Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study

• Published in: BMC health services research 2013-01, Vol.13 (1), p.25-25, Article 25
• Main Authors: Ukwaja, Kingsley N, Alobu, Isaac, Nweke, Chibueze O, Onyenwe, Ephraim C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis; Care and treatment; Confidence Intervals; Cross-Sectional Studies; Diagnosis; Female; Health care; Health facilities; Health services; Health-seeking delays; Humans; Leprosy; Low-resource setting; Male; Medical research; Medicine, Experimental; Middle Aged; Mycobacterium; Nigeria; Patient Acceptance of Health Care - psychology; Patient education; Patients; Private sector; Public sector; Public-private sector cooperation; Pulmonary tuberculosis; Questionnaires; Respiratory agents; Rural; Rural areas; Rural Population; Sex Distribution; Studies; Surveys and Questionnaires; Teaching hospitals; Time-to-Treatment - statistics & numerical data; Tuberculosis; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - physiopathology; Variables; Walking
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-13-25

Nigeria ranks fourth among 22 high tuberculosis (TB) burden countries. Although it reached 99% DOTS coverage in 2008, current case detection rate is 40%. Little is known about delays before the start of TB therapy and health-seeking behaviour of TB patients in rural resource-limited settings. We aimed to: 1) assess healthcare-seeking behaviour and delay in treatment of pulmonary TB patients, 2) identify the determinants of the delay in treatment of pulmonary TB. We conducted a cross-sectional study of adult new pulmonary TB patients notified to the National Tuberculosis Control Programme (NTP) by three rural (two mission/one public) hospitals. Data on health-seeking and delays were collected using a standardised questionnaire. We defined patient delay as the interval (weeks) between the onset of cough and the first visit to any health provider, and health system delay as the time interval (weeks) between patient's first attendance to any health provider, and the onset of treatment. Total delay is the sum of both delays. Multiple linear regression models using nine exposure variables were built to identify determinants of delays. Of 450 patients (median age 30 years) enrolled, most were males (55%), subsistent farmers (49%), rural residents (78%); and 39% had no formal education. About 84% of patients reported first consulting a non-NTP provider. For such patients, the first facilities visited after onset of symptoms were drug shops (79%), traditional healers (10%), and private hospitals (10%). The median total delay was 11 (IQR 9-16) weeks, patient delay 8 (IQR 8-12) and health system (HS) delay 3 (IQR 1-4) weeks. Factors associated with increased patient delay were older age (P