CARE SEEKING AND DELAYS IN CASE OF DRUG-RESISTANT TUBERCULOSIS PATIENTS IN BANGLADESH

Abstract

Intro: Drug-Resistant Tuberculosis (DR-TB) has become a major global concern as well as in Bangladesh. Any delays in care-seeking, diagnosis, or treatment initiation cause continuous transmission of the drug-resistant bacilli in the communities. Hence, the study aimed to identify the risk factors associated with the different care-seeking behaviors and delays among DR-TB patients in Bangladesh. Methods: A cross-sectional study was conducted from 17th November to 7th December 2018 among 92 culture positive and registered DR-TB patients in four selected hospitals and their catchment areas in Bangladesh. Data were collected through face-to-face interviews with survey questionnaires as well as record reviews. Findings: Among the 92 study participants, 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 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 was 108.5 (IQR 57.5, 238) days among the DR-TB patients. Non-diabetic patients and care-seeking from multiple health care points have a higher chance of being delayed (Odd Ratio>1). Conclusion: Visiting multiple care-seeking points contributed to the different kinds of delays in the study participants in Bangladesh. Future studies may be warranted to explore the causes of not seeking care in formal health care points or TB centers. General health system strengthening and awareness building among the community people in the identification of DR-TB with a focus to curtail long delays is required to curb the transmission and reduce the burden of the disease.