Background: Tuberculosis (TB) remains a major global public health problem. Early
detection and initiation of treatment shortens infectious period and is key to
TB control. A considerable proportion of TB patients presenting with advanced
symptoms suggests delay in seeking care. As TB control programs rely on passive
case finding, TB care-seeking behavior is critical as un-diagnosed cases act as
reservoirs for transmission. This study assessed patient health seeking
behavior and choice of place of care among TB patients in Nigeria. Methods: This was a pro-gramme
implementation, facility-based cross-sectional study in 14 states, 92 facilities
across three levels of care. Interviewer-administered semi-structured
questionnaires were used. Information on personal characteristics and health
seeking behavior was collected from June 2020 to December 2021. The analysis
was based on the various healthcare providers where the respondents first
sought care. Data analysis was done using
IBM SPSS and summarized using frequency and percentages. Chi square test
was used for associations of characteristics of patients and choice of place of
care at p < 0.05. Results: In all 14 states, distribution of overall
first place of seeking care for TB symptoms was: 7208 (75.8%) health facilities (range 57% to 88%),
while 2294 (24.2%) visited other places including community pharmacist, patent
medicine vendor, traditional/home, un-specified/none. For Health facilities,
the majority were at public facilities 6563 (69.1%) and private 641 (6.7%).
Moreover, 6 states had >20% of respondents who first sought care at PMVs, while 3 states (Delta,
Imo, and Rivers) had 10% of respondents who first sought care at Community
Pharmacist. Conclusions: Nearly a quarter of people with TB
References
[1]
Federal Government of Nigeria (2012) Report of the First National TB Prevalence Survey 2012.
[2]
Adolphus, I. and Abebe, F. (2012) Assessment of Defaulting from Directly Observed Treatment Short Courses and Its Determinants in Benin City. Journal of Tuberculosis Research, 2, 30-39.
[3]
Ford, C.M., Bayer, A.M., Gilman, R.H., Onifade, D., Acosta, C., Cabrera, L., Vidal, C. and Evans, C.A. (2009) Factors Associated with Delayed Tuberculosis Test-Seeking Behavior in the Peruvian Amazon. The American Journal of Tropical Medicine and Hygiene, 81, 1097-1102. https://doi.org/10.4269/ajtmh.2009.08-0627
[4]
Paramasivam, S., Thomas, B., Thayyil, J., Rahim, A., Thavody, J., Lilabi, M.P. and Jayadev, V.K. (2016) Knowledge and Health Seeking Behaviour of Tuberculosis Patients in Kerala. International Journal of Community Medicine and Public Health, 3, 2464-2471. https://doi.org/10.18203/2394-6040.ijcmph20163055
[5]
Khan, A., Shaikh, B.T. and Baig, M.A. (2020) Knowledge, Awareness, and Health-Seeking Behaviour Regarding Tuberculosis in a Rural District of Khyber Pakhtunkhwa, Pakistan. Biomed Research International, 2020, Article ID: 1850541. https://doi.org/10.1155/2020/1850541
[6]
Asres, M., Gedefaw, M., Kahsay, A. and Weldu, Y. (2017) Patients’ Delay in Seeking Health Care for Tuberculosis Diagnosis in East Gojjam Zone, Northwest Ethiopia. The American Journal of Tropical Medicine and Hygiene, 96, 1071-1075. https://doi.org/10.4269/ajtmh.16-0892
[7]
Wandwalo, E.R. and Morkve, O. (2000) Delay in Tuberculosis Case-Finding and Treatment in Mwanza, Tanzania. The International Journal of Tuberculosis and Lung Disease, 4, 133-138. https://pubmed.ncbi.nlm.nih.gov/10694091/
[8]
Lambert, M.L. and Van der Stuyft, P. (2005) Editorial: Delays to Tuberculosis Treatment: Shall We Continue to Blame the Victim? Tropical Medicine & International Health, 10, 945-946. https://doi.org/10.1111/j.1365-3156.2005.01485.x
[9]
Chanda-Kapata, P., Kapata, N., Masiye, F., Maboshe, M., Klinkenberg, E., Cobelens, F. and Grobusch, M.P. (2016) Health Seeking Behaviour among Individuals with Presumptive Tuberculosis in Zambia. PLOS ONE, 11, e0163975. https://doi.org/10.1371/journal.pone.0163975
[10]
Gamtesa, D.F., Tola, H.H., Mehamed, Z., Tesfaye, E. and Alemu, A. (2020) Health Care Seeking Behavior among Presumptive Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-Analysis. BMC Health Services Research, 20, Article No. 445. https://doi.org/10.1186/s12913-020-05284-5
[11]
Ward, H., Mertens, T.E. and Thomas, C. (1997) Health Seeking Behaviour and the Control of Sexually Transmitted Disease. Health Policy and Planning, 12, 19-28. https://doi.org/10.1093/heapol/12.1.19
[12]
Calnan, M. (1988) Towards a Conceptual Framework of Lay Evaluation of Health Care. Social Science & Medicine, 27, 927-933. https://doi.org/10.1016/0277-9536(88)90283-3
[13]
Rubel, A.L. and Garo, L.C. (1992) Social and Cultural Factors in the Successful Control of Tuberculosis. Public Health Reports, 107, 626-636. https://pubmed.ncbi.nlm.nih.gov/1454974/
[14]
Rolle, R.A. and Onwuma, O.C. (2020) Determinants of Choice of Treatment by Tuberculosis Patients in Nigeria. Amity Journal of Healthcare Management, 4, 1-14. https://www.researchgate.net/publication/338158865_Determinants_of_ Choice_of_Treatment_by_Tuberculosis_Patients_in_Nigeria
[15]
Yimer, S., Holm-Hansen, C., Yimaldu, T. and Bjune G. (2009) Health Care Seeking among Pulmonary Tuberculosis Suspects and Patients in Rural Ethiopia: A Community-Based Study. BMC Public Health, 9, Article No. 454. https://doi.org/10.1186/1471-2458-9-454
[16]
Orubuloye, I.O. and Ajakaiye, D.O.I. (2022) Health Seeking Behaviours in Nigeria. Nigerian Institute of Social and Economic Research, Central Bank of Nigeria Library. http://library.cbn.gov.ng:8088/cgi-bin/koha/opac-detail.pl?biblionumber=4341
[17]
van der Werf, M.J., Chechulin, Y., Yegorova, O.B., Marcinuk, T., Stopolyanskiy, A., Voloschuk, V., Zlobinec, M., Vassall, A., Veen, J., Hasker, E. and Turchenko, L.V. (2006) Health Care Seeking Behaviour for Tuberculosis Symptoms in Kiev City, Ukraine. The International Journal of Tuberculosis and Lung Disease, 10, 390-395. https://pubmed.ncbi.nlm.nih.gov/16602402/
[18]
Kelkar-Khambete, A., Kielmann, K., Pawar, S., Inamdar, V., Datye, A. and Rangan, S. (2008) India’s Revised National Tuberculosis Control Programme: Looking beyond Detection and Cure. The International Journal of Tuberculosis and Lung Disease, 12, 87-92. https://pubmed.ncbi.nlm.nih.gov/18173883/
[19]
Nair, N., Wares, F. and Sahu, S. (2010) Tuberculosis in the WHO South-East Asia Region. Bulletin of the World Health Organization, 88, 164-165. https://doi.org/10.2471/BLT.09.073874
[20]
Kasse, Y., Jasseh, M., Corrah, T., Donkor, S.A., Antonnio, M., Jallow, A., Adegbola, R.A. and Hill, P.C. (2006) Health Seeking Behaviour, Health System Experience and Tuberculosis Case Finding in Gambians with Cough. BMC Public Health, 5, Article No. 143. https://doi.org/10.1186/1471-2458-6-143
[21]
Lugga, M.C.L., Muita, M., Matiru, V. and Muchiri, E. (2011) Factors Associated with Patient and Health Service Delays in the Management of TB in Central Equatoria State in 2008. South Sudan Medical Journal, 4, 83-85. https://www.ajol.info/index.php/ssmj/article/view/132465
[22]
Leung, E.C.C., Leung, C.C. and Tam, C.M. (2007) Delayed Presentation and Treatment of Newly Diagnosed Pulmonary Tuberculosis Patients in Hong Kong. Hong Kong Medical Journal, 13, 221-227. https://pubmed.ncbi.nlm.nih.gov/17548911/
[23]
Engeda, E.H., Dachew, B.A., Woreta, H.K., Kelkay, M.M. and Ashenafie, T.D. (2016) Health Seeking Behaviour and Associated Factors among Pulmonary Tuberculosis Suspects in Lay Armachiho District, Northwest Ethiopia: A Community-Based Study. Tuberculosis Research and Treatment, 2016, Article ID: 7892701. https://doi.org/10.1155/2016/7892701
[24]
Oluwadare, C. and Ibirinde, B. (2010) Health Seeking Behaviour of Tuberculosis Patients in Ekiti State, Nigeria. Studies on Ethno-Medicine, 4, 191-197. https://doi.org/10.1080/09735070.2010.11886380
[25]
Grover, A., Kumar, R. and Jindal, S.K. (2006) Socio-Demographic Determinants of Treatment-Seeking Behavior among Chest Symptomatics. Indian Journal of Community Medicine, 31, 145-149. https://www.researchgate.net/publication/45261991_Socio-demographic_ Determinants_of_Treatment-Seeking_Behavior_among_Chest_Symptomatics/fulltext/0e60a544f0c4cf5df7c560ac/ Socio-demographic-Determinants-of-Treatment-Seeking-Behavior-among-Chest-Symptomatics.pdf
[26]
Fochsen, G., Deshpande, K., Diwan, V., Mishra, A., Diwan, V.K. and Thorson, A. (2006) Health Care Seeking among Individuals with Cough and Tuberculosis: A Population-Based Study from Rural India. International Journal of Tuberculosis and Lung Disease, 10, 995-1000. https://pubmed.ncbi.nlm.nih.gov/16964790/
[27]
Buregyeya, E., Kulane, A., Colebunders, R., Wajja, A., Kiguli, J., Mayanja, H., Musoke, P., Pariyo, G. and Mitchell, E.M. (2011) Tuberculosis Knowledge, Attitudes and Health-Seeking Behaviour in Rural Uganda. The International Journal of Tuberculosis and Lung Disease, 15, 938-942. https://doi.org/10.5588/ijtld.10.0211
[28]
Ayisi1, J.G., Hoog, A.H., Agaya, J.A., Mchembere, W., Nyamthimba, P.O., Muhenje, O. and Marston, B.J. (2011) Care Seeking and Attitudes towards Treatment Compliance by Newly Enrolled Tuberculosis Patients in the District Treatment Programme in Rural Western Kenya: A Qualitative Study. BMC Public Health, 11, Article No. 515. https://doi.org/10.1186/1471-2458-11-515
[29]
Gidado, M. (2019) Assessment of Tuberculosis Underreporting by Level of Reporting System in Lagos, Nigeria. Master’s Thesis, Walden University, Minneapolis. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=8815&context=dissertations
[30]
Onah, C.K., Azuogu, B.N., Ossai, E.N., Agu, A.P., Alobu, I. and Ogah, E.O. (2021) Addressing Constraints to Informal Providers’ Involvement in Tuberculosis Control: A Qualitative Study of Patent Medicine Dealers and Tuberculosis Programme Managers. Global Health Research and Policy, 6, Article No. 43. https://doi.org/10.1186/s41256-021-00227-x
[31]
Paynter, S., Hayward, A., Wilkinson, P., Lozewicz, S. and Coker, R. (2004) Patient and Health Service Delays in Initiating Treatment for Patients with Pulmonary Tuberculosis: Retrospective Cohort Study. The International Journal of Tuberculosis and Lung Disease, 8, 180-185.
[32]
Murray, C.J.L., Styblo, K. and Rouillon, A. (1990) Tuberculosis in Developing Countries: Burden, Intervention and Cost. Bulletin of the International Union against Tuberculosis and Lung Disease, 65, 6-24.
[33]
Razia, F., Mahboob, U.H., Aashifa, Y., Nasir, M., Ahmad, K.L., Osberg, M., Makayova, J., Hymoff, A. and Hanson, C. (2017) Delivering Patient-Centered Care in a Fragile State: Using Patient-Pathway Analysis to Understand Tuberculosis Related Care Seeking in Pakistan. The Journal of Infectious Diseases, 216, S733-S739. https://doi.org/10.1093/infdis/jix380
[34]
Makgopa, S. and Madiba, S. (2021) Tuberculosis Knowledge and Delayed Health Care Seeking among New Diagnosed Tuberculosis Patients in Primary Health Facilities in an Urban District, South Africa. Health Services Insights, 14, 1-9. https://doi.org/10.1177/11786329211054035