Research on behaviors and delay in seeking health services of tuberculosis patient at nam dinh province in 2013 – Nguyen Dinh Tuan

Journal of military pharmaco-medicine no5-2018 149 RESEARCH ON BEHAVIORS AND DELAY IN SEEKING HEALTH SERVICES OF TUBERCULOSIS PATIENT AT NAM DINH PROVINCE IN 2013 Nguyen Dinh Tuan*; Nguyen Viet Nhung*; Le Van Bao** SUMMARY Objectives: To describe the knowledge, behaviors seeking health services and determine the time from onset of symptoms until the tuberculosis disease was diagnosed. Subjects and methods: Cross-sectional study by interviewing 341 tuberculosis patients, who registered tuberculosis treatment in 4 districts of Nam Dinh province in 2013. Results: Patients lacked knowledge about tuberculosis, only 57.8% of patients correctly understood the cause of the disease, 36.1% of patients agreed to vaccinate against tuberculosis for infants and 27.6% agreed to go early examination when having signs of tuberculosis. Behavior seeking health care services for the first time when tuberculosis patients with suggestive symptoms of tuberculosis in the commune health station was 49.9% and in district general hospital was 58.7% and in private health facilities was 31.7%. The time from the onset of symptoms until the diagnosed tuberculosis was fairly long, an average of 1.2 months. The most common reason that patients delay in detecting tuberculosis was that they didn , t think they had tuberculosis with 74.2%, and economic difficulties accounted for 17.5%. Conclusion: Patient lacked knowledge about tuberculosis, behaviors seeking health services of tuberculosis patients mainly in primary health facilities, time from onset of symptoms until tuberculosis diagnosed fairly long. * Keywords: Tuberculosis behaviors; Health services; Tuberculosis patient; Nam Dinh province. INTRODUCTION Vietnam still has a high burden of tuberculosis (TB), ranks 16th out of 30 countries with the highest number of tuberculosis patients in the world and ranks 13th out of 30 countries with a burden of multidrug-resistant TB [1]. Nowadays, private health services have been developing, while people seeking health care services in private health facilities are on the rise. Several studies have shown that private health facilities lack of knowledge and practice about TB, which has implications for the early detection of tuberculosis [1]. Research on behavior and delays in seeking medical services of TB patients will help managers with approciated intervention plans to increase the early detection of TB. Objectives of the study: - Describe the knowledge, behavior of seeking medical services of TB patients - Determine the length of time from the onset of TB symptoms to the diagnosis of TB. * Hochiminh University of Medicine and Pharmacy ** *** Corresponding author: Nguyen Dinh Tuan (nguyendinhtuan05@gmail.com) Date received: 08/03/2018 Date accepted: 23/05/2018 Journal of military pharmaco-medicine no5-2018 150 SUBJECTS AND METHODS 1. Study subjects. Tuberculosis patients registered for treatment in four districts of Nam Dinh province (Xuan Truong, Giao Thuy, Truc Ninh, Nghia Hung). 2. Methods. A cross-sectional study by interviewing TB patients by questionnaires. * Sample size: Sample size of the study description. Inside: + n: Minimum sample size. + Z(1- /2): Reliability, with probability 95%, Z(1- /2) = 1.96. + p: The rate of TB patients delayed in detecting ≥ 30 days; p = 0.76. + q = 1- p = 0.24. + d: Tolerance at 5% (d = 0.05). Sample size was calculated (n = 281). However, the sample size in the study was all pulmonary TB patients registered treatment in 4 studying districts in 2013. The actual sample size in the study was 341 pulmonary TB patients. * Data collection: interviews of all pulmonary TB patients by questionnaires at the time of the study. RESULTS AND DISCUSSION 1. Characteristics of research subjects. Table 1: Characteristics of age, gender of patients (n = 341). Age group Male Female Total n % n % n % 15 - 24 12 4.7 8 9.4 20 5.9 25 - 34 27 10.5 11 12.9 38 11.1 35 - 44 51 19.9 9 10.6 60 17.6 45 - 54 41 16.0 4 4.7 45 13.2 55 - 64 54 21.1 13 15.3 67 19.6 ≥ 65 71 27.7 40 47.1 111 32.6 Total 256 75.1 85 24.9 341 100 The average age 52.8 ± 16.9 57.4 ± 22.4 54.0 ± 18.5 The average age of the TB patient was 54.0. The proportion of male was 75.1%, which was 3.0 times higher than that of female (24.9%). The age and gender of TB patients in the study matched with those of other studies and statistics 2013 of National Tuberculosis Program [4, 2]. Journal of military pharmaco-medicine no5-2018 151 Table 2: Characteristics on the patient's education (n = 341). Education Quantity % Illiterate 14 4.1 Not graduated primary school 25 7.3 Graduated primary school 52 15.2 Graduated secondary school 159 46.6 Graduated high school 62 18.2 Graduated college, university 21 6.1 The education level of TB patients is generally low. Table 3: Occupational characteristics of patients (n = 341). Occupation Quantity % Agriculture 248 72.7 Fishermen 3 0.9 Business 16 4.7 Workers and employees 9 2.6 Work for private sectors 12 3.5 Students 23 6.7 Housewife 12 3.5 Retirement 16 4.7 The main occupation of TB patients is farming, accounting for 72.7%, which is suitable because the four study districts are agricultural districts. 2. Knowledge and behavior of seeking medical services of TB patients. Table 4: Knowledge about the causes of tuberculosis and how to prevent it (n = 341). Causes of tuberculosis Quantity % Food - related 8 2.3 Genetic 40 11.7 Tuberculosis bacteria 197 57.8 Sick due to work hard 96 28.2 Preventative measures Get vaccination for newborns 123 36.1 No contact with TB patients 246 72.1 Early examination when signs of TB 94 27.6 Journal of military pharmaco-medicine no5-2018 152 Only 57.8% of the respondents were aware of the cause of TB disease. There was a large percentage of patients with a lack of knowledge about the cause of TB (42.2%). The majority of patients lacked knowledge about TB prevention, only 36.1% agreed to vaccinate newborns and 27.6% agreed to go to the clinic early. * Behavior of seeking medical services of patients for the first time showing signs of disease (n = 341): Most TB patients seek health services at the grassroots level, 58.7% chose district general hospitals, 49.9% chose commune health stations and 31.7% selected private health facilities (private practitioners/clinics/ pharmacies). Patients chose provicial lung hospital and provicial general hospital were 6.7% and 2.3%, respectively. Therefore, if there is good coordination with the grassroots level, especially with the participation of private facilities, it will help increase the proportion of people having access to TB examination services [5]. * Time delay for disease detection: The duration from the onset of TB symptoms to TB patients diagnosed was quite long with an average of 1.2 months, of which the detection time < 30 days accounted for 43.1%. Detection time ≥ 30 days accounted for 56.9%. This result is consistent with the study by Vu Ngoc Bao, D. Scott LaMontagne, Nguyen Viet Nhung [3]. Table 5: Reasons for detection delay of tuberculosis. Reasons for detection delay Quantity % Do not think of TB 144 74.2 Economic difficulties 34 17.5 Home far away from the district hospital 8 4.1 Trouble when visiting the state health facilities 2 1.0 Do not know where to TB examination 2 1.0 The main reason of delayed detection delay was that the patient did not think they had TB with rate of 74.2%. The reason of economic difficulties accounted for 17.5%, home far away from the district hospital was 4.1%, troubles in the state health facilities and didn,t know where TB clinic was low rate (1%). This result was consistent with studies by Vu Ngoc Bao, D. Scott LaMontagne, Nguyen Viet Nhung, Le Thi Nga [3]. CONCLUSION Patients lacked knowledge about tuberculosis. The health service seeking behavior of the patients was mainly at the grassroots level. The time from onset of symptoms until tuberculosis diagnosed was fairly long (1.2 months). The most basic reason for delaying the diagnosis was that they didn’t think they had TB (74.2%). Journal of military pharmaco-medicine no5-2018 153 RECOMMENDATION Strengthening communication activities and health education on TB in the community. Implementation of interventions at the grassroots level, especially involving private health facilities to enhance the early detection of tuberculosis. REFERENCES 1. Bộ Y tế - CTCLQG. Hướng dẫn phối hợp giữa các cơ sở y tế trong quản lý bệnh lao - Phần I (giới thiệu). Sách hướng dẫn. Nhà xuất bản Y học. 2015, pp.19-23. 2. Trịnh Hữu Hùng. Nghiên cứu sự chậm trễ tiếp cận dịch vụ y tế của bệnh nhân lao phổi AFB (+) mới tại tỉnh Thanh Hóa và giải pháp can thiệp. Luận án Tiến sỹ. Viện Vệ sinh Dịch tễ Trung ương. 2008. 3. Vũ Ngọc Bảo, D.S.L, Nguyễn Viết Nhung, Lê Thị Nga. Những rào cản đối với việc tiếp cận và sử dụng dịch vụ chẩn đoán lao tại Việt Nam. 2013. 4. Nguyễn Viết Nhung, N.B.H, Phạm Huyền Khanh, Cornelia Hennig. Tuberculosis case notification data in Viet Nam, 2007 to 2012. Surveillance report. 2015. 5. World Health Organization. Global Tuberculosis Report 2017. 2017. 6. N.B Hoa, E.W.T, D.N Sy, N.V Nhung, M Vree, M.W Borgdorff, F.G.J Cobelens. Health- seeking behaviour among adults with prolonged cough in Vietnam. Tropical Medicine and International Health doi. 2011, 16 (10), pp.1260-1267.