Abstract:
Background: Delays in diagnosis, treatment and health care seeking behavior of
Tuberculosis patient may increase the mortality and morbidity from Tuberculosis
and the risk of transmission in the community.This study was conducted to
investigate the factors that influence the patient and health system delays of
Pulmonary Tuberculosis in five Upazila of Gopalganj district, Bangladesh.
Objective: To identify the factors responsible for delays in diagnosis, length
of patient & health system delays and to determine the health care seeking
behavior of the Pulmonary TB Patient.
Methods: A descriptive cross sectional study was conducted at DOTS centers
of five Upazila of Gopalganj district providing both diagnostic and treatment
facilities using Directly Observed Treatment Short Course. Data were collected
from Pulmonary TB patients aged 15 years and above using pretested
questionnaires. Health seeking behaviors were evaluated for association with
patient delay and health care provider delay for TB diagnosis and treatment.
The univariate analysis of chi-square and odds ratios and 95% confidence
intervals were used for statistically evaluation of the association.
Results: A total of 205 Pulmonary TB patients were interviewed, the median total
delay was 90 days; with 28 days patient delay and 42 days health system delay. A
large proportion (63%) of the overall total delay was due to health system delay.
Patients from urban areas were (46%) more likely to present to health care providers
than patients from rural areas. Patients from urban areas were (54%) more likely
to be diagnosed and start treatment earlier than patients from rural areas. Male
patients were short delayed to present to health care providers than Female patients
but longer health system delay than Female patients.
Conclusion: A greater portion of the overall total delay was contributed by
health system delay. The number of DOTS center should be increased and
make easy accessible to the community people. New policy and strategy should
be developed for strengthening of the existing health system.
Key Words: Pulmonary Tuberculosis, Health Care.