Patient predictors of health-seeking behaviour for persons coughing for more than two weeks in high-burden tuberculosis communities: the case of the Western Cape, South Africa.
Adult
Chronic Disease
Cough
/ epidemiology
Epidemiologic Methods
Female
Health Behavior
Humans
Male
Patient Acceptance of Health Care
/ psychology
Sex Distribution
Social Class
Social Stigma
South Africa
/ epidemiology
Time-to-Treatment
/ statistics & numerical data
Tuberculosis
/ epidemiology
Vulnerable Populations
Zambia
/ epidemiology
Chronic cough
Consulting
Delayed health seeking behaviour
Presumptive TB
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
13 Mar 2019
13 Mar 2019
Historique:
received:
09
08
2018
accepted:
06
03
2019
entrez:
15
3
2019
pubmed:
15
3
2019
medline:
7
5
2019
Statut:
epublish
Résumé
This study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing for more than 2 weeks to better understand this vulnerable and important population. The study analysed data from a cohort study (SOCS - Secondary Outcome Cohort Study) embedded in a community randomised trial ZAMSTAR (Zambia and South Africa TB and AIDS Reduction Study) in eight high-burden TB communities in the Western Cape, South Africa. These datasets are unique as they contain TB-related data as well as data on health, health-seeking behaviour, lifestyle choices, employment, socio-economic status, education and stigma. We use uni- and multivariate logistic regressions to estimate the odds ratios of consulting for a cough (of more than 2 weeks duration) for a range of relevant patient predictors. Three hundred and forty persons consulted someone about their cough and this represents 37% of the 922 participants who reported coughing for more than 2 weeks. In the multivariate analysis, respondents of black ethnic origin (OR 1.99, 95% CI 1.28-3.12, P < 0.01), those with higher levels of education (OR 1.05 per year of education, 95% CI 1.00-1.10, P = 0.05), and older respondents (OR 1.02 per year, 95% CI 1.01-1.04, P < 0.01) had a higher likelihood of consulting for their chronic cough. Individuals who smoked (OR 0.63, 95% CI 0.45-0.88, P < 0.01) and those with higher levels of socio-economic status (OR 0.81, 95% CI 0.71-0.92, P < 0.01) were less likely to consult. We find no evidence of stigma playing a role in health-seeking decisions, but caution that this may be due to the difficulty of accurately and reliably capturing stigma due to, amongst other factors, social desirability bias. The low levels of consultation for a cough of more than 2 weeks suggest that there are opportunities to improve case-finding. These findings on health-seeking behaviour can assist policymakers in designing TB screening and active case-finding interventions that are targeted to the characteristics of those with a chronic cough who do not seek care.
Sections du résumé
BACKGROUND
BACKGROUND
This study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing for more than 2 weeks to better understand this vulnerable and important population.
METHODS
METHODS
The study analysed data from a cohort study (SOCS - Secondary Outcome Cohort Study) embedded in a community randomised trial ZAMSTAR (Zambia and South Africa TB and AIDS Reduction Study) in eight high-burden TB communities in the Western Cape, South Africa. These datasets are unique as they contain TB-related data as well as data on health, health-seeking behaviour, lifestyle choices, employment, socio-economic status, education and stigma. We use uni- and multivariate logistic regressions to estimate the odds ratios of consulting for a cough (of more than 2 weeks duration) for a range of relevant patient predictors.
RESULTS
RESULTS
Three hundred and forty persons consulted someone about their cough and this represents 37% of the 922 participants who reported coughing for more than 2 weeks. In the multivariate analysis, respondents of black ethnic origin (OR 1.99, 95% CI 1.28-3.12, P < 0.01), those with higher levels of education (OR 1.05 per year of education, 95% CI 1.00-1.10, P = 0.05), and older respondents (OR 1.02 per year, 95% CI 1.01-1.04, P < 0.01) had a higher likelihood of consulting for their chronic cough. Individuals who smoked (OR 0.63, 95% CI 0.45-0.88, P < 0.01) and those with higher levels of socio-economic status (OR 0.81, 95% CI 0.71-0.92, P < 0.01) were less likely to consult. We find no evidence of stigma playing a role in health-seeking decisions, but caution that this may be due to the difficulty of accurately and reliably capturing stigma due to, amongst other factors, social desirability bias.
CONCLUSIONS
CONCLUSIONS
The low levels of consultation for a cough of more than 2 weeks suggest that there are opportunities to improve case-finding. These findings on health-seeking behaviour can assist policymakers in designing TB screening and active case-finding interventions that are targeted to the characteristics of those with a chronic cough who do not seek care.
Identifiants
pubmed: 30866926
doi: 10.1186/s12913-019-3992-6
pii: 10.1186/s12913-019-3992-6
pmc: PMC6417175
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
160Subventions
Organisme : National Research Foundation
ID : RCA13102556861
Organisme : National Research Foundation
ID : CPRR150722129596
Organisme : National Research Foundation
ID : SDG160531166953
Organisme : Bill and Melinda Gates Foundation (US)
ID : 19790.01
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