Care Seeking Behavior of Chest Symptomatics: A Community Based Study Done in South India after the Implementation of the RNTCP
Care Seeking Behavior of Chest Symptomatics: A Community Based Study Done in South India after the Implementation of the RNTCP
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DOI：
10.1371/journal.pone.0012379
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发表时间：
2010-09-20
期刊：
影响因子：
3.7
通讯作者：
Wares, Fraser
中科院分区：
文献类型：
--
作者：
Charles, Niruparani;Thomas, Beena;Wares, Fraser
导言：随着修订的国家结核病控制规划（RNTCP）的建立，结核病服务已经变得分散，并且更容易获得。1997年一项研究报告说，大多数胸部症状患者首先到私人保健设施就诊，对政府保健设施普遍不满意。该研究在rntcp实施后重复进行，以深入了解当前胸部症状的求医行为。方法：2008年3月至8月期间，在印度南部金奈和马杜赖两个地区的4个地点（2个农村[R]和2个城市[U]）开展了一项基于社区的横断面研究，与1997年的研究一样。确定了640例胸部症状（r314; U 326），并对606例（R311; U295）进行了详细访谈。结果：城市、农村胸廓症状患病率分别为2.7%、4.9% (p < 0.01)，且随年龄增长呈上升趋势（χ 2为趋势，p < 0.01）。45岁以上的症状患者（p < 0.01）和以前接受过结核病治疗的患者（p < 0.05）在寻求治疗方面延误的时间更长。总体而言，50%（222/444）的胸部症状患者首先到政府卫生保健机构就诊(r142 (61%)；U 80 (38%), p = < 0.001)。这比1997年的研究中观察到的要明显（p < 0.001），当时只有38.4%的人首先接触政府设施。222人中有62人（28%）第二次前往政府设施（R26%; U31%），而17%的人转向私人设施（R14%; U21%）。对保健设施的不满是表达的主要原因之一。结论：RNTCP似乎对社区中政府卫生设施中结核病服务的可得性和可及性产生了影响。然而，随后转向私营保健设施的人数相对较高，因此需要采取紧急行动，使政府设施在提供RNTCP服务方面更有利于病人，提供高质量的护理设施。
Introduction: With the creation of the Revised National TB Control Programme (RNTCP), tuberculosis services have become decentralized and more accessible. A 1997 study prior to RNTCP implementation reported that most chest symptomatics accessed first private health care facilities and a general dissatisfaction with government health facilities. The study was repeated post-RNTCP implementation to gain insight into the current care seeking behavior of chest symptomatics.Methodology: A cross-sectional community-based study carried out between March-August 2008 in 4 sites (2 rural [R] and 2 urban [U]) from the same two districts of Chennai and Madurai, southern India, as in the 1997 study. Six hundred and forty chest symptomatics were identified (R 314; U 326), and detailed interviews were done for 606 (R311; U295).Results: Prevalence of chest symptomatics in the urban and rural areas were 2.7% and 4.9% respectively (p < 0.01), and was found to increase with age (Chi-square for trend, p < 0.01). Longer delays in seeking care were seen amongst symptomatics above 45 years of age (p 0.01), and those who had taken previous TB treatment (p = 0.05). Overall, 50% (222/444) of the chest symptomatics approached a government health care facility first (R 142 (61%); U 80 (38%), p = < 0.001). This was significantly (p < 0.001) more than were observed in the 1997 study, where only 38.4% approached a government facility first. Sixty two (28%) of the 222 made a second visit to a government facility (R26%; U31%), while 17% shifted to a private facility (R14%; U21%). Dissatisfaction with the health care facility was one of the major reasons expressed.Conclusions: It appears that the RNTCP has had an impact in the community with regard to the availability and accessibility of TB services in government health facilities. However the relatively high levels of subsequent shifting to private health facilities calls for urgent action to make government facilities more patients friendly with quality care facilities in the delivery of RNTCP services.