Factors associated with health seeking behaviour of pulmonary tuberculosis patients at Mulago National Referral Tuberculosis Treatment Centre.
Mpungu, Stephen Kiwuwa
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SETTING: The study was carried out at Mulago National Referral Tuberculosis Treatment Centre, Kampala, Uganda, East Africa. OBJECTIVE: The study aimed at assessing factors associated with the health-seeking behavior of smear positive pulmonary tuberculosis patients so as to make possible recommendations for the improvement of early diagnosis and treatment of tuberculosis. METHODOLOGY: The study was cross-sectional involving 231 consecutively sampled newly diagnosed pulmonary tuberculosis patients, interviewed using a pretested semi structured questionnaire. Time delays between onset of symptoms, first medical consultation and initiation of TB treatment were determined. Personal characteristics, clinical features and health system factors were evaluated for their effect on these intervals. Complimentary information was obtained from focus group discussions as well as in-depth interviews from six patients. RESULTS: The medians of total delay, patient delay and health provider delays were 12 weeks, 1 week and 9 weeks respectively. Patients most often presented to drug shops or pharmacies (39.4%) and private clinics (36.8%) than government health units (10%) as point of first contact. Median health provider delay was shortest for those who first presented to government hospitals compared to those presenting to private clinics was a significantly smaller proportion of total delay attributable to the health provider (43% vs 79% odds ratio= 0.20, 95%CI, 0.15-0.20). Sputum microscopy was underutilized by private clinics compared to government hospitals. Patients were found to have inadequate knowledge about TB. Perceptions that TB is caused by alcohol intake, smoking and that TB is dangerous, increasing AFB smear grades, having not schooled beyond primary, residing alone and having multiple health seeking encounters were associated with increased delay to treatment. Knowing that TB is spread through air, caused by germs and residing within 25 kilometers from mulago hospital, were associated with a shorter delay to treatment. CONCLUSIONS: Delay in diagnosis of pulmonary TB is prolonged in patients presenting at Mulago hospital with a significant proportion of health provider delay. Education of the general public about the symptoms of TB, the importance of early medical consultation and the inclusion of health education on communicable diseases in UPE curriculums will shorten patient delay. Decentralization of diagnosis and management of TB including training and support supervision of health personnel in peripheral health units will improve access to health care and shorten delay to initiation of TB treatment. Continuing medical education about TB management for all stakeholders in the private and government health sectors will shorten health provider’s delay and thereby improve tuberculosis control. Keywords: Pulmonary tuberculosis, diagnosis, delay, health seeking behavior, treatment.