Health seeking behaviour in pulmonary tuberculosis: a cross sectional study

Jebamalar J., Priya Senthilkumar, Mary Ramola


Background: Health seeking behaviour has been identified as a complex and dynamic process which influences disease burden of tuberculosis. The present study aimed to study health seeking behaviour among pulmonary tuberculosis patients in a metropolitan city and to assess diagnostic and treatment delays and their determinants.

Methods: A cross sectional study was conducted among newly diagnosed pulmonary tuberculosis patients registered for intensive phase of Category 1 ATT during the study period in Zone VIII of Chennai Corporation. The sample size was 197. The study was conducted over a period of one year from September 2015 to August 2016. A standardized WHO interview schedule on diagnostic delay was used for the study.

Results: Patients sought healthcare for more severe symptoms like hemoptysis (delay of 38 days) earlier than for cough (delay o- 8 days). Other reasons for delay in seeking care were hope of self-resolution, financial constraints, fear of what the diagnosis would be, incompatible timings etcetera. The total mean delay from onset of symptoms till start of treatment was around 47 days, out of which the patient delay was 42 days. Factors significantly associated with delay included smoking, age more than 35 years and not approaching healthcare facilities first.

Conclusions: An unacceptably high patient delay is the major contributor to total delay in the diagnosis and treatment of pulmonary tuberculosis patients. There is increased odds of delay among smokers compared to those who have never smoked. So smokers may be added to the high risk group for suspicion of tuberculosis for fast tracking of diagnosis and treatment. Furthermore, methods to curb over the counter medications should be explored.


Tuberculosis, Delays, Health seeking

Full Text:



WHO. Tuberculosis. WHO. Available from: Accessed on 10 March 2018.

Wang WB, Jiang QW, Chen Y, Xu B. Pathways from first health care seeking to diagnosis: obstacles to tuberculosis care in rural China. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2007;11(4):386–91.

Ukwaja KN, Alobu I, Nweke CO, Onyenwe EC. Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study. BMC Health Serv Res. 2013 Jan 17;13:25.

Charles N, Thomas B, Watson B, Raja Sakthivel M, Chandrasekeran V, Wares F. Care seeking behavior of chest symptomatics: a community based study done in South India after the implementation of the RNTCP. PloS One. 2010;5(9):e12379.

Yimer S, Holm-Hansen C, Yimaldu T, Bjune G. Evaluating an active case-finding strategy to identify smear-positive tuberculosis in rural Ethiopia. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2009;13(11):1399–404.

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.

Basnet R, Hinderaker SG, Enarson D, Malla P, Mørkve O. Delay in the diagnosis of tuberculosis in Nepal. BMC Public Health. 2009;;9:236.

Osei E, Akweongo P, Binka F. Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana. BMC Public Health. 2015;15:721.

Kasse Y, Jasseh M, Corrah T, Donkor SA, Antonnio M, Jallow A, et al. Health seeking behaviour, health system experience and tuberculosis case finding in Gambians with cough. BMC Public Health. 2006;6:143.

Rumman KA, Sabra NA, Bakri F, Seita A, Bassili A. Prevalence of tuberculosis suspects and their healthcare-seeking behavior in urban and rural Jordan. Am J Trop Med Hyg. 2008;79(4):545–51.

Ghosh S, Sinhababu A, Taraphdar P, Mukhopadhyay DK, Mahapatra BS, Biswas AB. A study on care seeking behavior of chest symptomatics in a slum of Bankura, West Bengal. Indian J Public Health. 2010;54(1):42–4.

EH, Dachew BA, Kassa Woreta H, Mekonnen Kelkay M, Ashenafie TD. Health Seeking Behaviour and Associated Factors among Pulmonary Tuberculosis Suspects in Lay Armachiho District, Northwest Ethiopia: A Community-Based Study. Tuberc Res Treat. 2016;2016:7892701.

JCDR - Care Seeking Behavior of the TB Patients who were Registered in an Urban Government Tuberculosis Control in Chennai, Tamilnadu, India. Available from:

dsa710.pdf. Available at: Accessed on 10 March 2018.

Fochsen G, Deshpande K, Diwan V, Mishra A, Diwan VK, Thorson A. Health care seeking among individuals with cough and tuberculosis: a population-based study from rural India. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2006;10(9):995–1000.

Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. 2008 ;8:15.

Lock WA, Ahmad RA, Ruiter RAC, van der Werf MJ, Bos AER, Mahendradhata Y, et al. Patient delay determinants for patients with suspected tuberculosis in Yogyakarta province, Indonesia. Trop Med Int Health TM IH. 2011;16(12):1501–10.

Belay M, Bjune G, Ameni G, Abebe F. Diagnostic and treatment delay among Tuberculosis patients in Afar Region, Ethiopia: a cross-sectional study. BMC Public Health. 2012;12:369.

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. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2002;6(9):789–95.

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 Off J Int Union Tuberc Lung Dis. 2007;11(2):161–7.

Odusanya OO, Babafemi JO. Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria. BMC Public Health. 2004;4:18.

Tobgay KJ, Sarma PS, Thankappan KR. Predictors of treatment delays for tuberculosis in Sikkim. Natl Med J India. 2006;19(2):60–3.

SSMJ_5_4_TB_case_detection.pdf.Available from: Accessed on 10 March 2018.

Lawn SD, Afful B, Acheampong JW. Pulmonary tuberculosis: diagnostic delay in Ghanaian adults. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 1998;2(8):635–40.

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.

Godfrey-Faussett P, Kaunda H, Kamanga J, van Beers S, van Cleeff M, Kumwenda-Phiri R, et al. Why do patients with a cough delay seeking care at Lusaka urban health centres? A health systems research approach. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2002;6(9):796–805.

Ndeikoundam Ngangro N, Chauvin P, Halley des Fontaines V. [Determinants of tuberculosis diagnosis delay in limited resources countries]. Rev Epidemiol Sante Publique. 2012;60(1):47–57.