Background
Methods
Study setting
Intervention study: tuberculosis case findings at the pharmacies
Short overview of LDFU sub-study
LDFU-study setting
LDFU-study population
Instrument
Variables
Outcome variables
Explanatory variables
Data collection
Data analysis
Analysis of perceived causes and health seeking variables
Analysis of factors associated with delay and LDFU
Qualitative data for the integrated analysis
Results
Sample characteristics
Characteristic n (%) | All n = 136 | Non-LDFUa n = 50 | Delayb n = 88 | LDFUc n = 86 |
---|---|---|---|---|
Age in years, median (IQR) | 32 (27–40) | 32 (26–36) | 32 (26–40) | 33 (28–40) |
Age group, years | ||||
18–27 | 35 (25.7) | 14 (28.0) | 24 (27.2) | 21 (24.4) |
28–37 | 57 (42.0) | 24 (48.0) | 35 (39.8) | 33 (38.4) |
≥ 38 | 44 (32.3) | 12 (24.0) | 29 (33.0) | 32 (37.2) |
Sex | ||||
Male | 54 (39.7) | 28 (56.0) | 29 (33) | 26 (30.2) |
Female | 82 (60.3) | 22 (44.0) | 59 (67) | 60 (69.8) |
Level of education | ||||
Primary/Secondary | 118 (86.8) | 46 (92.0) | 74 (84.1) | 72 (83.7) |
No formal education | 18 (13.2) | 4 (8.0) | 14 (15.9) | 14 (16.3) |
Religion | ||||
Muslim | 88 (64.7) | 32 (64.0) | 59 (67) | 56 (65.1) |
Christian | 48 (35.3) | 18 (36) | 29 (33) | 30 (34.9) |
Employment status | ||||
Unemployed | 36 (26.5) | 15 (30) | 27 (30.7) | 21 (24.4) |
Employed | 100 (73.5) | 35 (70) | 61 (69.3) | 65 (75.6) |
Monthly household income | ||||
Low income | 46 (33.3) | 17 (34.0) | 34 (38.6) | 35 (40.7) |
Middle income | 50 (36.7) | 18 (36.0) | 29 (32.9) | 25 (29.1) |
High income | 40 (29.4) | 15 (30.0) | 25 (28.4) | 26 (30.2) |
Household size | ||||
≤ 4 | 75 (55.2) | 27 (54) | 45 (51.1) | 48 (55.8) |
> 4 | 61 (44.8) | 23 (46) | 43 (48.9) | 38 (44.2) |
Perceived causes
“I work in the marketplace. My working environment is full of dust; I think this is what caused me to develop TB symptoms” (male, 41 years).
LDFU n = 86 | Non-LDFU n = 50 | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
How reporteda | How reporteda | |||||||||
Categorya | Total reported % | Spont % | Probe % | Most important % | Mean Prominenceb | Total reported % | Spont % | Probe % | Most important % | Mean Prominenceb |
Ingestion | 36.0 | 5.8 | 30.2 | 4.6 | 0.6 | 58.0 | 12.0 | 50.0 | 8.0 | 0.9 |
Food | 24.4 | 4.7 | 19.8 | 3.5 | 0.4 | 44.0 | 6.0 | 38.0 | 6.0 | 0.6 |
Water | 27.9 | 1.2 | 26.7 | 1.2 | 0.3 | 32.0 | 6.0 | 26.0 | 2.0 | 0.4 |
Substance use | 88.3 | 24.4 | 63.9 | 16.3 | 1.6 | 84.0 | 22.0 | 62.0 | 10.0 | 1.3 |
Alcohol | 56.9 | 5.8 | 51.2 | 4.7 | 0.8 | 44.0 | 8.0 | 36.0 | 2.0 | 0.6 |
Smoking | 69.7 | 20.9 | 48.8 | 11.6 | 1.3 | 66.0 | 20.0 | 46.0 | 8.0 | 1.1 |
Environmental causes | 97.7 | 82.6 | 15.1 | 45.4 | 3.2 | 98.0 | 84.0 | 14.0 | 44.0 | 3.1 |
Climate | 74.4 | 38.4 | 36.1 | 6.9 | 1.3 | 86.0 | 46.0 | 40.0 | 4.0 | 1.4 |
Dust | 75.6 | 47.7 | 27.9 | 18.6 | 1.8 | 86.0 | 54.0 | 32.0 | 28.0 | 2.2 |
Contamination | 69.8 | 27.9 | 41.8 | 5.8 | 1.1 | 56.0 | 10.0 | 46.0 | 2.0 | 0.7 |
Airborne illness | 48.8 | 19.8 | 29.1 | 13.9 | 1.1 | 40.0 | 6.0 | 34.0 | 10.0 | 0.8 |
Magico-religious courses | 93.0 | 70.9 | 22.0 | 15.1 | 2.1 | 98.0 | 62.0 | 36.0 | 14.0 | 2.0 |
Evil eye/sorcery | 80.2 | 45.3 | 34.9 | 13.9 | 1.6 | 70.0 | 28.0 | 42.0 | 12.0 | 1.3 |
Demons or Gods | 80.2 | 45.4 | 34.9 | 1.2 | 1.2 | 78.0 | 48.0 | 30.0 | 2.0 | 1.3 |
Contact | 68.6 | 24.4 | 44.2 | 5.8 | 1.1 | 62.0 | 14.0 | 48.0 | 8.0 | 1.0 |
Casual sexual contact | 22.1 | 5.8 | 16.3 | 2.3 | 0.3 | 34.0 | 2.0 | 32.0 | 2.0 | 0.4 |
Contact with infected person | 62.8 | 20.9 | 41.9 | 3.5 | 0.9 | 50.0 | 12.0 | 38.0 | 6.0 | 0.8 |
Other conditions | 68.6 | 24.4 | 44.2 | 10.5 | 1.2 | 78.0 | 24.0 | 54.0 | 8.0 | 1.3 |
Prior illness | 27.9 | 1.2 | 26.7 | 5.8 | 0.4 | 38.0 | 4.0 | 34.0 | 4.0 | 0.5 |
Heredity | 51.2 | 19.7 | 31.4 | 3.5 | 0.8 | 60.0 | 20.0 | 40.0 | 4.0 | 0.9 |
Others | 17.4 | 3.5 | 13.9 | 1.2 | 0.2 | 34.0 | 2.0 | 32.0 | 0 | 0.4 |
“My illness might have been caused by the environment at my previous work. As a cook, I was exposed to a lot of smoke and heat. Moreover, my workplace was near a dusty road. Therefore, I was exposed to dust as well. I strongly believe that was the cause of my illness” (male, 27 years).
“I work at the market where I often generate more profit than most of my surrounding neighbours. I began coughing blood and became very fragile, I thought my neighbours were jealous of my success and bewitched me. I visited a traditional healer” (female, 44 years).
Treatment seeking
“I belived that the pharmacist would understand what is my problem. She gave me some tablets to relieve pain and informed me it would be best to go to the clinic” (female 57 years).
LDFU women n = 60 | LDFU men n = 26 | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
How reporteda | How reporteda | |||||||||
Categorya | Total reported % | Spont % | Probe % | Most important % | Mean Prominenceb % | Total reported% | Spont % | Probe % | Most Important % | Mean Prominenceb |
Home remedies | 83.3 | 45.0 | 38.3 | 15.0 | 1.7 | 80.7 | 23.1 | 57.6 | 3.8 | 1.1 |
Pharmacy | 96.7 | 86.7 | 10.0 | 36.7 | 2.9 | 92.3 | 65.4 | 26.9 | 38.5 | 2.7 |
Hospital | 48.3 | 15.0 | 33.3 | 11.7 | 0.9 | 46.1 | 11.5 | 34.6 | 3.9 | 0.6 |
Traditional healer | 76.6 | 53.3 | 23.3 | 21.7 | 1.9 | 76.9 | 42.3 | 34.6 | 23.1 | 1.9 |
Religious healer | 40.0 | 11.7 | 28.3 | 6.7 | 0.7 | 42.3 | 11.5 | 30.8 | 11.5 | 0.8 |
Dispensary | 33.3 | 8.3 | 25.0 | 0 | 0.4 | 34.6 | 23.1 | 11.5 | 7.7 | 0.6 |
TB clinic | 10.0 | 6.7 | 3.3 | 6.7 | 0.4 | 23.1 | 3.8 | 19.2 | 3.8 | 0.3 |
Non-LDFU women n = 22 | Non-LDFU men n = 28 | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
How reporteda | How reporteda | |||||||||
Categorya | Total reported % | Spont % | Probe % | Most important % | Mean Prominenceb | Total reported% | Spont % | Probe % | Most Important % | Mean Prominenceb |
Home remedies | 86.3 | 54.5 | 31.8 | 9.1 | 1.6 | 75.0 | 32.1 | 43.0 | 14.3 | 1.5 |
Pharmacy | 81.8 | 40.9 | 40.9 | 27.3 | 2.0 | 96.4 | 75.0 | 21.4 | 28.6 | 2.6 |
Hospital | 68.2 | 36.4 | 31.8 | 4.6 | 1.2 | 71.4 | 50.0 | 21.4 | 7.1 | 1.4 |
Traditional healer | 81.8 | 36.4 | 45.5 | 22.7 | 1.7 | 67.9 | 39.3 | 28.6 | 32.1 | 2.0 |
Religious healer | 59.1 | 13.6 | 45.5 | 9.1 | 1.0 | 39.3 | 3.6 | 35.7 | 3.6 | 0.5 |
Dispensary | 40.9 | 18.1 | 22.7 | 0 | 0.5 | 42.8 | 7.1 | 35.7 | 3.6 | 0.6 |
TB clinic | 22.8 | 4.6 | 18.2 | 9.1 | 0.5 | 21.4 | 3.6 | 18.0 | 0 | 0.3 |
“I feel safer to visit a traditional healer. I will rather go to a traditional healer than to the hospital. Doctors at the hospital sometimes mismanage patients” (female, 27 years).
Patterns of distress
“I had a low fever and mild cough for a week. I purchased some antibiotics at the pharmacy. Yet I did not feel better and later I started noticing blood in my sputum. I thought it was serious and decided to visit the hospital for more check-ups” (male, 40 years).
“My colleagues were frightened with my condition which included fever and coughing blood. One day they explicitly mentioned that they no longer wanted to stay with me because I was coughing blood” (female, 51 years).
Factors associated with delay in seeking healthcare
“I described my symptoms to my colleague. His advice was to consult a traditional healer. The traditional healer prescribed some medications to use for a month and re-visit him after completion. My condition worsened after using the traditional medicines for more than two weeks. I decided to visit the pharmacy” (female, 35 years).
Variable | OR | 95% CI | P-value |
---|---|---|---|
Socio-demographics | |||
Sex | 0.03 | ||
Male | 1 (Ref) | ||
Female | 2.21 | 1.07–4.54 | |
Age groups | |||
18–27 | 1 (Ref) | ||
28–37 | 0.72 | 0.29–1.77 | 0.48 |
≥ 38 | 0.88 | 0.34–2.28 | 0.80 |
Level of education | 0.22 | ||
No formal education | 1 (Ref) | ||
Primary/secondary | 0.48 | 0.14–1.55 | |
Monthly household income | |||
Low income | 1 (Ref) | ||
Middle income | 2.18 | 0.92–5.17 | 0.07 |
High income | 1.28 | 0.53–3.04 | 0.57 |
Perceived causes | |||
Ingestion | 0.75 | 0.53–1.07 | 0.12 |
Magico-religious | 1.15 | 0.84–1.56 | 0.35 |
Environmental causes | 0.94 | 0.76–1.17 | 0.61 |
Substance Use | 1.21 | 0.90–1.65 | 0.20 |
Person to person contact | 0.97 | 0.71–1.34 | 0.89 |
Other conditions | 1.0 | 0.73–1.35 | 1.0 |
Help-seeking | |||
Traditional healers | 2.46 | 1.10–5.50 | 0.02 |
Religious healer | 1.27 | 0.62–2.59 | 0.50 |
Hospital | 0.85 | 0.42–1.74 | 0.67 |
Home remedies | 1.28 | 0.52–3.12 | 0.58 |
Dispensaries | 1.09 | 0.52–2.27 | 0.81 |
Variable | aOR | P-value | 95% CI |
---|---|---|---|
Sex | |||
Male | 1 (Ref) | ||
Female | 2.16 | 0.06 | 0.96–4.84 |
Monthly household income | |||
Low income | 1 (Ref) | ||
Middle Income | 3.35 | 0.01 | 1.21–9.21 |
High Income | 2.18 | 0.14 | 0.77–6.17 |
Occupation | |||
Employed | 1 (Ref) | ||
Unemployed | 2.81 | 0.05 | 1.00–7.90 |
Perceived causes | |||
Ingestion | |||
0 | 1 (Ref) | ||
1–5 | 0.41 | 0.03 | 0.18-0.93 |
Magico-religious | 1.11 | 0.56 | 0.76–1.63 |
Environmental causes | 1.09 | 0.57 | 0.79–1.50 |
Substance use | 1.41 | 0.07 | 0.96–2.06 |
Person to person contact | 0.93 | 0.73 | 0.64–1.36 |
Other conditions | 1.01 | 0.94 | 0.70–1.45 |
Help-seeking | |||
Traditional healers | 2.66 | 0.04 | 1.03–6.84 |
Religious healer | 1.67 | 0.23 | 0.71–3.87 |
“I am from a less privileged family. I could not afford the treatment expenses at the hospital. Traditional healers are cheaper compared to hospitals and other health facilities” (male, 29 years).
“I stayed for two months before going to the pharmacy. I just used grinded ginger for my symptoms. The reason was I did not have enough money. If I had enoughn money I would have gone earlier to the pharmacy” (female 26 years).
“I used to smoke a lot. I stopped because my wife did not like the behaviour. When I started coughing, I thought it was the aftermath of my behavior. I thought since I stopped, the cough will also disappear however it did not. My condition worsened then I decided to visit the traditional healer” (male 27 years).
“My experience of coughing frequently made me feel it was a normal cough that will eventually disappear with some antibiotics. I took antibiotics for almost a month nevertheless my condition worsened. I visited the pharmacy” (female, 39 years).
Factors associated with LDFU
Variable | OR | 95% CI | P-value |
---|---|---|---|
Socio-demographics | |||
Sex | |||
Male | 1 (Ref) | ||
Female | 3.51 | 1.70–7.23 | 0.001 |
Age groups | |||
18–27 | 1 (Ref) | ||
28–37 | 1.07 | 0.46–2.51 | 0.86 |
≥ 38 | 1.62 | 0.65–4.05 | 0.29 |
Level of education | |||
No formal education | 1 (Ref) | ||
Primary/secondary | 0.68 | 0.23–1.93 | 0.47 |
Monthly household income | |||
Low income | 1 (Ref) | ||
Middle income | 1.24 | 0.54–2.86 | 0.60 |
High income | 0.58 | 0.24–1.37 | 0.2 |
Perceived causes | |||
Ingestion | 0.68 | 0.47, 0.98 | 0.04 |
Magico-religious | 1.26 | 0.93–1.72 | 0.12 |
Environmental causes | 0.92 | 0.75–1.14 | 0.49 |
Substance use | 1.08 | 0.82–1.43 | 0.12 |
Person to person contact | 1.09 | 0.80–1.50 | 0.56 |
Other conditions | 1.15 | 0.84–1.56 | 0.36 |
Help-seeking | |||
Traditional healers | 1.74 | 0.79–3.84 | 0.16 |
Religious healer | 0.55 | 0.27–1.11 | 0.09 |
Hospitals | 0.48 | 0.24–0.98 | 0.04 |
Home remedies | 1.71 | 0.71–4.09 | 0.22 |
Dispensaries | 0.64 | 0.31–1.30 | 0.21 |
Variable | aOR | P-value | 95% CI |
---|---|---|---|
Sex | |||
Male | 1 (Ref) | ||
Female | 4.12 | 0.001 | 1.78–9.50 |
Perceived causes | |||
Ingestion | |||
0 | 1 (Ref) | ||
1–5 | 0.31 | 0.005 | 0.14, 0.70 |
Magico-religious | 1.29 | 0.18 | 0.88–1.91 |
Environmental causes | 1.06 | 0.68 | 0.78–1.43 |
Substance use | 1.26 | 0.19 | 0.88–1.80 |
Person to person contact | 1.13 | 0.51 | 0.77–1.66 |
Other conditions | 1.39 | 0.08 | 0.96–2.02 |
Help-seeking | |||
Traditional healers | 1.39 | 0.48 | 0.54–3.59 |
Religious healer | 0.51 | 0.11 | 0.22–1.17 |
Hospital | 0.54 | 0.15 | 0.23–1.24 |
Variable | Females aOR (95% CI) | Males aOR (95% CI) | P-Value (Interaction) |
---|---|---|---|
Perceived causes | |||
Ingestion | 0.50 | 0.16 | 0.54 |
Environmental causes | 1.17 | 0.84 | 0.24 |
Magico-religious | 1.96 | 0.97 | 0.14 |
Substance use | 1.48 | 1.02 | 0.29 |
Person to person contact | 1.46 | 0.76 | 0.99 |
Other conditions | 2.14 | 0.80 | 0.14 |
Help-seeking | |||
Traditional healers | 2.55 | 0.63 | 0.40 |
Religious healer | 0.84 | 0.14 | 0.14 |
Hospital | 1.47 | 0.14 | 0.11 |
“The pharmacist advised me to seek further help for my symptoms at the hospital. I decided not to. I did not want to impose more financial burden to my husband and family as a result of my condition” (female, 44 years).
“I was not concerned with the costs of treatment at the hospital. I was more worried that my boss will not understand me if I ask permission to visit the hospital” (male 41 years).
“The pharmacist gave me a small card to come for further check-ups. I was afraid to be asked to test for HIV. I was not ready to know my HIV status” (male 25 years).
“My friend was diagnosed with TB and people were afraid to even eat with him. I thought it would be the same with me that’s why I did not visit the hospital as advised at the pharmacy” (female 21 years).