Bacillary disease and health seeking behavior among Filipinos with symptoms of tuberculosis: implications for control

SETTING: Urban and rural communities and urban poor settlements in the Phil ippines. OBJECTIVE: To determine bacillary disease and action taking among individuals with symptoms of tuberculosis (TB), and to analyze their implic ations for TB control. STUDY DESIGN AND METHOD: Subjects aged 20 years and older were interviewed in the 1997 nationwide stratified multi-cluster survey. Sputum acid-fast sm ears and cultures were done in subjects with abnormal screening chest radio graphs. RESULTS: Individuals with TB symptoms comprised 18.1% of the population stu died. The prevalence of bacillary disease was 39/1000 in symptomatic subjec ts compared to 13/1000 in asymptomatic subjects. Symptom screening had a 14 .3% positive predictive value and a 91.4% negative predictive value for bac illary disease. Significantly more symptomatic than asymptomatic subjects a ttended chest radiographic screening during the survey. However, in respons e to their symptoms, the majority (43.0%) took no action or self medicated (31.6%), while 11.8% consulted a private practitioner, 7.5% a public health center, 4.4% a hospital, and 1.7% a traditional healer. CONCLUSION: Sputum smear examination after symptom screening was acceptable for case finding. The health seeking behavior of subjects with TB symptoms was inappropriate. A health education program and public-private collabora tion in directly observed therapy, short course (DOTS) are essential for TB control in the Philippines.