Predictors of healthcare seeking for tuberculosis symptoms in the private healthcare facilities: findings from a cross-sectional population-based survey in Tamil Nadu.

Abstract

To identify the factors influencing the choice of private healthcare facilities among individuals experiencing tuberculosis (TB) symptoms. Cross-sectional study. The data for this study were obtained from a cross-sectional population-based TB prevalence survey conducted in 33 districts of Tamil Nadu, a state in southern India, between February 2021 to July 2022. 130 932 individuals, 15 years and above, residents of the selected cluster for the past 1 month, were included. Hospitalised patients, sick/morbid individuals and the institutional population were excluded. Of 143 005 eligible individuals, 130 932 (91.6%) participated. Among them, 9540 individuals were found to have at least one TB symptom. Of these symptomatic individuals, 2678 sought healthcare, with 62.7% in the public facilities and 37.3% in private facilities. Factors associated with seeking care in the private healthcare facilities included working in organised sector (aOR: 1.3; 95% CI 1.0 to 1.7; p<0.05), being a housewife (aOR: 1.3; 95% CI 1.0 to 1.7; p<0.05), having symptom of expectoration (aOR: 1.3; 95% CI 1.1 to 1.6; p<0.05) and fatigue (aOR: 1.5; 95% CI 1.2 to 1.9; p<0.05).Conversely, individual with symptom of weight loss (aOR: 0.4; 95% CI 00.3 to 00.6; p<0.05), loss of appetite (aOR: 0.8; 95% CI 0.6 to 0.9; p<0.05), chest pain (aOR: 0.6; 95% CI 0.5 to 0.7; p<0.05), history of past TB care (aOR: 0.4; 95% CI 0.3 to 0.5; p<0.05), age >25 years (aOR: 0.6; 95% CI 0.4 to 0.9; p<0.05), living in a rural area (aOR: 0.7; 95% CI 0.6 to 0.8; p<0.05) and living below the poverty line (aOR: 0.7; 95% CI 0.6 to 0.9; p<0.05) were less likely to seek care in the private healthcare facilities. The study highlights the distinct factors that could affect healthcare seeking for TB symptoms in the public and private healthcare settings for TB and the need for tailored interventions and customised healthcare policies to address such gaps and distinctions in care seeking.