An exploration of the experience of patients who have had an episode of Tuberculosis in Bangladesh focusing on delay in seeking treatment and the socioeconomic impact on patients and their families

Abstract

This quantitative study explored the diversion, delay, social and economic impacts of an episode of tuberculosis on patients and their families in rural and urban areas of Bangladesh. A cross-sectional retrospective survey was conducted among 707 cured tuberculosis patients from 14 randomly selected rural and urban tuberculosis treatment units using a structured questionnaire. Information was obtained on diversion, delays, costs, other consequences, family income change and coping strategies for the whole span of the disease. Key findings include an examination of all the components of cost in relation to the tuberculosis episode, the impact on family incomes over the period, and the social impacts on patients and their families. Delay in seeking treatment was examined in detail and was found to be associated with the social process ‘diversion’ through patients shopping around and case holding by inappropriate health providers. The total costs were relatively high due to longer pre-treatment delay and higher indirect costs. Female patients, especially the divorced and widowed faced social rejection, and school children discontinued their studies. Poor patients were severely affected during the Tuberculosis episode and often had to sell or mortgage their assets to maintain daily life. However, higher income patients were more likely to be negatively affected in relation to household income in the longer term. So, effective policy and interventions should be initiated to reduce the number of health encounters and duration of delay before diagnosis since these are negative from a public health position and result in worse social and economic consequences for patients.