Patient predictors of health-seeking behaviour for persons coughing for more than two weeks in high-burden tuberculosis communities : the case of the Western Cape, South Africa
Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: This study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing
for more than 2 weeks to better understand this vulnerable and important population.
Methods: The study analysed data from a cohort study (SOCS - Secondary Outcome Cohort Study) embedded in a
community randomised trial ZAMSTAR (Zambia and South Africa TB and AIDS Reduction Study) in eight high-burden
TB communities in the Western Cape, South Africa. These datasets are unique as they contain TB-related data as well as
data on health, health-seeking behaviour, lifestyle choices, employment, socio-economic status, education and stigma.
We use uni- and multivariate logistic regressions to estimate the odds ratios of consulting for a cough (of more than 2
weeks duration) for a range of relevant patient predictors.
Results: Three hundred and forty persons consulted someone about their cough and this represents 37% of the 922
participants who reported coughing for more than 2 weeks. In the multivariate analysis, respondents of black ethnic
origin (OR 1.99, 95% CI 1.28–3.12, P < 0.01), those with higher levels of education (OR 1.05 per year of education, 95%
CI 1.00–1.10, P = 0.05), and older respondents (OR 1.02 per year, 95% CI 1.01–1.04, P < 0.01) had a higher likelihood of
consulting for their chronic cough. Individuals who smoked (OR 0.63, 95% CI 0.45–0.88, P < 0.01) and those with higher
levels of socio-economic status (OR 0.81, 95% CI 0.71–0.92, P < 0.01) were less likely to consult. We find no evidence of
stigma playing a role in health-seeking decisions, but caution that this may be due to the difficulty of accurately and
reliably capturing stigma due to, amongst other factors, social desirability bias.
Conclusions: The low levels of consultation for a cough of more than 2 weeks suggest that there are opportunities to
improve case-finding. These findings on health-seeking behaviour can assist policymakers in designing TB screening
and active case-finding interventions that are targeted to the characteristics of those with a chronic cough who do not
seek care.
Description
CITATION: Christian, C., et al. 2019. Patient predictors of health-seeking behaviour for persons coughing for more than two weeks in high-burden tuberculosis communities : the case of the Western Cape, South Africa. BMC Health Services Research, 19:160, doi:10.1186/s12913-019-3992-6.
The original publication is available at https://bmchealthservres.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at https://bmchealthservres.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
Chronic cough, Chronic diseases -- Patients -- Western Cape, South Africa -- Psychological aspects, Patient participation -- Western Cape, South Africa, Tuberculosis -- Patients -- Western Cape, South Africa
Citation
Christian, C., et al. 2019. Patient predictors of health-seeking behaviour for persons coughing for more than two weeks in high-burden tuberculosis communities : the case of the Western Cape, South Africa. BMC Health Services Research, 19:160, doi:10.1186/s12913-019-3992-6