ABSTRACT
Background: Little information is available on triggers and barriers for seeking appropriate healthcare among chest symptomatics (CS) from slum populations in India. Methods: Urban slums in Uttar Pradesh (UP) and Karnataka (KA) were selected based on case detection rate (2008), population size and geographic distribution. A door-to-door survey was conducted in 2010 and CS were identified and interviewed. Action taking patterns were collected and factors influencing these among behavers (CS visiting qualified providers) and non-behavers (CS not taking action or resorting to self-medication) compared. Results: Of 1526 CS in UP and 1515 in KA interviewed, 75% in UP and 58% in KA sought care; of them 79% in UP and 99% in KA visited a qualified provider. More than 80% in both UP and KA underwent recommended tests within a week (mean days: UP-1.8; KA-2.4). Only 16% of respondents in UP and 48% in KA reported that private qualified providers recommended sputum microscopy. Important triggers of visiting a qualified provider were being females; of higher economic status, self-efficacy, suspicion of having TB when suffering from persistent cough and that sputum microscopy should be done to diagnose TB. Additional triggers included knowledge that TB is caused by germs and can affect anyone (UP) and perceptions of quality of care and knowledge that TB is curable (KA). Implications: There is need to carry out targeted area-specific communication in slums to improve appropriate treatmentseeking behaviour and demand creation for DOTS by CS. The study recommends investments to focus on changing private provider behaviour.
Subject(s)
Adult , Aged , Directly Observed Therapy , Female , Health Knowledge, Attitudes, Practice , Humans , India/epidemiology , Male , Middle Aged , Patient Acceptance of Health Care , Population Groups , Poverty Areas , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiology , Young AdultABSTRACT
A cross-sectional, community based study was undertaken in Patpur slum of Bankura to determine the prevalence of chest symptomatics, their health care seeking Behavior and its correlates. Prevalence of chest symptomatics (cough for 3 weeks or more) was found to be 5.5%, three fourths of whom sought relief from a health care provider. Among them, 70.8% did so within 2 weeks, median being 7 days. No preference for either government or private health care provider was seen in first visit, where the major reason for choosing facilities was advice by family & friends (43.8%). Most of the chest symptomatics (75%) were retained in the same facility. Shift from private to government facility for subsequent visits (33.3%) was higher than from government to private facility (16.7%). The main reason (50%) for changing health facility was expectation for better service.