title: Lost in care pathway: a qualitative investigation on the health system delay of extra pulmonary tuberculosis patients in Bangladesh.
abstract: Although extra pulmonary tuberculosis (EPTB) has long been known as a major public health concern globally, the complex healthcare-seeking pathways of EPTB patients are not widely studied. This study aims to explore the pattern of healthcare-seeking pathways of rural and urban EPTB patients registered with the BRAC TB control programme. BRAC is a Bangladesh-based non-governmental organization dedicated to alleviating poverty through empowering the poor.
  
  
  
  Data were collected through 60 in-depth interviews with rural and urban EPTB patients in Bangladesh.
  
  
  
  The findings reveal that the rural EPTB patients encountered a substantial diagnostic delay as compared to the urban patients. However, the difference between the average number of healthcare providers consulted by the rural verses the urban EPTB patients was not significant. This study also shows that the healthcare-seeking journey of rural and urban EPTB patients usually starts either at pharmacies or private facilities. Through exploring the detailed nature of the pathway, this study reveals the ways in which non-medical informants, mainly relatives and friends, can benefit patients.
  
  
  
  The private and informal healthcare providers should receive appropriate training on the diagnosis of EPTB. Such training could effectively shorten the long and complex healthcare-seeking pathways of EPTB patients.
authors.affiliation: James P. Grant School of Public Health, BRAC University, 68 Mohakhali, Dhaka, 1212, Bangladesh. malabika@bracu.ac.bd.
authors.forename: Malabika
authors.identifier: 0000-0001-7293-8805
authors.initials: M
authors.lastname: Sarker
authors.affiliation: Department of Media Studies and Journalism, University of Liberal Arts Bangladesh, House 56, Road 4/A, Dhanmondi, Dhaka, 1209, Bangladesh.
authors.forename: Din
authors.initials: D
authors.lastname: Mohammad
authors.affiliation: James P. Grant School of Public Health, BRAC University, 68 Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Sukanta
authors.initials: S
authors.lastname: Paul
authors.affiliation: James P. Grant School of Public Health, BRAC University, 68 Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Rahima
authors.initials: R
authors.lastname: Akter
authors.affiliation: Health Nutrition and Population Programme, BRAC, 75 Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Shayla
authors.initials: S
authors.lastname: Islam
authors.affiliation: James P. Grant School of Public Health, BRAC University, 68 Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Goutam
authors.initials: G
authors.lastname: Biswas
authors.affiliation: National Tuberculosis Control Programme, Directorate General of Health Services, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Asheque
authors.initials: A
authors.lastname: Hossain
authors.affiliation: Health Nutrition and Population Programme, BRAC, 75 Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Akramul
authors.initials: A
authors.lastname: Islam
mesh_terms: D001459:Bangladesh; D057210:Delayed Diagnosis; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008483:Medical Assistance; D009938:Organizations; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012424:Rural Population; D014376:Tuberculosis / Q000175:diagnosis*; D014505:Urban Population
keywords: Bangladesh; DOTS; EPTB; Extra pulmonary; Healthcare-seeking pathway; Tuberculosis