Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; Missed opportunity for early tuberculosis diagnosis

Abstract

Background Tuberculosis (TB) is the 9 th leading cause of death from a single infectious agent. Patients live in a complex health care system with both formal and informal providers, and it is important that a TB diagnosis is not missed at the first interaction with the health care system. In this study, we highlight the health seeking behavior of patients and missed opportunities for early TB diagnosis for which interventions could be instituted to ensure early TB diagnosis and prompt TB treatment initiation. Methods This study was nested in a cross-sectional study that assessed the accuracy of different Xpert MTB/Rif implementation strategies in programmatic settings at the referral hospitals in Uganda. We documented the symptom profile of presumptive TB patients and assessed the health seeking behavior of those with chronic cough by calculating proportion of patients that visited each type of health facility and further calculated the odds of being TB positive given the type of health facility initially visited for consultation. Results A total of 1,863 presumptive TB patients were enrolled of which 979 (54.5%) were male, and 1795 (99.9%) had chronic cough. A total of 1352 (75.4%) had previously sought care for chronic cough, with 805 (59.6%) seeking care from a public health facility followed by private health facility (289; 21.4%). Up to 182 (13.5%) patients visited a drug store for chronic cough. Patients whose first contact was a private health facility were more likely to have a positive GeneXpert test (adjOR 1.4, 95% CI: 1.0–1.9; p = 0.047). Conclusions Chronic cough is a main symptom for many of the presumptive TB patients presenting at referral hospitals, with several patients having to visit the health system more than once before a TB diagnosis is made. This suggests the need for patients to be thoroughly evaluated at first interface with the health care system to ensure prompt diagnosis and treatment initiation. Improved TB diagnosis possibly with the GeneXpert test, at first contact with the health care system has potential to increase TB case finding and break the transmission cycle in the community.

Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study

“…It is of concern that many patients visited private health care facilities or pharmacies as their first point contact, incurring additional expenses in the process. Our findings corroborate studies in other settings where patients incurred higher costs and a circuitous path to care, [24] resulting in significant delays in accessing treatment [31]. The economic burden of TB treatment remains considerable, especially in poorer and developing countries without universal health coverage (UHC), including our study setting [5,32].…”

Presumptive pulmonary tuberculosis and its associated factors among adult patients availing out-patient services in a tertiary care center, Puducherry, South India

“…9 The most common symptom found was cough which is very similar to other studies. 10 A statistically significant difference was found between PPTB and sociodemographic (gender, residence) as well as behavioural characteristics (tobacco use, alcohol use). There are no studies that have looked into the risk factors of PPTB, however, high use of tobacco among PPTB patients have been reported previously.…”

Health Seeking Behaviour among Past and Current Tuberculosis Patients in a Low-Income Country

“…The assessment done in improving pathways to care through interventions co-created with communities in Malawi showed that clear pathways to care involve interventions that need to consider in contextual concerns by resolving personal level of socio-economic aspects and also boarder level of structural factors of gendered social dynamics and health system environment [20], the socio-economic and traditional factors are also substantial 'bottleneck' to hastening the uptake and utilisation of diagnostic and treatment tools for TB services [21], and adequate knowledge and positive health behaviour supports the TB patients in taking timely help from appropriate diagnosis and treatment health care outlets [22]. A quarter of the TB patients preferred for seeking care from the private health care service providers in Uganda [23]. However, more than seventy percent of people in Nepal still use and intend to visit the government health facilities to take TB diagnosis and treatment services.…”