Health-seeking norms for tuberculosis symptoms in southern Angola: implications for behaviour change communications.

SETTING

A passive case-finding strategy as present in the DOTS strategy presupposes a patient's willingness to seek care. This requires awareness of tuberculosis (TB) symptoms and the diagnostic process, and positive attitudes towards access and probability of cure.

OBJECTIVE

To measure parameters of health-seeking intention in Southern Angola and to inform the design of context-specific interventions to improve case detection.

DESIGN

A survey in four communities based on the cough-to-cure pathway represented by five domains with either one or two proxy measures. These were assessed for association with appropriate health-seeking behaviour (visiting a medical institution or service).

RESULTS

In total, 805 individuals were included in the study. Appropriate health-seeking behaviour was positively associated with knowing the disease (OR 3.1, 95%CI 1.4-6.8), knowing key symptoms (OR 1.4, 95%CI 1.0-1.9), perceived curability (OR 1.3, 95%CI 1.0-1.6), and the perception that TB services were free of charge (OR 1.9, 95%CI 1.4-2.7). Respondents who perceived a personal risk for TB were less likely to have an appropriate intended health-seeking behaviour (OR 0.7, 95%CI 0.5-0.9).

CONCLUSION

Knowledge about TB should include key symptoms, perceived curability and information on access to services when designing interventions to improve case detection. The study highlights the importance of advocacy, social mobilisation and communication strategies.