DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20163055

Knowledge and health seeking behaviour of tuberculosis patients in Kerala, India

Selvam Paramasivam, Bina Thomas, Jayakrishnan Thayyil, Asma Rahim, Jayakrishnan Thavody, Lilabi M. P., Jayadev V. K.

Abstract


Background: Patients confront several problems in timely and effective utilization of TB health facilities which have often delayed diagnosis of TB. It is hence the need of the hour to look beyond the case detection rates towards other factors that can promote early diagnosis.

Methods: A community-based cross-sectional study was conducted among newly diagnosed smear positive pulmonary tuberculosis patients aged ≥15 years on the Intensive Phase of treatment. A pretested semi-structured questionnaire was used to study knowledge, stigma, health seeking behaviour and other factors.

Results: The predominant symptom for seeking care was cough (93.0%). 45.7% of patients sought the services of a health care provider within 2 weeks. Modern medicine was the preferred system for 94.7% of the patients. The majority (58.6%) of the patients consulted a private health facility. Illiterates and Below Poverty Line patients preferred government facilities. The average number of consultations before diagnosis was 3.11±1.9. 34.1% had adequate knowledge about tuberculosis and women had a significantly higher knowledge score. low per capita income, smoking and alcohol use, cough alone, cough with other symptoms, history of TB in Family, distance more than ≥ 5 km to health facility showed significant association with delayed health-seeking action (>14 days).

Conclusions: Private practitioners and private hospitals were the predominant health providers preferred by the study subjects for the first consultation. Delayed health seeking action was probably due to the presence of a cough alone and coughs with other symptoms, history of tuberculosis among the family members and increased distance to TB health facility.


Keywords


Health seeking behaviour, Tuberculosis, Knowledge, Stigma, Patient delay

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References


Park K. Park’s Text Book of Preventive and Social medicine 22 nd ed: M/s Banarsidas. Bhanot Publishers, 1167, Prem nagar, Jabalpur, 482001 (M.P.) India. 2013.

Lawn SD, Afful B, Acheampong JW. Pulmonary tuberculosis: diagnostic delay in Ghanaian adults. The International Journal of Tuberculosis and Lung Disease. 1998;2(8):635-40.

Schneider D, McNabb SJN, Safaryan M, Davidyants V, Niazyan L, Orbelyan S. Reasons for Delay in Seeking Care for Tuberculosis, Republic of Armenia, 2006-2007. Interdisciplinary perspectives on infectious diseases. 2010. http://dx.doi.org/ 10.1155/2010/412624.

Yimer S, Bjune G, Alene G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infectious Diseases. 2005;5(1):112.

Farah MG, Rygh JH, Steen TW, Selmer R, Heldal E, Bjune G. Patient and health care system delays in the start of tuberculosis treatment in Norway. BMC Infectious Diseases. 2006;6(1):33.

Rajeswari R, Chandrasekaran V, Suhadev M, Sivasubramaniam S, Sudha G, Renu G. Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India. The International Journal of Tuberculosis and Lung Disease. 2002;6(9):789-95.

Salaniponi FML, Harries AD, Banda HT. Care seeking behaviour and diagnostic processes in patients with smear-positive pulmonary tuberculosis in Malawi. The International Journal of Tuberculosis and Lung Disease. 2000;4(4):327-32.

Wondimu T, Kassahun W, Getachew S. Delay in initiating tuberculosis treatment and factors associated among pulmonary tuberculosis patients in East Wollega, Western Ethiopia. Ethiopian Journal of Health Development. 2007;21(2):148-56.

Lienhardt C, Rowley J, Manneh K. Factors affecting time delay to treatment in a tuberculosis control programme in a sub-Saharan African country: the experience of The Gambia. The International Journal of Tuberculosis and Lung Disease. 2001;5(3):233-9.

Esther N, Godfrey M, Eliud W, Odd M. Delay in Tuberculosis case detection in Pwani region, Tanzania. a cross sectional study. BMC Health Services Research. 2009;9.

Bam TS, Enarson DA, Hinderaker SG, Bam DS. Longer delay in accessing treatment among current smokers with new sputum smear-positive tuberculosis in Nepal. The International Journal of Tuberculosis and Lung Disease.16(6):822-7.

Tobgay KJ, Sarma PS, Thankappan KR. Predictors of treatment delays for tuberculosis in Sikkim. National Medical Journal of India. 2006;19(2):60.

Huong NT, Vree M, Duong BD. Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: a cross-sectional study. BMC Public Health. 2007;13;7:110.

Uplekar M, Rangan S. Tackling TB: the search for solutions: Foundation for Research in Community Health; 1996.

Uplekar M, Juvekar S, Morankar S, Rangan S, Nunn P. Tuberculosis patients and practitioners in private clinics in India. Int J Tuberc Lung Dis. Apr 1998;2(4):324-9.

Kelkar-Khambete A, Kielmann K, Pawar S. India's Revised National Tuberculosis Control Programme: looking beyond detection and cure. The International Journal of Tuberculosis and Lung Disease. 2008;12(1):87-92.

Nair N, Wares F, Sahu S. Tuberculosis in the WHO south-east Asia region. Bulletin of the World Health Organization. 2010;88(3):164.

Rintiswati N, Mahendradhata Y, Subronto Y, Varkevisser CM, Van Der Werf MJ. Journeys to tuberculosis treatment: a qualitative study of patients, families and communities in Jogjakarta, Indonesia. BMC Public health. 2009;9(1):158.

Lugga MCL, Muita M, Matiru V, Muchiri E. Factors associated with patient and health service delays in the management of TB in Central Equatoria State in 2008. South Sudan Medical Journal. 2010;4(4):83-5.

Leung ECC, Leung CC, Tam CM. Delayed presentation and treatment of newly diagnosed pulmonary tuberculosis patients in Hong Kong. Hong Kong Medical Journal. 2007;13(3):221.

Bawankule S, Quazi SZ, Gaidhane A, Khatib N. Delay in DOTS for new pulmonary tuberculosis patient from rural area of Wardha District, India. Online Journal of Health and Allied Sciences. 2010;9(1):1-10.

Ahmad RA, Mahendradhata Y, Utarini A, de Vlas SJ. Diagnostic delay amongst tuberculosis patients in Jogjakarta Province, Indonesia is related to the quality of services in DOTS facilities. Tropical Medicine & International Health. 2011;16(4):412-23.

Selvam JM, Wares F, Perumal M, Gopi PG, Sudha G, Chandrasekaran V, et al. Health-seeking behaviour of new smear-positive TB patients under a DOTS programme in Tamil Nadu, India, 2003. Int J Tuberc Lung Dis. 2007;11(2):161-7.

Ngamvithayapong J, Yanai H, Winkvist A, Diwan V. Health seeking behaviour and diagnosis for pulmonary tuberculosis in an HIV-epidemic mountainous area of Thailand. The International Journal of Tuberculosis and Lung Disease. 2001;5(11):1013-20.

Mesfin MM, Newell JN, Walley JD, Gessessew A, Madeley RJ. Delayed consultation among pulmonary tuberculosis patients: a cross sectional study of 10 DOTS districts of Ethiopia. BMC Public Health. 2009;9:53.

Abebe G, Deribew A, Apers L, Woldemichael K, Shiffa J, Tesfaye M, et al. Knowledge, Health Seeking Behavior and Perceived Stigma towards Tuberculosis among Tuberculosis Suspects in a Rural Community in Southwest Ethiopia. PLoS One. 2010;5(10):e13339.

Sharma N, Malhotra R, Taneja DK, Saha R, Ingle GK. Awareness and perception about tuberculosis in the general population of Delhi. Asia-Pacific Journal of Public Health. 2007;19(2):10-5.

Machado ACFT, Steffen RE, Oxlade O, Menzies D, Kritski A, Trajman A. Factors associated with delayed diagnosis of pulmonary tuberculosis in the state of Rio de Janeiro, Brazil. J Bras Pneumol. 2011;37(4):512-20.

Wandwalo ER, Morkve O. Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania. The International Journal of Tuberculosis and Lung Disease. 2000;4(2):133-8.

Mesfin MM, Tasew TW, Tareke IG, Kifle YT, Karen WH, Richard MJ. Delays and care seeking behavior among tuberculosis patients in Tigray of northern Ethiopia. Ethiopian Journal of Health Development. 2005;19(I):7.

Cáceres-Manrique FM, Orozco-Vargas LC. Delayed diagnosis of pulmonary tuberculosis in a particular part of Colombia. Revista de Salud Pública. 2008;10(1):94-104.

Ford CM1, Bayer AM, Gilman RH, Onifade D, Acosta C, Cabrera L, et al. Factors associated with delayed tuberculosis test-seeking behavior in the Peruvian Amazon. Am J Trop Med Hyg. 2009;81(6):1097-102.

Kiwuwa MS, Charles K, Harriet MK. Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study. BMC Public health. 2005;5:122.