Health seeking behavior and its predictors among new pulmonary tuberculosis patients in Kilimanjaro region

Background: Early seeking of modern health unit among new pulmonary TB patients enhances early suspect diagnosis and treatment and so prevent more transmission of TB in the community, more advance disease leading to death, and more complications.

This study aimed to determine the health seeking behavior and its predictors among new pulmonary TB patients in Kilimanjaro region.

Method: This analytical cross-sectional study was conducted using both qualitative and quantitative methods; where 84 new pulmonary TB patients were involved in quantitative data method and 10 new pulmonary TB patients were involved in qualitative method. Quantitative data were collected   using structured questionnaire administered face to face. Qualitative data were collected using interview guide 

Results: Among 84 new pulmonary TB who responded, 43 (51.2%) were male, 74 (88.1%) were aged between18-48. Forty-seven 47 (56%) were married and 73 (86.9%) had formal education. Twenty-six, 26(31%) were smokers and 28 (33.3%) drink alcohol, 64 (71.4%) Those living within 0- 10 km were 43 (51.2%) and 48 (57.1%) were living in rural area Fifty one51 (61%) spent less than three hours to reach health facility while 7(8%) spent more than six hours. The median time to reach health facility was 2 hours and mean time was 2.7 hours.

38 (70.4%) reported a monthly income of 100,000TSH and bellow and 59 (93.6%) spent 1000 TSH or less on transport per visit. Seventy-eight (93%) reported to have spent money on their illness during the course of treatment, of them 59 (75.6%) reported to have spent equal or less than 100,000 TSH on their illness during the course of treatment.66 (78.6%) sought modern care as first choice (private (42.9%) and public35.7%) while 4(4.8%) sought traditional care as first choice.48 (57%) sought modern care more than 4weeks after onset of first symptom.

On predictors of type of care sought at first, living a distance of 0-10 km to modern health facility OR12.86, p=0.01 and severe symptom (Hemoptysis) OR 16.67 p=0.045 were associated with seeking modern care as first choice.        

On predictors for delay in seeking modern care, factors such as sex, age, expenditure per illness distance to health facility, severity of symptoms and monthly income did not show statistical significance association, however expenditure of 100,000TSH per illness OR 4.33 p=0.06 and I living more than 10 km from modern health facility OR 3.38. p=0.06 Showed a trend toward significance.

Patients involved in In-depth interview reported a complex health seeking pattern, within modern care and modern care to alternative care and vice versa. Study found out that there are different perceptions in the community about the cause of TB. Most of New pulmonary TB interviewed related the cause of TB and their occupation, some with witchcraft. Perception about the cause of TB determines the type of care one will seek for, Traditional healers were consulted when modern care has failed and patient not improving. This study also confirmed that there is knowledge gap in the community about TB and HIV/AIDS that TB symptom was associated with HIV/AIDS. Severity of symptoms determines the type of care to seek; less severe TB symptoms are taken as normal symptoms and were treated by using home remedies and one will seek modern care when they have severe symptoms like coughing blood sputum (Hemoptysis).

Conclusion: This study has shown that; new pulmonary TB patients in Kilimanjaro region have demonstrated pluralism health care seeking, by seeking care in both: modern health care facilities (public and private) and alternative care providers (traditional healers, home remedies, spiritual healers). Most patients sought modern care as first choice.

Study also found out beliefs about TB and fear of being HIV positive which exist in the community influences health seeking in terms, of place to seek care at first and when to seek care.

There is a need to improve TB/HIV control communication to the community, ensure smooth linkage and referral between alternative care providers and modern care providers and reinforce early TB screening for people with persistent cough for two weeks or more