Treatment seeking pathways in pediatric tuberculosis patients attending DOTS centers in urban areas of Delhi

Abstract

BackgroundThe treatment seeking pathways prior to initiation of Direct Observed Treatment Short-course Therapy (DOTS), provides the extent of patient and health system delays among pediatric tuberculosis (TB) patients. ObjectivesThe study attempted to understand the treatment seeking pathways of pediatric TB patients under revised national tuberculosis control program (RNTCP). Study design and settingIt was a prospective observational study carried out from January 2015 to December 2015. A predesigned, pretested and semi-structured questionnaire was used to interview 141 caregivers of pediatric patients (0–14 years) at two chest clinics selected purposively. ResultsThirteen different treatment seeking pathways were identified and fever was the commonest symptom (41.8%) for seeking care from 1st health facility. Median time taken from onset of symptoms to first consultation varied from 1 to 144 weeks. More than half of the study subjects were first taken to a private practitioner (64.5%) followed by a pharmacist (19.1%) and trust in provider was the commonest reason for choosing the first care-provider in 52 (41.1%), followed by easy access or convenience in 49 (34.8%). ConclusionA significant delay was found in treatment initiation of patients with extra pulmonary tuberculosis (EPTB), those belonging to lower socio-economic class families, low literacy level of parents, who went to private facility first and availed more than three health facilities before diagnosis.