Full Project – Health seeking behaviours of persons with tuberculosis among residents

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CHAPTER ONE

INTRODUCTION

1.1     Background to the study

According to the 2015 World Health Organization (WHO) global tuberculosis (TB) report, TB remains a major global health problem that killed 1.5 million people in 2014 alone. This report also showed that an estimated number of 9.6 million new tuberculosis cases are diagnosed in the same year (WHO, 2015). Evidences showed that over 81% of TB related morbidity and mortality occurred in developing countries (Tadesse et al, 2011). This enormous burden of TB was mainly because of high prevalence of human immune deficiency virus infection, emergence of multidrug resistant (MDR) TB, social inequalities, ineffective TB control efforts, and low TB case detection rates (Tadesse et al, 2011). Moreover, many studies indicated that reservoirs for the extensive transmission of TB found predominantly in the community are being undiagnosed (Tadesse et al, 2013; Huong, 2017).

In Nigeria, TB is the major cause of hospital admission and mortality (Abebe, 2010). The country stands 7th globally and 2nd in Africa, among the high TB burden countries (WHO, 2015). The estimated annual incidence and prevalence of TB in Nigeria is 258 and 237 per 100,000 populations, respectively (Abebe, 2010). A TB trend analysis study also indicated that the incidence rate of TB in Nigeria was increasing at a rate of 5 new TB cases per 100,000 populations per year (Nigatu and Abraha, 2010). Nigeria adopted the internationally recommended TB control strategy, the Directly Observed Treatment Short (DOTS) course, by 2003. The major components of this strategy included case detection by sputum smear microscopy and standardized treatment with supervision (Abebe, 2010). However, despite the early introduction of such an important strategy, a recent national report showed a TB case detection rate of 58.9% which is below the national target of detecting 82.7% of infectious TB cases (FMOH, 2014). Low TB case detection rate may be related to individual or organizational factors. That is to say, either the patients fail to seek health care or the health care system fails to address TB case detection particularly at the community level (Yimer et al, 2013). In one or another way, this usually ends up with a delay in diagnosis of TB patients.

Health seeking behaviour is defined as any action taken by the individual TB suspect to get relief from his/her presenting symptoms (Grover, Kumar & Jindal, 2016). This action may include any form of traditional illness management including self-treatments by taking or applying local remedies, visit to traditional healers, “Holy Water,” local injectors, and/or buying medications from drug stores without prescription. On the other hand, people with TB symptoms may visit government or private modern health care facilities to get prescribed treatment (Yimer et al, 2013; Grover, Kumar & Jindal, 2016).

The health care seeking behaviour of TB patients and suspects varies from country to country. In Ukraine, for instance, 88% of the respondents reported that they visited polyclinic or hospital as a primary choice (Van der wef, et al, 2016). In Northern India, 87% of the study participants reported that they had taken some kind of self- initiated action such as home remedies (Grover, Kumar & Jindal, 2016). In another Indian study, 72% of respondents reported that they had consulted nonprofessional private healer (Fochsen et al, 2016). In Vietnam, TB case suspects’ visits to pharmacy and private practitioner were the initial actions for alleviating TB symptoms (Huong, 2017). In Gambia, majority of people from the study population seek help from modern health institutions early (Kasse, et al, 2016). Respondents from Uganda reported that they used self-treatment as a primary choice and visited health institutions when they became bedridden in most cases (Zerbini, 2012). A study done in Ethiopia demonstrated that 60% of the respondents visited modern health institutions while 22% and 18% of the respondents sought traditional healers and took no action, respectively (Yimer et al, 2013).

There are several factors which can affect the health seeking behaviour of TB suspects. According to the literature, health seeking behaviour is a dynamic process which is influenced by cultural, religious, socio-demographic, environmental, political, and other issues (Yimer et al, 2013). These factors shape the behaviour of individual patients by influencing their perception about symptoms. Moreover, their decision on the choice of a particular health care action is largely influenced by those factors (Shaikh and Hatcher, 2015).

In relation to the health seeking behaviour of TB suspects, a considerable degree of diagnosis and treatment delay had been observed in some studies. For instance, the median time between the start of symptoms and first visit to health care provider in Ukraine and Ethiopian studies was 30 days (Yimer et al, 2013; Van der wef, et al, 2016). A delay in visiting modern health care facilities results in a delay in detecting infectious tuberculosis (Zerbini et al, 2012). This in turn results in a more complicated disease process, increased patient suffering, extensive transmission of the infection within the community, and higher risk of TB associated mortality (Basnet et al, 2013). Various strategies had been tried in the past to bring the health seeking behaviour of TB suspects on the right track and to overcome diagnostic delays. Among these, public health education, identifying target groups for health education, and targeting vulnerable and difficult to reach groups were the major ones (Huong, 2017; Van der wef, et al, 2016; Grover, Kumar & Jindal, 2016).

In Nigeria a significant number of facility-based studies had been conducted on the health seeking behaviour of newly diagnosed TB patients. However, community-based studies are rarely available at national level in general and no information is found at the current study area in particular. Nevertheless, the health seeking behaviour of TB suspects who preferred to stay within the community may be different as compared to those who visited modern health care facilities. Therefore, this study will be immensely important to describe the level of modern health care seeking behaviours and practice in the rural community and factors associated with it.

1.2     Statement of problem  

Health care services are a major component towards providing quality living, it is a common problem that such services has poise a greater challenges on the health seeking behaviour of the rural communities. Health Care is a top social problem facing the rural areas with the lack of awareness of health care services posing a threat on the health of residents, inadequate and poor health care facility management are some of the factors affecting the seeking behaviour of the people towards practice and utilization particularly those residing in rural areas and poor implementation of National Health Policy.

In Nigeria, poor adherence to TB treatment has also been found to lead to MDR-TB, a severe form of the disease (Norgbe, 2011). According to Thiam et al. (2017), the increase in TB mortality is associated with poor treatment adherence. This situation has remained a major challenge in the total eradication of TB in Nigeria. As TB incidence increases, there is the need to focus on possible drivers associated with non-adherence to treatment and health seeking behaviours (Tabong, 2017; Blesson et al., 2015). Few studies have focused on the influence of physical, cultural and psychosocial forces on compliance and adherence among TB patients (Pachi, Bratis, Moussas, & Tselebis, 2013; Bam et al., 2016). Previous researches conducted in relation to the issue did not focus on extensive factors and how it associates with the social factors to influence on compliance and adherence to DOTS in rural areas and communities (Azagba, 2013; Noora, 2015; Burton et al., 2011). Furthermore, it is necessary to employ a qualitative research approach to explore the compliance with proper treatment and health seeking behavior among tuberculosis patients in rural communities (Creswell, 2013). It is therefore this foregoing that informed the researcher to carry out this study on the health seeking behaviours of persons with tuberculosis among residents in Amanator community in Ideato South LGA of Imo State.

1.3     Objectives of the study

The overall purpose of this study is to evaluate the health seeking behaviours of persons with tuberculosis among residents in Amanator community in Ideato South LGA of Imo State. The specific objectives are as follows;

1. Assess the patients’ knowledge and perception of tuberculosis and its causes in Amanator community
2. Assess the level of knowledge of preventive actions and practices on tuberculosis among residents of Amanator community
3. Investigate the health care seeking behaviours and action taken by persons with tuberculosis in Amanator community

1.4     Research Questions

The research questions are formulated based on the objectives and statement of problem to include;

1. What is the patients’ knowledge and perception of tuberculosis and its causes in Amanator community?
2. What is the level of knowledge of preventive actions and practices on tuberculosis among residents of Amanator community?
3. What are the health care seeking behaviours and action taken by persons with tuberculosis in Amanator community?

1.5     Significance of the study

Findings will be of great importance to the society, as the study seeks to emphasise on the role of health care seeking behaviours in the management and control of tuberculosis in the rural community. The importance of the health education, information and training programme to health workers and the society cannot be over emphasized. It may help in the improvement of infection control practices among individuals and residents of the community. The findings from this study will also encourage the practice of strict adherence to medications and healthcare information given by among nurses and healthcare professionals, as a measure of the respondents’ health seeking behaviours. Also, the patients and community residents will be conversant with what to do and how to properly treat and manage the disease from spreading, in terms of preventing infection. Finally, information gathered from this study will serve as a source of literature and guide for future research and as well serve as empirical reference for further studies.

1.6     Scope of study

The focus of this study is to assess the health seeking behaviours of persons with tuberculosis among residents in Amanator community in Ideato South LGA of Imo State. Amanator community was used as the study area, and community residents as the respondents for data collection and analysis. Variables considered include patients’ knowledge and perception of tuberculosis and its causes, of knowledge of preventive actions and practices on tuberculosis among residents, impact of health education and community treatment facilities in minimizing tuberculosis prevalence among residents, and the health care seeking behaviours and action taken by persons with tuberculosis in Amanator community.

1.7     Operational definition of terms

Health Seeking Behaviour: is defined as a “sequence of remedial actions that individuals undertake to rectify perceived ill-health.”

Tuberculosis: often abbreviated ‘TB’, is a highly contagious infection caused by the bacterium called Mycobacterium tuberculosis.

Preventive Actions: An action taken to reduce or eliminate the probability of specific undesirable events from happening in the future; in this case, tuberculosis.

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Full Project – Health seeking behaviours of persons with tuberculosis among residents