title: Access to tuberculosis care: what did chronic cough patients experience in the way of healthcare-seeking?
abstract: OBJECTIVE
  The directly observed treatment-short course (DOTS) has been adopted in China's modern tuberculosis (TB) control programme since 1992. However, the case detection rate of TB is far below the global 70% target. The aims of this study are to analyse the healthcare-seeking experiences and economic burden of potential TB patients with more than two weeks of cough in counties with and without a DOTS project and to explore the barriers to access for potential TB patients in rural China.
  
  
  METHODS
  A cross-sectional study using questionnaire interviews was conducted in a DOTS project county (Jianhu) and a non-DOTS county (Funing) in Jiangsu Province. A total of 1,204 chronic cough hospital patients were interviewed about their care-seeking experiences.
  
  
  RESULTS
  The mean patient delays were 34 and 29 days respectively in Jianhu and Funing (p = 0.070). A shorter patient delay was associated with the availability of medical insurance (RR = 1.36, p<0.01). More than 97% of patients sought care in the general health system, rather than in the special TB dispensary. Only 1.8% (Jianhu) and 5.0% (Funing) of the subjects had been sputum smear tested (p<0.001). The average patient's expenditure was CNY346 in Jianhu and CNY256 in Funing (p>0.05).
  
  
  CONCLUSIONS
  Potential TB patients' access to TB care needs improving under DOTS. The expenses for treatment of cough are a heavy burden for the poor. Since the low-income patients first seek care at village health stations or township hospitals for cough, it is vital to involve the general health system in the DOTS project.
authors.affiliation: School of Public Health, Fudan University, China. bxu@shmu.edu.cn
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Diwan
authors.forename: Lennart
authors.initials: L
authors.lastname: Bogg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D002908:Chronic Disease; D017281:Cost of Illness; D003371:Cough / Q000175:diagnosis; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control