Abstract
BackgroundThis study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing for more than 2 weeks to better understand this vulnerable and important population.MethodsThe study analysed data from a cohort study (SOCS - Secondary Outcome Cohort Study) embedded in a community randomised trial ZAMSTAR (Zambia and South Africa TB and AIDS Reduction Study) in eight high-burden TB communities in the Western Cape, South Africa. These datasets are unique as they contain TB-related data as well as data on health, health-seeking behaviour, lifestyle choices, employment, socio-economic status, education and stigma. We use uni- and multivariate logistic regressions to estimate the odds ratios of consulting for a cough (of more than 2 weeks duration) for a range of relevant patient predictors.ResultsThree hundred and forty persons consulted someone about their cough and this represents 37% of the 922 participants who reported coughing for more than 2 weeks. In the multivariate analysis, respondents of black ethnic origin (OR 1.99, 95% CI 1.28–3.12, P < 0.01), those with higher levels of education (OR 1.05 per year of education, 95% CI 1.00–1.10, P = 0.05), and older respondents (OR 1.02 per year, 95% CI 1.01–1.04, P < 0.01) had a higher likelihood of consulting for their chronic cough. Individuals who smoked (OR 0.63, 95% CI 0.45–0.88, P < 0.01) and those with higher levels of socio-economic status (OR 0.81, 95% CI 0.71–0.92, P < 0.01) were less likely to consult. We find no evidence of stigma playing a role in health-seeking decisions, but caution that this may be due to the difficulty of accurately and reliably capturing stigma due to, amongst other factors, social desirability bias.ConclusionsThe low levels of consultation for a cough of more than 2 weeks suggest that there are opportunities to improve case-finding. These findings on health-seeking behaviour can assist policymakers in designing TB screening and active case-finding interventions that are targeted to the characteristics of those with a chronic cough who do not seek care.
Highlights
This study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing for more than 2 weeks to better understand this vulnerable and important population
TB transmission is amplified in the context of the prevailing Human immunodeficiency virus (HIV) pandemic in the WHO (World Health Organization) African region, where 31% of all new TB cases in adults are attributable to HIV infection [1]
Summary of health-seeking outcomes Three per cent of the full ZAMSTAR sample (922 out of 30,017 persons) reported coughing for more than 2 weeks. These 922 observations constitute the sample of interest
Summary
This study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing for more than 2 weeks to better understand this vulnerable and important population. TB transmission is amplified in the context of the prevailing HIV pandemic in the WHO (World Health Organization) African region, where 31% of all new TB cases in adults are attributable to HIV infection [1]. In this context where transmissions occur more readily, delays to seeking healthcare have a higher mortality and morbidity cost [2, 3]. Studies focus on delays in diagnosis to explore both demand and supply dynamics Often such approaches do not allow for a detailed exploration of patient considerations
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