ABSTRACT
Background: Successful tuberculosis control requires specific behaviors from patients and health providers. Therefore, understanding behaviors is fundamental to design interventions to strengthen tuberculosis control programs, including communication interventions. The aim of this study was to assess the healthcare-seeking behavior of pulmonary tuberculosis (PTB) patients in Jabalpur district.Methods: Cross-sectional study was conducted among category I new sputum positive PTB patients identified from nine designated microscopy centres from November 2013 to October 2014. Calculated sample size of 135 with a multistage random sampling method was used. Student’s t-test and Chi-square test were used along with descriptive statistics.Results: Mean age of patients was 33.87 (14.3) years, males constituted 66.7%, 72.5% patients belonged to below class IV socioeconomic status. Cough was experienced by 91.1% subjects, followed by fever (69.6%). First action was consulting a health care provider (HCP) in 41.5% followed by self-medication (21.5%). It took two attempts for 76% of patients to reach a formal health care provider. Private health care providers were consulted as first choice among HCPs by 86.7% patients, initial diagnosis was made by them in 25.9% cases. Sixty-three percent of patients were not satisfied with care at government hospitals, 41.5% had not heard of tuberculosis before their diagnosis, 59.5% of patients got information about tuberculosis from their relatives suffering from it.Conclusions: Cough is the most common and earliest symptom responsible for seeking care in pulmonary tuberculosis. Government health facilities contribute maximum to diagnosis but private health facility is the first choice for initial consultation. Patients’ perception of suggestive symptoms needs to be changed.
ABSTRACT
Background: Delay in diagnosis of pulmonary tuberculosis (PTB) causes patients to have more severe disease, more complications and lead to higher mortality with disease spread. The aim of the study was to estimate patient proportion having delayed diagnosis of PTB and to estimate patient’ and health providers’ delay and associated factors.Methods: This cross sectional study was conducted on sample of 135 new sputum positive PTB patients from nine designated microscopy centres of Jabalpur district. Data collected on modified world health organization questionnaire. The criterion for defining delay was formulated keeping in mind the Revised TB Control Programme algorithm for diagnosis of PTB in PTB suspects. Mann Whitney U and Kruskal Wallis tests were used (α=5%).Results: Mean age was 33.87 (14.3) years. Males constituted 66.7%. Proportion of diagnostic delay was 87.4%. Median patient and health care personnel (HCP) interval were 39 days (IQR 22-75) and 34 days (IQR 12-79) respectively. Factors significantly associated with patient delay were poor knowledge about TB, smoking, symptoms perceived non serious, first action with symptom onset, and mode of transport patient used to reach the nearest public health facility. Stigma didn’t affected patient interval. Factors significantly associated with health providers’ delay were first consultations with; a non-formal HCP, private health facility, non-allopathic practitioner; consultation with multiple HCP’s; living more than half an hour away from public health facility.Conclusions: Unacceptable high delay in diagnosis, more from patient side. More attempts at increasing awareness are needed.
ABSTRACT
Background: Lymphatic filariasis is the second leading cause of disability worldwide accounting for more than 5 million disability adjusted life years annually. It has been a major public health problem in India which leads to irreversible chronic manifestations which are responsible for considerable economic loss and severe physical disability to the affected individuals. Mass drug administration (MDA) means administration of diethylcarbamazine and albendazole tablets to all people (excluding children <2 years, pregnant women, seriously ill persons) in endemic areas once in a year. The objective of the study was to assess coverage, compliance of MDA and awareness about lymphatic filariasis in Tikamgarh district of Madhya Pradesh.Methods: Cross-sectional study was conducted and total 120 households were surveyed in four randomly selected clusters of Tikamgarh district of Madhya Pradesh.Results: Out of total 743 persons 678 (91.25%) persons were eligible for MDA. Coverage rate was 86.57% and compliance rate was 74.27%. The main reason for non-compliance was not having the concerned disease (55.78%) followed by fear of side effect (22.31%). Only 40.83% among the surveyed families were aware about MDA and only 45.83% respondents had heard about lymphatic filariasis.Conclusions: There is coverage and compliance gap and awareness about the lymphatic filariasis and MDA program is limited. Drug compliance need to be improved and awareness need to be raised. MDA program should not be confined to tablet distribution only and due importance should be given to compliance rate.