Open AccessSuch a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us
Author(s) -
Aruna Bhattacharya Chakravarty,
Sheela Rangan,
Yatin Dholakia,
S.N. Rai,
Swaran Kamble,
Tejaswi Raste,
Sanchi Shah,
Shimoni Shah,
Nerges Mistry
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0209924
Subject(s) - tuberculosis , extensively drug resistant tuberculosis , medicine , drug , multi drug resistant tuberculosis , drug resistance , mycobacterium tuberculosis , environmental health , family medicine , pharmacology , biology , microbiology and biotechnology , pathology
The Indian Tuberculosis (TB) Programme currently faces the dual challenges of tackling increasing numbers of drug resistant (DR) TB cases and regulating practices of a pluralistic private sector catering to TB patients. A study of health seeking behaviour of DR-TB patients in such a situation, offers an opportunity to understand the problems patients face while interacting with health systems. Methodology Forty-six DR-TB patients drawn from 15 high TB burden wards in Mumbai were interviewed using an open ended interview tool. Interviews were audio recorded and transcribed. Pathway schematics developed from analysis of patient records, were linked to transcripts. Open coding was used to analyse these units and themes were derived after collating the codes. Results and discussion The paper presents themes interwoven with narratives in the discussions. These include awareness-action gap among patients, role of neighbourhood providers, responsiveness of health systems, the not-such a ‘merry go round’ that patients go/are made to go on while seeking care, costs of diagnostics and treatment, and how DR-TB is viewed as the ‘big TB’. Conclusion The recommendations are based on a preventative ethos which is sustainable, compared to interventions with top-down approaches, which get piloted, but fail to sustain impact when scaled up.