|Year : 2010 | Volume
| Issue : 1 | Page : 42-44
A study on care seeking behavior of chest symptomatics in a slum of Bankura, West Bengal
Sreeparna Ghosh1, Apurba Sinhababu2, Pranita Taraphdar3, Dipta Kanti Mukhopadhyay3, Banamali Sinha Mahapatra2, Akhil Bandhu Biswas4
1 Student, Third Professional MBBS: Part-I, Department of Community Medicine, B.S. Medical College, Bankura, India
2 Associate Professor, Department of Community Medicine, B.S. Medical College, Bankura, India
3 Assistant Professor, Department of Community Medicine, B.S. Medical College, Bankura, India
4 Professor, Department of Community Medicine, B.S. Medical College, Bankura, India
|Date of Web Publication||29-Sep-2010|
Dipta Kanti Mukhopadhyay
Assistant Professor, Dept of Community Medicine, B. S. Medical College, Bankura
Source of Support: None, Conflict of Interest: None
| Abstract|| |
A cross-sectional, community based study was undertaken in Patpur slum of Bankura to determine the prevalence of chest symptomatics, their health care seeking Behavior and its correlates. Prevalence of chest symptomatics (cough for 3 weeks or more) was found to be 5.5%, three fourths of whom sought relief from a health care provider. Among them, 70.8% did so within 2 weeks, median being 7 days. No preference for either government or private health care provider was seen in first visit, where the major reason for choosing facilities was advice by family & friends (43.8%). Most of the chest symptomatics (75%) were retained in the same facility. Shift from private to government facility for subsequent visits (33.3%) was higher than from government to private facility (16.7%). The main reason (50%) for changing health facility was expectation for better service.
Keywords: Chest symptomatics, slum community, care seeking behaviour
|How to cite this article:|
Ghosh S, Sinhababu A, Taraphdar P, Mukhopadhyay DK, Mahapatra BS, Biswas AB. A study on care seeking behavior of chest symptomatics in a slum of Bankura, West Bengal. Indian J Public Health 2010;54:42-4
|How to cite this URL:|
Ghosh S, Sinhababu A, Taraphdar P, Mukhopadhyay DK, Mahapatra BS, Biswas AB. A study on care seeking behavior of chest symptomatics in a slum of Bankura, West Bengal. Indian J Public Health [serial online] 2010 [cited 2020 Sep 29];54:42-4. Available from: http://www.ijph.in/text.asp?2010/54/1/42/70553
The control of tuberculosis requires prompt diagnosis and effective treatment. Mere administration of good treatment to diagnosed cases is insufficient to control the disease, unless accompanied by efficient case finding and compliance. To identify cases of TB, the Revised National Tuberculosis Control Programme (RNTCP) relies upon the passive method of screening chest symptomatics who seek care at health facilities. A better understanding of their care-seeking behavior is needed to identify any barriers to timely TB diagnoses and compliance to treatment  . So, understanding the behavior of chest symptomatics is of crucial importance to improve the detection and retention under the RNTCP.
Against this background the present study was undertaken among the population aged 15 years & above in a slum of Bankura town with the following objectives to determine the prevalence of chest symptomatics among the study population and study their health care seeking behavior and identify the underlying socio-demographic correlates.
A cross-sectional, community-based descriptive study was conducted during July to October 2008 among all persons aged 15 years and above residing in Patpur slum of Bankura Municipal area in the district of Bankura, West Bengal, the field practice area of the department of Community Medicine, B. S. Medical College, Bankura. A pre designed, pre-tested, semi-structured questionnaire in local vernacular was used. House to house visit was made for detection of "chest symptomatics'. After obtaining informed consent, relevant information regarding their socio-demographic characteristics and health care seeking behavior were collected by interviewing the subject concerned.
'Chest symptomatic' was defined as a person with cough for 3 weeks or more with or without haemoptysis, fever, chest pain, weight loss and / or night sweating. The study subjects were enquired whether such symptoms were present within a recall period of 2 weeks or not. The term 'Care seeking Behavior' meant action taken by the chest symptomatics for alleviation of their symptoms. Social class was determined by using modified Kuppuswamy scale (updating for 2007)  .
Data were entered in MS Excel-2003. Proportion was used to calculate the prevalence of chest symptomatics and their health care seeking behavior. The study obtained ethical clearance from Institutional Ethics Committee, B. S. Medical College, Bankura.
The survey covered 342 households having 1156 population aged 15 years and above, identifying 64 chest symptomatics, giving a prevalence of 5.5%. Similar prevalence of 5.5% in rural and 3.9% in urban population was reported by a study in Tamil Nadu  . Higher prevalence (12%) was found in a study from Northern India  where Vietnam  reported prevalence as low as 1.6%. This large variability could be due to lack of uniformity in definition of chest symptomatics, population covered, time frame of symptoms and seasonal variations  .
Out of total 64 chest symptomatics, 44 (68.8%) were male, 32 (50.0%) were in the age group of 15-29 years and 34 (53.1%) belonged to lower socio-economic status. Majority of the chest symptomatics (75%) visited any health facility for treatment and most of them (70.8%) did so within two weeks of onset of symptoms. [Table 1] revealed that a higher proportion of females (30%), older people above 44 years (33.3%) and people belonging to upper-lower social class (29.4%) did not seek health care when compared to males (22.7%), younger people less than 30 years (18.8%) and people belonging to relatively higher social class (25.0%). The interval between onset and reporting for care showed wide variation ranging from 1 to 180 days with the median being 7 days. Median interval between onset and reporting for care was shorter in females (4 days), younger age groups 15-29 years (5 days) and upper middle social class (2 days) in comparison to other groups. The most important reasons cited for not seeking care were insufficient severity of symptoms (56.3%), lack of time due to work pressure (25%) and cost associated with seeking care (18.7%). The reasons given for the delay in seeking care were similar to those given for not seeking care. A study in Northern India  reported that 81% sought care and among them 82% went to health care providers, but the median delay in seeking care was 56.6 days. Another study from Tamil Nadu  reported that 93% of chest symptomatics sought care within 1 month of onset of symptoms. Though literacy and lower monthly income affected their care seeking behavior, age and sex had no significant association, whereas a study in Vietnam  reported that men were less likely to seek care.
|Table 1 :Health care seeking Behavior of chest symptomatics according to socio- demographic characteristics (n = 64)|
Click here to view
No preference for either government or private health care provider was seen in first visit, (50% in each). Similar results were found in earlier studies from South India , which reported 46% and 51% of chest symptomatics who sought care, visited a government health facility. However, subsequent studies from Northern India,  Karnataka,  and Tamil Nadu,  observed that private health care facilities were preferred (67.2%, 65%, 57% respectively) by the chest symptomatics. [Figure 1] showed that more than 80% chest symptomatics were retained in government facility where as 66.7% were retained in private facilities. Rest of the chest symptomatics changed the facility in the second visit and shift from private to government facility (33.3%) was higher than from government to private facility (16.7%). In government facility, retention was higher (87.5%) in younger age group (15-29 years), whereas in the age group of 30 years and above, 85.7% continued care in the private facilities. Earlier Indian studies showed that around one third to half of chest symptomatics changed the providers ,.
Initially, major reasons for choosing facilities were advice by family/ friends (43.8%), proximity to residence (29.2%), and expectation of better service (27%). For changing of facility, aspiration for better services was cited as most important reason by majority (50%) followed by advice of family/ friends (25%) and referral by the concerned facility (25%).
Thus, government health care was preferred when patients changed facilities and expectation of better health services was the major reason cited. Availability of diagnostic and treatment services free of charge in government health facility may be another factor. These findings underscore the importance of quality assurance of health services as well as partnership between government and private heath facility in control of tuberculosis.
| Acknowledgement|| |
The study was supported by ICMR-STS.
| References|| |
|1.||Sudha G, Nirupa C, Rajasakthivel M, Sivasusbramanian S, Sundaram V, Bhatt S, et al. Factors influencing the care-seeking Behavior of chest symptomatics: a community-based study involving rural and urban population in Tamil Nadu, South India. Trop Med Int Health 2003;8:336-41. [PUBMED] [FULLTEXT] |
|2.||Kumar N, Sekhar C, Kumar P, Kundu AS. Kuppuswamy's socioeconomic status scale-updating for 2007. Indian J Pediatr 2007;74:1131-2. |
|3.||Grover A, Kumar R, Jindal SK. Treatment seeking Behavior of chest symptomatics. Indian J Tuberc 2003;50:87-94. |
|4.||Thorson A, Hoa N, Long N. Health-seeking behavior of individuals with a cough of more than 3 weeks. Lancet 2000; 356:1823-24. |
|5.||Narayanan R, Thomas S, Kumari P, Prabhakar S, Ramaprakash AN, Suresh T, et al. Prevalence of chest symptoms and action taken by symptomatics in a rural community. Indian J Tuberc 1976;23:160-8. |
|6.||Subramanian T. Sample survey of awareness of symptoms and utilisation of health facilities by chest symptomatics. Indian J Tuberc 1990;37:69-71. |
|7.||Nair SS, Radhakrishna S, Seetha MA, Rupert SG. Behavior patterns of persons with chest symptoms in Karnataka state. Indian J Tuberc 2002;49:39-48. |
|This article has been cited by|
||The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis
| ||Ramnath Subbaraman,Ruvandhi R. Nathavitharana,Srinath Satyanarayana,Madhukar Pai,Beena E. Thomas,Vineet K. Chadha,Kiran Rade,Soumya Swaminathan,Kenneth H. Mayer,Megan Murray |
| ||PLOS Medicine. 2016; 13(10): e1002149 |
|[Pubmed] | [DOI]|
||Knowledge and behaviour of chest symptomatics in urban slum populations of two states in India towards care-seeking
| ||George, O. and Sharma, V. and Sinha, A. and Bastian, S. and Santha, T. |
| ||Indian Journal of Tuberculosis. 2013; 60(2): 95-106 |