Title : Impact of health seeking behavior on Pulmonary TB care in Raipur District of Chhattisgarh province India: Community based study
Abstract:
Introduction: Patients with undiagnosed pulmonary TB act as reservoirs for transmission and will result in 10-15 secondary infections in 1-5 Yrs. Health seeking behavior plays important role in early diagnosis and prompt treatment in TB care. Identification of factors influencing TB care could help in better programmatic impact and overall outcome of TB care.
Material and Methods: This cross sectional study was conducted among 262 Pulmonary TB Pt during Nov – Oct 2022. In-depth interviews were done among study subjects. After informed consent we assessed patient’s experiences and documented their journey from initial symptoms until they reached public health facility.
Results: Overall, 198 (78.57%) index cases 21.42% caretakers were interviewed. Mean age of study participants was 36.7 ± 16 years; 87% belonged to the backward class and 56% were from rural areas, 25.39% were illiterate, approximately half (46%) of them were laborers and 29.36% belonged to the joint family. Cough >2wks (55.6%) and evening rise of temperature (32.1%) were the first symptoms followed by chest pain and loss of appetite. Most (97.2%) participants didn’t know earlier sign & symptoms of TB; 91.7% didn’t know which health care facility to be accessed for the same while 85% had accustomed to visit private health facilities for common illnesses. About one third (32%) participants got appropriate treatment on 1st contact followed by 55%, 71.4%, 81.82% and 100% in subsequent health facility contacts (i.e. 2nd 3rd, 4th and & 5th). Very few (14.3%) had a fear of TB. Waiting time to access TB care at Public health facility was for 31 days (31 ± 45 days) and 57 days (± 60 days). Male, self-medication, ignorant to classical symptoms of TB were significant determinants for health seeking behavior. Participants who contacted private health facility, not aware of signs and symptoms of TB were 4 times at higher risk, adopted self-medication were 3 times, more than two consultations were 12-13 times higher risk of experiencing waiting time (≥30days) for diagnosis (Odds ratio 3.056, 4.086 and 14.617 respectively . [p-value ≤ 0.05]. Study participants who were residing in a rural area, middle & lower socio-economic class and visited private health facility first, were significant predictors for increase waiting time (≥ 30days) for diagnosis in study area. aOR 2.176[95% CI (1.017-4.659)].aOR2.627[95% CI (1.114-6.196)].
Conclusions: Poor health-seeking behavior among study subjects due to ignorance of the sign and symptoms of pulmonary TB, more than two consultations, seeking care from a private health facility and not getting appropriate referral from formal as well as informal health facilities in study area. The common determinants were self-medication, illiteracy, middle and lower-class status and ignorance about classic signs and symptoms.
