title: Care seeking in tuberculosis: results from a countrywide cluster randomised survey in Bangladesh.
abstract: OBJECTIVE
  To explore systematically the care seeking trajectories of tuberculosis (TB) cases up to four subsequent places of care and to assess the type of services provided at each place.
  
  
  METHODS
  TB cases detected actively during the 2007-2009 national TB prevalence survey and passively under the routine programme in the same period were interviewed by administering a standardised questionnaire. Care seeking and services provided up to four subsequent points were explored. Care seeking was further explored by categorising the providers into formal, informal and 'self-care' groups.
  
  
  RESULTS
  A total of 273 TB cases were included in this study, of which 33 (12%) were detected during the survey and 240 (88%) from the TB registers. Out of the 118 passively detected cases who first sought care from an informal provider, 52 (44.1%) remained in the informal sector at the second point of care. Similarly, out of the 52, 17 (32.7%) and out of the 17, 5 (29.4%) remained in the informal sector at the third and fourth subsequent points of care, respectively. All the 33 actively detected cases had 'self-care' at the first point, and 27 (81.8%) remained with 'self-care' up to the fourth point of care. Prescribing drugs (59-99%) was the major type of care provided by the formal and informal care providers at each point and was limited to the non-existent practice of investigation or referrals.
  
  
  CONCLUSIONS
  Free TB services are still underutilised by TB cases and informal caregivers remained the major care providers for such cases in Bangladesh. In order to improve case detection, it is necessary that the National Tuberculosis Programme immediately takes effective initiatives to engage all types of care providers, particularly informal providers who are the first point of care for the majority of the TB suspects.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Shahed
authors.initials: S
authors.lastname: Hossain
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: K
authors.initials: K
authors.lastname: Zaman
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Abdul
authors.initials: A
authors.lastname: Quaiyum
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Sayera
authors.initials: S
authors.lastname: Banu
authors.affiliation: National TB Control Programme (NTP), DGHS, Dhaka, Bangladesh.
authors.forename: Ashaque
authors.initials: A
authors.lastname: Husain
authors.affiliation: Health Programme, BRAC, Dhaka, Bangladesh.
authors.forename: Akramul
authors.initials: A
authors.lastname: Islam
authors.affiliation: Department of Clinical Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Centre for Infection and Immunity Amsterdam, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Public Health Service, Amsterdam, The Netherlands.
authors.forename: Martien
authors.initials: M
authors.lastname: Borgdorff
authors.affiliation: Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands KNCV Tuberculosis Foundation, The Hague, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van Leth
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011897:Random Allocation; D012648:Self Care; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000628:therapy; D055815:Young Adult
keywords: Bangladesh; Care seeking; Informal provider; Organisation of health services < HEALTH SERVICES ADMINISTRATION & MANAGEMENT