title: Health seeking behaviour, health system experience and tuberculosis case finding in Gambians with cough.
abstract: BACKGROUND
  Studies in Africa investigating health-seeking behaviour by interviewing tuberculosis patients have revealed patient knowledge issues and significant delays to diagnosis. We aimed to study health-seeking behaviour and experience of those with cough in The Gambia and to identify whether they had tuberculosis.
  
  
  METHODS
  During a round of a population under 3-monthly demographic surveillance, we identified people >10 years old who had been coughing > or = 3 weeks. A questionnaire was administered concerning demographic data, cough, knowledge, health seeking, and experience at health facilities. Case finding utilised sputum smear and chest X-ray.
  
  
  RESULTS
  122/29,871 coughing individuals were identified. Of 115 interviewed, 93 (81%) had sought treatment; 76 (81.7%) from the health system. Those that visited an alternative health provider first were significantly older than those who visited the health system first (p = 0.03). The median time to seek treatment was 2 weeks (range 0-106). 54 (58.1%) made their choice of provider because they believed it was right. Of those who left the health system to an alternative provider (n = 13): 7 believed it was the best place, 3 cited cost and 2 failure to improve. 3 cases were identified by sputum analysis, 11 more by X-ray; all had visited the health system first. Total 'excess' cough time was 1079 person weeks.
  
  
  CONCLUSIONS
  The majority of people with cough in this population seek appropriate help early. Improved case detection might be achieved through the use of chest X-ray in addition to sputum smear.
authors.affiliation: Tuberculosis Division, Medical Research Council Laboratories, Banjul, The Gambia. yayak25@hotmail.com
authors.forename: Yaya
authors.initials: Y
authors.lastname: Kasse
authors.forename: Momodou
authors.initials: M
authors.lastname: Jasseh
authors.forename: Tumani
authors.initials: T
authors.lastname: Corrah
authors.forename: Simon A
authors.initials: SA
authors.lastname: Donkor
authors.forename: Martin
authors.initials: M
authors.lastname: Antonnio
authors.forename: Adama
authors.initials: A
authors.lastname: Jallow
authors.forename: Richard A
authors.initials: RA
authors.lastname: Adegbola
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003371:Cough / Q000175:diagnosis*; D005260:Female; D005714:Gambia / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D011859:Radiography; D013183:Sputum; D011795:Surveys and Questionnaires; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control