¹Assistant Professor, Department of Respiratory Medicine, SRTR Government Medical College, Ambajogai, Maharashtra, INDIA.

²Assistant Professor, ³Professor and HOD, Department of Medicine, SRTR Government Medical College, Ambajogai, Maharashtra, INDIA.

Email: drsachchaudhari@gmail.com

Table 2: Factors determining the visit to government or private health facility

Table 3: Knowledge about tuberculosis amongst study population

Table 4: Knowledge score among study subjects and Patient Delay

DISCUSSION

TB is the cause of a large burden of disease in developing countries like India. TB is a completely curable disease with six to eight months of Anti-tubercular treatment (ATT) in cases of drug sensitive TB. TB carries a social stigma in developing countries like India and thus poses a great hurdle to control it.  The DOTS strategy, recommended by the World Health Organization (WHO) for the prevention and control of TB, relies on passive case finding by sputum smear microscopy.²   Suspects are therefore expected to be able to recognize TB symptoms and have positive attitudes towards TB being managed by formal health services. Successful implementation of DOTS relies on TB patient’s prompt access to high-quality health care facilities, accurate diagnosis and adherence to TB treatment. Various studies have found delays in TB case detection associated with poor perception of the health services,^{3, 4} fear of stigmatisation,⁵ lack of knowledge about TB and traditional beliefs.⁶ Knowledge of study subjects was assessed for symptoms, infectiousness, social beliefs and treatment of tuberculosis by using a set of questions. Only 37.0% knew the symptoms of tuberculosis. About 56.0% knew that tuberculosis is an infectious disease while 90.0% knew that it is a curable disease. All patients (100.0%) knew that treatment of tuberculosis is free and 94.0% agreed that tuberculosis is a social stigma. Only 28% and 33.0% knew the most common body part affected and the time for the disappearance of symptoms respectively. About 82.0% agreed that tuberculosis may become life threatening if untreated and 84.0% knew the duration of treatment for complete cure. The knowledge questionnaire contained nine questions. Based on total number of correct answers given, subjects were classified into two categories. Those who correctly answered more than five questions out of nine were considered to have satisfactory knowledge. Less than five correct answers were considered to have unsatisfactory knowledge. This criteria was fixed based on the median value. 82.0% patients had unsatisfactory knowledge on tuberculosis where as only 18.0% had satisfactory knowledge scores. In comparison to patients who had satisfactory knowledge patient delay was more in those who had unsatisfactory knowledge scores (22.22% Vs.78.04%). The association was found to be significant (‘p’ value <0.05). The first consultation of 64.0% tuberculosis patients was with the private practitioners. The rest (36.0%) visited government health centre. No patient was presented to traditional healer. These findings were in accordance with findings from many other studies in India and abroad. Some of the Indian studies by Rajeshwari. R et al⁷, Ashoo Grover et al⁸, Sanganthi P et al ⁹,Dinesh M. Nair et al¹⁰, have found that nearly half prefer private practitioners for their first consultation. The factors influencing study subjects to first contact government or private health facilities were as follows:

• As the age increased, proportion of subjects consulting private facilities was more, but not statistically significant (‘p’ value >0.05)
• Females have preferred private facilities (67.74%) over government facilities when compared with males (57.89%), but not statistically significant (‘p’ value >0.05).
• Higher the educational status, higher is the proportion of them going to private health facility (86.49% Vs 50.79%; p<0.05).
• Single subjects approached private facilities more as compared to those who were married (87.50% vs. 59.52; p<0.05).
• Patients with history of addiction to alcohol and smoking approached private facilities significantly more when compared with non-addicts (75.0% Vs 20.0%; p<0.05).

CONCLUSION

H7uBehavioral change among the family members for the elderly and females is must. Majority of the patients seek private health facilities, resulting in delay in diagnosis. Efforts should be done so that patients should have easy accessibility to Govt. health facilities. Mass media such as television is an effective vehicle for spread of information about the tuberculosis symptoms and treatment for both literate and illiterates. Socio-economical development along with improvement in the literacy rate should be the prime areas of focus so as to change the health seeking behaviour and shorten the delay in diagnosis of tuberculosis.

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