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Free Content Health seeking behaviour and diagnosis for pulmonary tuberculosis in an HIV-epidemic mountainous area of Thailand

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Abstract:

SETTING: Chiang Rai Hospital, Chiang Rai Province, the epicentre of the human immunodeficiency virus (HIV) in Thailand.

OBJECTIVE: To describe the health seeking behaviour among tuberculosis (TB) patients, to measure patient and provider delays and to analyse factors determining these delays.

DESIGN: All patients aged over 15 years with new smear-positive pulmonary TB detected in Chiang Rai Hospital (n = 557) were interviewed using a structured questionnaire.

RESULTS: The median patient delays for HIV-positive and HIV-negative patients and those whose HIV status was unknown were 10, 15 and 15 days respectively, while provider delays were respectively 7, 7.5 and 10 days. HIV-positive patients suffered more symptoms and had a shorter patient's delay. Risk factors of long patient delay (>21 days) included being HIV-negative, having no health insurance, hill tribe ethnicity, no previous visits to the hospital, and borrowing money for hospital visits. Multivariate logistic analysis suggested that being married or widowed and being HIV-positive led to the shortest patient delay. Provider delay was significantly longer in female patients than male patients.

CONCLUSION: Although patient and provider delays were favourably short, certain specific groups require further attention. Hill tribe people should be targeted to improve accessibility to TB treatment. Active case-finding services for people known to be HIV-positive should be encouraged. The reasons for the longer provider delay in female patients require further investigation.

Keywords: TB and HIV; Thailand; delay; health seeking behaviour; hill tribe minorities

Document Type: Regular Paper

Affiliations: 1: TB/HIV Research Project, The Research Institute of Tuberculosis (RIT), Japan Anti-TB Association (JATA), Chiang Rai, Thailand; Division of International Health, Karolinska Institute, Stockholm, Sweden; Department of Public Health and Clinical Medi 2: TB/HIV Research Project, The Research Institute of Tuberculosis (RIT), Japan Anti-TB Association (JATA), Chiang Rai, Thailand 3: Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden 4: Division of International Health, Karolinska Institute, Stockholm, Sweden and Nordic School of Public Health, Goteborg, Sweden

Publication date: November 1, 2001

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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