title: Socio economic position in TB prevalence and access to services: results from a population prevalence survey and a facility-based survey in Bangladesh.
abstract: BACKGROUND
  In Bangladesh DOTS has been provided free of charge since 1993, yet information on access to TB services by different population group is not well documented. The objective of this study was to assess and compare the socio economic position (SEP) of actively detected cases from the community and the cases being routinely detected under National Tuberculosis Control Programme (NTP) in Bangladesh.
  
  
  RESULTS
  SEP was assessed by validated asset item for each of the 21,427 households included in the national tuberculosis prevalence survey 2007-2009. A principal component analysis generated household scores and categorized in quartiles. The distribution of 33 actively identified cases was compared with the 240 NTP cases over the identical SEP quartiles to evaluate access to TB services by different groups of the population. The population prevalence of tuberculosis was 5 times higher in the lowest quartiles of population (95.4, 95% CI: 48.0-189.7) to highest quartile population (19.5, 95% CI: 6.9-55.0). Among the 33 cases detected during survey, 25 (75.8%) were from lower two quartiles, and the rest 8 (24.3%) were from upper two quartiles. Among TB cases detected passively under NTP, more than half of them 137 (57.1%) were from uppermost two quartiles, 98 (41%) from the second quartile, and 5 (2%) in the lowest quartile of the population. This distribution is not affected when adjusted for other factors or interactions among them.
  
  
  CONCLUSIONS
  The findings indicate that despite availability free of charge, DOTS is not equally accessed by the poorer sections of the population. However, these figures should be interpreted with caution since there is a need for additional studies that assess in-depth poverty indicators and its determinants in relation to access of the TB services provided in Bangladesh.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh. shahed@icddrb.org
authors.forename: Shahed
authors.initials: S
authors.lastname: Hossain
authors.forename: Mohammad Abdul
authors.initials: MA
authors.lastname: Quaiyum
authors.forename: Khalequ
authors.initials: K
authors.lastname: Zaman
authors.forename: Sayera
authors.initials: S
authors.lastname: Banu
authors.forename: Mohammad Ashaque
authors.initials: MA
authors.lastname: Husain
authors.forename: Mohammad Akramul
authors.initials: MA
authors.lastname: Islam
authors.forename: Erwin
authors.initials: E
authors.lastname: Cooreman
authors.forename: Martien
authors.initials: M
authors.lastname: Borgdorff
authors.forename: Knut
authors.initials: K
authors.lastname: Lönnroth
authors.forename: Abdul Hamid
authors.initials: AH
authors.lastname: Salim
authors.forename: Frank
authors.initials: F
authors.lastname: van Leth
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys / Q000191:economics* / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult