Abstract:

In Nepal, the estimated incident cases are 0.07 million, of them, 0.03 million people are diagnosed and enrolled in the treatment annually, and numbers of undiagnosed people living with tuberculosis (TB) might be a threat to achieving END TB strategy targets. Understanding health-seeking behaviour and care pathways is crucial to reducing missed cases and decreasing TB transmission. The objective of the study was to identify the health-seeking behavior of TB patients and understand the reasons behind TB diagnostic and treatment delays in Nepal. This was a cross-sectional, population-based survey carried out in 99 clusters of 55 districts (total of 77) of Nepal. Primary Sampling Units were Village Development Committees or Municipalities and wards selected using systematic proportional to population size method. Of the total 54,200 people who attended in the survey, 1,825 had a history of TB and asked their health-seeking practice. 62% and 72% of the TB patients utilised the government health facilities for diagnosis and treatment. 18% of the TB patients said that they received diagnosis services, and 16% of patients took their treatment from outside of the country, especially India, due to fear of stigma and easy access to the services. The majority of the TB patients utilised government health facilities to receive diagnosis and treatment services. Some of the participants sought TB services from private health care providers, and a significant proportion of participants received them from India due to difficulty in accessing local services and fear of stigma and discrimination.
Keywords: Community Based Directly Observed Treatment, Health Seeking Behaviour, Prevalence Survey, Tuberculosis.

References:

[1] World Health Organisation, (2019), Global Tuberculosis Report.

[2] Ministry of Health and Population, National Tuberculosis Control Centre, (2020), Annual Progress Report.

[3] Onuka O, et al., 2018, Effectiveness of Contact Tracing of Index Tuberculosis Cases in Nigeria. Adv Infect Dis. 2018;08(04):173–99.

[4] Amo-Adjei J, 2016., Individual, household and community-level factors associated with keeping tuberculosis status secret in Ghana. BMC Public Health [Internet]. 2016;16(1):1–9 http://dx.doi.org/10.1186/s12889-016-3842.

[5] World Health Organisation (2011), Tuberculosis Prevalence Surveys: a handbook-the lime book, WHO/HTM/TB/2010.17.

[6] Andersen RM, (1995), Andersen and Newman Framework of Health Services Utilization. J Health Soc Behav [Internet]. 1995;36 (December):1–10. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/7738325.

[7] Department of Health Republic of Philippines (2016), National TB Prevalence Survey, Philippines. Manila; 2017.

[8] Kasse et al.; (2006), Health seeking behaviour, health system experience and tuberculosis case finding in Gambians with cough, BMC Public Health 2006, 6:143 doi:10.1186/1471-2458-6-143.

[9] Nurul Islamy, (2012), Health Care Seeking Behaviour of Community and TB patients and capability of the nonformal health service provider in Tanjung Bentang Subdistrict, Indonesia, Journal Kedokteran dan Keschatan Universitas Lampung, Volume 2, Nomor 2, page 59-63.

[10] A. L. Cremers, et al., (2013), Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon, Public Health Action, VOL 3, NO 4, http://dx.doi.org/10.5588/pha.13.0038.

[11] Paramasivam S et al., (2016), Knowledge and health-seeking behaviour of tuberculosis patients in Kerala, India, Int J Community Med Public Health. 2016 Sep;3(9):2464-2471 http://www.ijcmph.com.

[12] Saw et al.; (2009), Public and/or private health care: Tuberculosis patients' perspectives in Myanmar, Health Research Policy and Systems 2009, 7:19 DOI:10.1186/1478-4505-7-19.

[13] Basnyat B, et al., (2018), Tuberculosis in South Asia: A tide in the affairs of men. Vol. 13, Multidisciplinary Respiratory Medicine. BioMed Central Ltd.

[14] Li et al., (2013), Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis, BMC Medicine, http://www.biomedcentral.com/1741-7015/11/156.

[15] Surya A, et al. (2017), Quality Tuberculosis Care in Indonesia: Using Patient Pathway Analysis to Optimize Public-Private Collaboration. J Infect Dis. 2017;216: S724–32.

[16] Ministry of Health Republic of Indonesia (2015), National Tuberculosis Prevalence Survey 2013-2014.

[17] Der, JB; (2021) Pathways to tuberculosis diagnosis and treatment in Ghana: identifying the gaps and seeking solutions. PhD (research paper style) thesis, London School of Hygiene & Tropical Medicine.

DOI: https://doi.org/10.17037/PUBS.04660749.

[18] Santosha Kelamane et al., (2021), Engaging Informal Private Health Care Providers for TB Case Detection: Experiences from RIPEND Project in India, Hindawi Tuberculosis Research and Treatment Volume 2021, Article ID 9579167, 10 pages https://doi.org/10.1155/2021/9579167.

[19] Cosmas Kenan Onah et al., (2021), Addressing Constraints to Informal Health Service Providers’ Involvement in Tuberculosis Control: A Qualitative Study of Patent Medicine Dealers and Tuberculosis Programme Managers in Ebonyi State Nigeria, DOI: https://doi.org/10.21203/rs.3.rs-632368/v1.

[20] Phiri MM, Makepeace E, Nyali M, et al. (2020), Improving pathways to care through interventions co-created with communities: a qualitative investigation of men’s barriers to tuberculosis care-seeking in an informal settlement in Blantyre, Malawi. BMJ Open 2021;11: e044944. doi:10.1136/ BMJ open-2020-044944.

[21] Msoka EF et al. (2021), Qualitative assessment of the impact of socio-economic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study. BMJ Open 2021;11: e050911. doi:10.1136/ BMJ open-2021-050911.

[22] Janmejaya Samal, (2016), Health Seeking Behaviour among Tuberculosis Patients in India: A Systematic Review, Journal of Clinical and Diagnostic Research. 2016 Oct, Vol-10(10): LE01-LE06, DOI: 10.7860/JCDR/2016/19678.8598.

[23] Muttamba W, et al. (2019), Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; Missed opportunity for early tuberculosis diagnosis. PLoS ONE 14(6): e0217900. https://doi.org/10.1371/journal. pone.0217900.

[24] Norton S, et al (2019), Detailed characterisation of the tuberculosis epidemic in Western Sydney: a descriptive epidemiological study. ERJ Open Res. 2019;5(3):00211–2018.

[25] Gautam N, et al, (2021), Knowledge on
tuberculosis and utilization of DOTS service by tuberculosis patients in Lalitpur District, Nepal. PLoS ONE 16(1): e0245686. https://doi.org/10.1371/journal.pone.0245686.