title: Adults with chronic cough in urban Bangladesh: healthcare utilization and management of cases by private practitioners.
abstract: Tuberculosis (TB) case detection under the Directly Observed Treatment - Short-course (DOTS) strategy largely relies upon care seeking of chronic coughers and the actions taken by their healthcare providers. This study aimed to describe the healthcare utilization of people 15 years of age with a chronic cough in urban areas of Bangladesh and to understand their management by private practitioners. A community-based, household survey included 60,382 persons ≥ 15 years of age from two administrative areas of Dhaka City. A total of 1138 (2%) were identified to have had a cough for 3 weeks or more. This survey was linked to interviews of licensed and unlicensed practitioners in Dhaka and the Chittagong City Corporation of Bangladesh. Among identified coughers, 1046 (92%) were interviewed, of whom 648 (62%) reported having sought care from any provider. Among care seekers, 16% directly attended a DOTS facility. The remaining 84% sought care from the private sector, where less than 1% reported referral to a DOTS facility. Bivariate and multivariate assessments showed that care seeking from a licensed private practitioner or a DOTS centre was significantly associated with severity of the disease and previous diagnosis of TB.
authors.affiliation: Health Systems and Infectious Diseases Division, ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh. shahed@icddrb.org
authors.forename: S
authors.initials: S
authors.lastname: Hossain
authors.forename: C P
authors.initials: CP
authors.lastname: Larson
authors.forename: M A
authors.initials: MA
authors.lastname: Quaiyum
authors.forename: A I
authors.initials: AI
authors.lastname: Khan
authors.forename: K
authors.initials: K
authors.lastname: Zaman
authors.forename: V
authors.initials: V
authors.lastname: Begum
authors.forename: N C
authors.initials: NC
authors.lastname: Saha
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D002908:Chronic Disease; D003371:Cough / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000175:diagnosis; D014505:Urban Population; D055815:Young Adult