Health seeking and perceived causes of tuberculosis among patients in Manila, Philippines

Inefficient case finding is an important stumbling block to successful cont rol of tuberculosis (TB). Multiple health seeking may account for delayed c ase finding. Health-seeking behaviour, health seeking delay, perceived caus es, and perceived quality of care related to TB were studied in interviews with 319 sputum smear-positive TB patients. The patients were treated in 22 governmental health centres of Malabon, a municipality of Metro Manila, Ph ilippines. Only 29% of the respondents had gone first to a health cent-re a fter onset of TB-related symptoms, and more than half (53%) had initially c onsulted a private doctor. A chest X-ray was obtained for nearly everyone ( 97%). Two thirds of the patients (66%) had received a prescription far drug s, and 29% had purchased and taken anti-TB drugs for at least three weeks b efore they came to a governmental health centre. Concerning community inter actions, 36% said riley knew at least one person who had been created for T B without success. The health seeking delay after symptom onset was relativ ely short - 64% of the respondents said they went to a health facility with in 1 month. Case studies illustrate the rationale for health seeking and ex plain delayed initiation of appropriate treatment for many patients. Findin gs underscore the need for and indicate approaches to health communication for improved control of TB. Our findings from interview narratives also sug gest that improved interpersonal skills of health centre staff and co-ordin ation between the private doctors and the health centres may substantially improve services for TB patients.