Healthcare seeking behavior and delays in case of Drug-Resistant Tuberculosis patients in Bangladesh: Findings from a cross-sectional survey

Md Zulqarnine Ibne Noman; Shariful Islam; Shaki Aktar; Ateeb Ahmad Parray; Dennis G Amando; Jyoti Karki; Zafria Atsna; Dipak Kumar Mitra; Shaikh A Shahed Hossain

doi:10.1371/journal.pgph.0001903

Healthcare seeking behavior and delays in case of Drug-Resistant Tuberculosis patients in Bangladesh: Findings from a cross-sectional survey

PLOS Glob Public Health. 2024 Jan 24;4(1):e0001903. doi: 10.1371/journal.pgph.0001903. eCollection 2024.

Authors

Affiliations

¹ BRAC James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh.
² EcoHealth Alliance Bangladesh Programs, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh.
³ International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh.
⁴ Department of International Health, Health Systems Program, The Johns Hopkins University, Baltimore, MD, United States of America.
⁵ Department of Public Health, North South University, Dhaka, Bangladesh.

Abstract

The emergence of Drug-Resistant Tuberculosis (DR-TB) has become a major threat globally and Bangladesh is no exception. Delays in healthcare seeking, proper diagnosis and initiation of treatment cause continuous transmission of the resistant tubercule bacilli through the communities. This study aimed to assess the different health care-seeking behaviors and delays among DR-TB patients in Bangladesh. A prospective cross-sectional study was conducted from November to December 2018, among 92 culture positive and registered DR-TB patients in four selected hospitals in Bangladesh. Data were collected through face-to-face interviews with survey questionnaire as well as record reviews. Among the 92 study participants, the median patient delay was 7 (IQR 3, 15) days, the median diagnostic delay was 88 (IQR 36.5, 210), the median treatment delay was 7 (IQR 4,12) days, and the median total delay among DR-TB patients was 108.5 (IQR 57.5, 238) days. 81.32% sought initial care from informal healthcare providers. The majority (68.48%) of the informal healthcare providers were drug sellers while 60.87% of patients sought care from more than four healthcare points before being diagnosed with DR-TB. The initial care seeking from multiple providers was associated with diagnostic and total delays. In Bangladesh, DR-TB cases usually seek care from multiple providers, particularly from informal providers, and among them, alarmingly higher healthcare-seeking related delays were noted. Immediate measures should be taken both at the health system levels and, in the community, to curb transmission and reduce the burden of the disease.

Copyright: © 2024 Noman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The study was conducted under Summative Learning Project (SLP), as a partial requirement of Master of Public Health degree at BRAC James P Grant School of Public Health (BRAC JPGSPH), BRAC University. The SLP that this study is based on titled “Drug-resistance Tuberculosis in Bangladesh: epidemiological estimates, programmatic implications, and people’s perspectives” was supported by Tropical Diseases Research (WHO-TDR), the Special Programme for Research and Training in Tropical Diseases, which is hosted at the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and World Health Organization, under grant number: B40297 (Postgraduate training scheme: Building the capacity of the next generation of researchers and global health leaders, acquired by the researchers of BRAC JPGSPH). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.