Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 19;11(8):ofae412.
doi: 10.1093/ofid/ofae412. eCollection 2024 Aug.

Estimating and Explaining the Differences in Health Care Seeking by Symptom Burden Among Persons With Presumptive Tuberculosis: Findings From a Population-Based Tuberculosis Prevalence Survey in a High-Burden Setting in India

Prathiksha Giridharan  1   2 , Karikalan Nagarajan  1 , Sriram Selvaraju  1 , Asha Frederick  3 , Esakkipriya Subbiah  1 , Sasikumar Mani  1 , Kannan Thiruvengadam  4 , T S Selvavinayagam  5 , Chandrasekaran Padmapriyadarsini  1 ; Tamil Nadu TB Prevalence Study Group
Collaborators, Affiliations

Estimating and Explaining the Differences in Health Care Seeking by Symptom Burden Among Persons With Presumptive Tuberculosis: Findings From a Population-Based Tuberculosis Prevalence Survey in a High-Burden Setting in India

Prathiksha Giridharan et al. Open Forum Infect Dis. .

Abstract

Background: There is a lack of research evidence on the quantitative relationship between symptom burden and health care seeking among individuals with presumptive tuberculosis (TB).

Methods: Data were derived from a cross-sectional population-based TB survey conducted between February 2021 and July 2022 in 32 districts of India. Eligible and consented participants (age >15 years) underwent TB symptom screening and history elicitation. Fairlie decomposition analysis was used to estimate the net differences in health care seeking due to varied symptom burden-from 1+ burden (>1 symptom) to 4+ burden (>4 symptoms)-and decomposed by observable covariates based on logit models with 95% CIs.

Results: Of the 130 932 individuals surveyed, 9540 (7.3%) reported at least 1 recent TB symptom, of whom 2678 (28.1%; 95% CI, 27.1%-28.9%) reportedly sought health care. The net differences in health care seeking among persons with symptom burden 1+ to 4+ ranged from 6.6 percentage points (95% CI, 4.8-8.4) to 7.7 (95% CI, 5.2-10.2) as compared with persons with less symptom burden. The presence of expectoration, fatigue, and loss of appetite largely explained health care seeking (range, 0.9-3.1 percentage points [42.89%-151.9%]). The presence of fever, cough, past TB care seeking, weight loss, and chest pain moderately explained (range, 5.3%-25.3%) health care seeking.

Conclusions: Increased symptom burden and symptoms other than the commonly emphasized cough and fever largely explained health care seeking. Orienting TB awareness and risk communications toward symptom burden and illness perceptions could help address population gaps in health care seeking for TB.

Keywords: India; decomposition; health seeking; symptoms; tuberculosis.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

Figures

Figure 1.
Figure 1.
Flowchart depicting study enumeration and recruitment process. Participant screening and enrollment status.
Figure 2.
Figure 2.
Contribution of individual tuberculosis symptoms in explaining health care seeking at different symptom burden levels.
See this image and copyright information in PMC

References

    1. Sreeramareddy CT, Qin ZZ, Satyanarayana S, Subbaraman R, Pai M. Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review. Int J Tuberc Lung Dis 2014; 18:255–66. - PMC - PubMed
    1. Getnet F, Demissie M, Assefa N, Mengistie B, Worku A. Delay in diagnosis of pulmonary tuberculosis in low- and middle-income settings: systematic review and meta-analysis. BMC Pulm Med 2017; 17:202. - PMC - PubMed
    1. Samal J. Health seeking behaviour among tuberculosis patients in India: a systematic review. J Clin Diagn Res 2016; 10:LE01–6. - PMC - PubMed
    1. Marks GB, Nguyen NV, Nguyen PTB, et al. Community-wide screening for tuberculosis in a high-prevalence setting. N Engl J Med 2019; 381:1347–57. - PubMed
    1. Thomas BE, Thiruvengadam K, Raghavi S, et al. Understanding health care-seeking behaviour of the tribal population in India among those with presumptive TB symptoms. PLoS One 2021; 16:e0250971. - PMC - PubMed