Assessing health seeking behaviour among tuberculosis patients in rural South Africa

SETTING: South Africa's rural Northern Province. OBJECTIVES: To examine patterns of health seeking behaviour among hospitali sed tuberculosis patients. DESIGN: Information on personal characteristics, health seeking behaviour a nd delays to presentation and hospitalisation was collected from hospitalis ed TB patients. Analysis of rates was used to investigate factors associate d with delay. RESULTS: Among 298 patients, median total delay to hospitalisation was 10 w eeks, with patient delay contributing a greater proportion than service pro vider delay. Patients more often presented initially to public hospitals (4 1%) or clinics (31%) than to spiritual/traditional healers (15%) or private GPs (13%). Total delay was shorter amongst those presenting to hospitals t han those presenting to clinics (rate ratio 1.33, 95%CI 1.13-1.85), with a significantly smaller proportion of the total delay attributable to the hea lth service provider (18% vs. 42%). Those exhibiting a conventional risk pr ofile for TB (migrants, alcohol drinkers, history of TB) were diagnosed mos t quickly by health services, while women remained undiagnosed for longer. CONCLUSION: Considerable delay exists between symptom onset and treatment i nitiation among pulmonary tuberculosis patients. While a substantial delay was attributable to late patient presentation, an important, preventable pe riod of infectiousness was caused by the failure of recognised clinical ser vices to diagnose tuberculosis among symptomatic individuals.