Care-seeking behavior for respiratory symptoms in a Brazilian favela(slum)

Background: Active case finding for tuberculosis (TB) has not historically been part of the WHO's TB control policy because prior studies have suggested that people with TB symptoms seek care, but aren't diagnosed. Identifying whether blocks to case detection occur because patients don't seek care or providers don't diagnose TB is crucial to setting policy for TB control. This analysis evaluates whether people with TB symptoms in the high-incidence Brazilian favela, Rocinha, seek care. Methods: As part of an active case finding intervention, 7 neighborhoods of the favela were randomly allocated to receive door-to-door TB symptom screens by community health workers using standardized data collection tools. Factors potentially affecting care-seeking behavior were evaluated, including gender, age, history of TB, contact status and duration of cough. Interactions were assessed. Univariate analysis and GEE were performed in STATA 8.Results: 23,801 people in 7937 houses were surveyed. Of 1310 people reporting cough, 111 (8.5%) acknowledged seeking help for their symptoms. Of 430 people with a cough of 3 or more weeks, 66 (15.4%) had sought care. Of variables mentioned above, only younger age groups (0-5 and 6-15) (Odds ratio(OR)and 95%CIs 5.37(3.00,9.62)and 2.80 (1.44, 5.44) respectively) and duration of cough (3 weeks or more) (OR 4.84, 95%CI 3.09, 7.56), were significantly associated with increased odds of care seeking. Discussion: In this favela setting, adults, who are more likely to transmit infection than children, are not seeking treatment for their respiratory symptoms. Increasing case detection in symptomatic adults will be of value in this setting.