Sharmeen Ahmed

Why are tuberculosis patients not treated earlier? A study of informal health practitioners in Bangladesh.

SETTING Five districts and four cities of Bangladesh. OBJECTIVE To study the role of informal health practitioners in delays in initiating tuberculosis (TB) treatment in new smear-positive TB patients. DESIGN A cross-sectional study of all patients registered within specific projects in Bangladesh using routine records from projects. Definitions were as follows: 1) total delay: duration from onset of symptoms to initiation of treatment; 2) patient delay: onset of symptoms to first visit to any practitioner; and 3) health system delay: first visit to practitioner to treatment initiation. RESULTS A total of 7280 cases were enrolled. Prolonged delay was calculated as ≥ 5 weeks for patient delay, ≥ 10 weeks for health system delay and ≥ 13 weeks for total delay. Prolonged patient delay was less frequent when patients first consulted informal as compared to qualified health practitioners (30% vs. 68%). Similar figures for prolonged health system delay were respectively 52% and 16%, while those for total delay were 47% and 27%. The differences were statistically significant (P < 0.05). CONCLUSION Patients seeking care from informal practitioners access care more promptly, but have prolonged delays in initiating treatment. Further investigation on how to involve these practitioners in the programme should be evaluated.