Why do people with a cough delay seeking tuberculosis (TB) care? Research involving the London School of Hygiene and Tropical Medicine and the UNZA-School of Medicine found that poor perception of health services in Lusaka, Zambia, is a more important cause of delay than people’s understanding of TB.

TB incidence increased fourfold over the past decade in Zambia, driven by the HIV epidemic. 30 per cent of cases occur in the capital, Lusaka. TB is one of the six main health priorities in the newly reformed public health sector. TB control activities were incorporated into plans for Zambia’s Essential Healthcare Package.

Delay in seeking care is bad for the patient, whose illness may become more severe, and for the community, as there is a greater chance that infection will spread. The study investigated risk factors for delay among patients coming to urban health centres with a cough. Investigators used health systems research methods involving a broad range of policy-makers, healthcare staff and community members, plus interviews with 427 patients at two clinics. Health systems research is a rapid and relatively low-cost tool to study obstacles that healthcare providers meet in their work. It gives ownership of the results and conclusions to the people who are closest to the problem.

The study found that 35 per cent of patients delay seeking treatment for more than one month. Delay is associated with:

• older age
• severe underlying illness
• poor perception of services
• distance from the health facility
• prior attendance at a private clinic.

There is no relationship between delay and knowledge about TB or education, socio-economic status or gender. People feel that TB and HIV are closely linked and highly stigmatised. For example:

• 79 per cent would not wish to share utensils with a relative who was on TB treatment.
• 35 per cent of subjects would be unwilling to work with them.
• 60 per cent would not marry someone who has TB.
• Nine per cent would not be happy to shake hands with them.
• 43 per cent of subjects would not want to share a bed with their spouse while they were taking TB treatment.

However, stigma was not demonstrated to be associated with longer delays in seeking treatment.

Information, education and communication campaigns that aim to enhance people’s knowledge about TB will not encourage them to seek earlier care if delays are due to health service quality and not to patients’ understanding of TB. The researchers conclude that policy-makers can reduce diagnostic delays and thus improve TB control by:

• investing in improvements in the health system
• ensuring accessibility for older and sicker patients
• enhancing working conditions to raise the morale of nursing and clinical staff.

Source(s):
‘Why do patients with a cough delay seeking care at Lusaka urban health centres? A health systems research approach’, International Journal of Tuberculosis and Lung Disease 6 (9): 796-805, by P. Godfrey-Faussett et al., 2002

Funded by: European Union; UK Department for International Development; Wellcome Trust; World Health Organisation

id21 Research Highlight: 12 March 2003

Further Information:
Peter Godfrey-Faussett
Clinical Research Unit
Department of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK

Tel: +44 (0) 20 7612 7804
Fax: +44 (0) 20 7612 7860
Contact the contributor: Peter.Godfrey-Faussett@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

School of Medicine, University of Zambia

Other related links:
Time lapse - delays in TB diagnosis in Zambia

Coughing up for TB tests - cost-effective diagnosis in Zambia

See id21's collection of links relevant to infectious diseases.

Follow id21's email discussion on access to HIV treatment online.

See id21's collection of links relevant to health systems and economics.