Patient Health Seeking and Diagnostic Delay in Extrapulmonary Tuberculosis: A Hospital Based Study from Central India

Abstract EN

Objective.

We aimed to investigate the awareness, health care seeking behavior, and diagnostic delay in extrapulmonary tuberculosis (EPTB) in a resource-constrained setting from Central India.

Setting and Method.

Questionnaire based interview of 1220 EPTB patients ≥14 years of age was conducted between July 2004 and August 2012 at Ujjain charitable Hospital, Ujjain, India.

Results.

Only 15% of patients had ever heard about EPTB and 2-4% knew about its prevention or treatment.

Only 12% patients first sought medical advice while 49% patients practiced self-medication, 28% consulted traditional healers and 11% drug store/pharmacy.

The median patient delay was 8 weeks (4.6-21.4 weeks).

Majority (78%) of patients visited ≥3 health centers.

Thirty-eight percent patients first visited any government health facility.

Majority (97%) who first visited district and primary public health center were referred to private sector for investigations and 82% patients changed the consultation to private doctor after initial visit to public hospital.

The median health system delay was 7 weeks (0.6-16.4 weeks).

Conclusion.

Patients had very poor awareness of EPTB.

Patients were referred from public to private sector in search of diagnostic facilities.

Improvement of public awareness about EPTB and better public-private partnership may contribute towards reduction in diagnostic delay.