Barriers in seeking health care in TB control programme, an Institutional Based Pilot Study in Dhaka, Bangladesh

Abstract:

Setting: Two TB diagnostic centres - TB Control & Training Institute,   Chankharpool  and            National TB Control Project, Shyamoli, Dhaka city were the study places.

The objectives: of the study were to assess the pattern of health seeking hehaviour and to explore the barriers in seeking health care among the TB suspects with gender differentials.

Study Design & Method: An institution based, cross sectional study, which was conducted among 998 identified TB suspects of both sexes and of ages 15 years or more. Information and socio-demographic characteristics, presenting symptoms/complaints, health seeking behaviour and barriers in seeking health care of the TB suspects were collected by using pre-tested semi-structured questionnaires.

Results: Overall male:female ratio was 57:43. More than 52 % of the studied TB suspects were below 30 years of age. Higher number of female was found in the age group of 15-19 years and beyond that males were more. Overall mean age was significantly higher in male TB suspects than that in female TB suspects (p<001). About 68% of the TB suspects were urban area and no sex difference was found regarding their place of residence, (p> 0.05). Mostly they were from low socio-economic status.

Along with cough other complaints were chest pain (87%), fever (82%), night sweat (62%), loss of appetite (86%), loss of weight (89%) and blood in sputum (33%). Compared to males higher number of females complained of fever, chest pain and loss of appetite (p<0.05 in each case). Duration of symptoms showed no significant sex difference except night sweat by which female suffered fro longer duration (p=0.044).

About 17% of the TB suspects did not seek any advice for their symptoms. In this regard there was no significant sex difference. The most common cause for not seeking health care was lack of awareness or ignorance (52%). Others causes were want of money (32%) and lack of time (15%).

Among those who sought advice for their symptoms, 42% visited paraprofessionals or irrelevant sources and another 38% visited either qualified private practitioners or private hospitals. Only 16.5% visited government hospital/health posts. No significant gender difference was found in this regard. Significantly more males had to loose wages and more females had to take an accompanying person for visiting the centre. About   75% of the TB suspects faced some form of social stigmatization.
Conclusion: A substantial proportion of the TB suspects in this study did not seek health care due to lack of awareness or ignorance. Among those who sought advice for their symptoms, most of them visited paraprofessionals or private sectors. Some of the TB suspects faced social stigmatization problem. Strengthening of awareness programme for paraprofessionals and expansion of public private partnership are vital to achieve the target of TB case detection. 
 Key Words: TB suspects; gender differences; barriers, health seeking