Health-seeking Behavior of Tuberculosis Patients in an Eastern Indian State: A Cross-sectional Study and Review of Literature

Introduction: Health-seeking behaviour impacts the entire cascade of tuberculosis (TB) care at an individual level. Similarly, improved health-seeking at the community level can aid in TB elimination. With this background, a study was conducted to understand the health-seeking behavior of TB patients in Odisha. Materials and Methods: A blended approach was adopted in which the health-seeking behaviour of private sector patients was assessed through a descriptive cross-sectional study followed by a literature review. The cross-sectional study was conducted among 26 private sector patients across 7 National TB Elimination Programme districts using a beneficiary tool, and the data were analysed using jamovi (version 2.3). The literature review was conducted using PubMed, DOAJ and Scopus databases with the final inclusion of 5 articles for review. Results: Among the private sector patients, 65.38% ( n = 17) of the patients had fever followed by tiredness and fatigue (46.15%, n = 12), loss of appetite (42.30%, n = 11), weight loss (42.30%, n = 11), and cough (38.46%, n = 10) as the symptoms of TB. Of the 26 patients, 23.1% of the patients had to visit 5 times before the final diagnosis followed by two times by 34.6% of the patients. The Chi-squared test showed no significant association between the type of health facility first visited, gender, occupation and the level of education with the frequency of visits, diagnosis and treatment delay however the association was significant with religion in case of frequency of visits. The median diagnosis and treatment delays were 15.0 days and 7.0 days, respectively. Private sector patients visited a combination of public and private facilities before ending up with a final diagnosis. Of the 5 studies included in the literature review, 2 studies are cross-sectional in design and one each is of the retrospective cohort, action research and mixed method in design with a major focus on tribal-dominated districts of the state. All these studies identified several factors of health-seeking behaviours on both sides of the health system including social factors. Conclusion: Positive health-seeking is paramount in aiding in the elimination efforts of TB. Factors on the demand side can be addressed through increased awareness about the disease and the services available and the supply side factors can be addressed through system strengthening.