Multiple perspectives on diagnosis delay for tuberculosis from key stakeholders in poor rural China: Case study in four provinces

Yan, Fei; Thomson, Rachael; Tang, Shenglan; Squire, S. Bertel; Wang, Wei; Liu, Xiaoyun; Gong, Yi; Zhao, Fang; Tolhurst, Rachel

doi:10.1016/j.healthpol.2006.08.001

Cited by 33 publications

(43 citation statements)

References 10 publications

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“…Of 28 studies, 20 (71%) investigated gender-related differences in TB-related stigma [17–20, 22–37]. Among these, 9 (45%) studies found that women experienced greater stigma than men [17, 18, 20, 22, 28, 31–33, 35], 8 (40%) studies found no gender-related difference [19, 24–26, 29, 30, 34, 36], two (10%) studies reported that men faced a greater stigma burden than women [23, 37], and one study reported that women in the community had higher prejudice toward TB patients [27]. …”

Section: Resultsmentioning

confidence: 99%

“…The impact of TB-related stigma on marriage was noted in six studies. Many of these [23, 34, 36, 37] found that TB-related stigma affected the marriage prospects of both genders, with men having a slightly more difficult time finding a wife in areas with a low female/male ratio [23, 37]. Two studies [18, 32] discussed divorce as a direct consequence of TB to be more likely to affect females, and, of these, one study [18] reported that TB-infected females were more likely than TB-infected males to face difficult marital prospects.…”

Section: Resultsmentioning

confidence: 99%

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Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies

Krishnan

Akande

Shankar

et al. 2014

Tuberculosis Research and Treatment

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Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified “inductive coding” system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies

Krishnan

Akande

Shankar

et al. 2014

Tuberculosis Research and Treatment

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“…Increasing case detection is an international priority, however the obstacles to accessing services are complex and rooted in disadvantage and exclusion [4]. Obtaining a diagnosis of TB is a prerequisite for obtaining free treatment [5], yet diagnostic facilities are often sparsely distributed, particularly in rural settings, and access can be difficult [6] and costly [7]. The majority of individuals with TB live a precarious existence on a low income and are preoccupied with immediate survival [8].…”

Section: Introductionmentioning

confidence: 99%

Barriers to Completing TB Diagnosis in Yemen: Services Should Respond to Patients' Needs

et al. 2014

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Objectives and BackgroundObtaining a diagnosis of tuberculosis (TB) is a prerequisite for accessing specific treatment, yet one third of estimated new cases are missed worldwide by National Programmes. This study investigated economic, geographical, socio-cultural and health system factors hindering adults' attendance and completion of the TB diagnostic process in Yemen, to inform interventions designed to improve patient access to services.MethodologyThe study employed a mixed methods design comprising a cross-sectional survey and In-Depth-Interviews (IDIs) and Focus Group Discussions (FGDs) among patients abandoning the diagnosis or registering for treatment. Adults with cough of ≥2 weeks attending a large governmental referral centre in Sana'a, Yemen, between 2009 and 2010, were eligible to participate.Results497 and 446 (89.7%) participants were surveyed the first and second day of attending the services and 48 IDIs and 12 FGDs were also conducted. The majority of patients were disadvantaged and had poor literacy (61% illiterate), had travelled from rural areas (47%) and attended with companions (84%). Key barriers for attendance identified were clinic and transport costs (augmented by companions), distance from home, a preference for private services, strong social stigma and a lack of understanding of the diagnostic process. There were discrepancies between patient- and doctor-reported diagnosis and 46% of patients were unaware that TB treatment is free. Females faced more difficulties to attend than men. The laboratory practice of providing first-day negative smear results and making referrals to the private sector also discouraged patients from returning. Strategies to bring TB diagnostic services closer to communities and address the multiple barriers patients face to attend, will be important to increase access to TB diagnosis and care.

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“…Several studies reported that rural patients had to pay 40-100% of their annual income for TB-related medical costs and most of this was spent before their TB diagnosis [11,19]. Lack of cooperation between TB dispensaries and general hospitals was another factor contributing to high patient cost because treating patients was more profitable for general hospitals than receiving the referral incentives [20][21][22]. Patients commented that they appreciated the free treatment policy operated alongside the incentives more than the travel incentives, because the free treatment policy covered more costs of TB treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Social factors such as gender, poverty and old age have all been identified as barriers to accessing TB services [22,25].…”

Section: Discussionmentioning

confidence: 99%

Why financial incentives did not reach the poor tuberculosis patients? A qualitative study of a Fidelis funded project in Shanxi, China

et al. 2009

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Multiple perspectives on diagnosis delay for tuberculosis from key stakeholders in poor rural China: Case study in four provinces

Cited by 33 publications

References 10 publications

Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies

Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies

Barriers to Completing TB Diagnosis in Yemen: Services Should Respond to Patients' Needs

Why financial incentives did not reach the poor tuberculosis patients? A qualitative study of a Fidelis funded project in Shanxi, China

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