of the qualified practitioners in the NTP are highly recommended.

Highlights

Diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB
We evaluated the health care seeking patterns of the TB patients before commencing treatment at the Upazila Health Complex, in order to assess the delay for the diagnosis of TB
This paper suggests that all medical service providers, both qualified and non-qualified, should be integrated into the National Tuberculosis Control Programme (NTP)

Summary

Introduction

Diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB. In 2016, of the 10.4 million new cases worldwide, 1.3 million resulted in death [1]. This infectious disease is most commonly spread by coughing [2] and is most prevalent among productive-age adults between 15 and 59 years [3]. According to ‘The End TB Strategy’ in the Sustainable Development Goals (SDGs), early diagnosis of TB and engagement of public and private health care providers is essential [1, 4]. To reduce the case fatality rate from 16 to 10% between 2015 and 2020, it is necessary to diagnose and treat patients without any delay [1]. The increased incidence of multi-drug resistant tuberculosis has contributed to the increased global burden of TB [7]

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