Giridharan Prathiksha, Nagarajan Karikalan, Selvaraju Sriram, Frederick Asha, Subbiah Esakkipriya, Mani Sasikumar, Thiruvengadam Kannan, Selvavinayagam T S, Padmapriyadarsini Chandrasekaran
ICMR-National Institute for Research in Tuberculosis, Chennai, India.
Division of Infectious Disease Epidemiology, ICMR-National Institute of Epidemiology, Chennai, India.
Open Forum Infect Dis. 2024 Jul 19;11(8):ofae412. doi: 10.1093/ofid/ofae412. eCollection 2024 Aug.
There is a lack of research evidence on the quantitative relationship between symptom burden and health care seeking among individuals with presumptive tuberculosis (TB).
Data were derived from a cross-sectional population-based TB survey conducted between February 2021 and July 2022 in 32 districts of India. Eligible and consented participants (age >15 years) underwent TB symptom screening and history elicitation. Fairlie decomposition analysis was used to estimate the net differences in health care seeking due to varied symptom burden-from 1+ burden (>1 symptom) to 4+ burden (>4 symptoms)-and decomposed by observable covariates based on logit models with 95% CIs.
Of the 130 932 individuals surveyed, 9540 (7.3%) reported at least 1 recent TB symptom, of whom 2678 (28.1%; 95% CI, 27.1%-28.9%) reportedly sought health care. The net differences in health care seeking among persons with symptom burden 1+ to 4+ ranged from 6.6 percentage points (95% CI, 4.8-8.4) to 7.7 (95% CI, 5.2-10.2) as compared with persons with less symptom burden. The presence of expectoration, fatigue, and loss of appetite largely explained health care seeking (range, 0.9-3.1 percentage points [42.89%-151.9%]). The presence of fever, cough, past TB care seeking, weight loss, and chest pain moderately explained (range, 5.3%-25.3%) health care seeking.
Increased symptom burden and symptoms other than the commonly emphasized cough and fever largely explained health care seeking. Orienting TB awareness and risk communications toward symptom burden and illness perceptions could help address population gaps in health care seeking for TB.
关于疑似结核病患者症状负担与寻求医疗服务之间的定量关系，缺乏研究证据。
数据来自2021年2月至2022年7月在印度32个地区进行的一项基于人群的横断面结核病调查。符合条件并同意参与的参与者（年龄>15岁）接受了结核病症状筛查和病史询问。使用Fairlie分解分析来估计由于症状负担不同（从1+负担（>1种症状）到4+负担（>4种症状））导致的寻求医疗服务的净差异，并根据logit模型由可观察的协变量进行分解，置信区间为95%。
在130932名接受调查的个体中，9540人（7.3%）报告至少有1种近期结核病症状，其中2678人（28.1%；95%置信区间，27.1%-28.9%）据报告寻求了医疗服务。与症状负担较轻的人相比，症状负担为1+至4+的人寻求医疗服务的净差异范围为6.6个百分点（95%置信区间，4.8-8.4）至7.7个百分点（95%置信区间，5.2-10.2）。咳痰、疲劳和食欲不振的存在在很大程度上解释了寻求医疗服务的情况（范围为0.9-3.1个百分点[42.89%-151.9%]）。发热、咳嗽、既往结核病治疗史、体重减轻和胸痛的存在适度解释了（范围为5.3%-25.3%）寻求医疗服务的情况。
症状负担增加以及除了通常强调的咳嗽和发热之外的症状在很大程度上解释了寻求医疗服务的情况。将结核病意识和风险沟通导向症状负担和疾病认知，可能有助于解决结核病寻求医疗服务方面的人群差距。
