Abstract
SettingRevised National Tuberculosis Control Programme (RNTCP), Delhi, India.ObjectiveTo ascertain the number and sequence of providers visited by TB patients before availing treatment services from DOTS; to describe the duration between onset of symptoms to treatment.Study designA cross sectional, qualitative study. Information was gathered through in-depth interviews of TB patients registered during the month of Oct, 2012 for availing TB treatment under the Revised National TB Control Programme from four tuberculosis diagnosis and treatment centers in Delhi.ResultsOut of the 114 patients who registered, 108 participated in the study. The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly. Most patients sought medical care from more than two providers, before being diagnosed as TB. Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively).ConclusionThe pathways followed by TB patients, illustrated in this study, provide valuable lessons on the importance of different types of providers (both formal and informal) in the health system in a society like India and the delays in the diagnosis and treatment of tuberculosis.
Highlights
The burden of Tuberculosis (TB) is estimated to be highest in India
The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly
The pathways followed by TB patients, illustrated in this study, provide valuable lessons on the importance of different types of providers in the health system in a society like India and the delays in the diagnosis and treatment of tuberculosis
Summary
The burden of Tuberculosis (TB) is estimated to be highest in India. Evidence suggests that TB patients, from low income groups or underserved areas take long and sometimes difficult pathways to reach health facilities that provide appropriate care [3]. Such studies provide little evidence in terms of tracking and mapping the pathways taken by TB patients, to reach appropriate treatment facilities. Under the Revised National Tuberculosis Control Programme (RNTCP) of the Government of India, provisions have been made to provide access to diagnostic and treatment services in a decentralized manner through a network of ,13,000 sputum smear microscopy centers and ,650,000 of Directly Observed Treatment Short-course (DOTS) centers within the public health system [4]
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