Tuberculosis patients not covered by treatment in public health services: Findings from India’s National Family Health Survey 2015–16

Abstract

objective Half of the TB patients in India seek care from private providers resulting in incomplete notification, varied quality of care and out-of-pocket expenditure. The objective of this study was to describe the characteristics of TB patients who remain outside the coverage of treatment in public health services. methods Cross-sectional data from National Family Health Survey-4 (2015–16) were analysed using logistic regression analysis. TB treatment was the dependent variable. Sociodemographic factors and place where households generally seek treatment were independent variables. results Prevalence of self-reported TB was 308.17/100 000 population (95% CI: 309.44–310.55/ 100 000 population) and 38.8% (95% CI: 36.5–41.1%) of TB patients were outside care of public health services – 3.3% did not seek treatment and 35.3% accessed treatment from private sector. Factors associated with not seeking treatment were age <10 years [OR = 3.43; 95% CI (1.52–7.77); P = 0.00]; no/preschool education [OR = 1.82; 95% CI (1.10–3.34); P = 0.02]; poorest wealth index [OR = 1.86; 95% CI (1.01–3.34); P = 0.04] and household’s general rejection of the public sector when seeking health care [OR = 1.69; 95% CI (1.69–2.26); P = 0.00]. Factors associated with seeking treatment from private providers were female sex [OR = 1.29; 95% CI (1.11–1.50); P = 0.001], younger age of the patient [OR = 2.39; 95% CI (1.62–3.53); P = 0.00], higher education [OR = 1.82; 95% CI (1.11–2.98); P = 0.02] and household’s general rejection of the public sector when seeking health care [OR = 4.56; 95% CI (3.95–5.27); P = 0.00]. Patients from households reporting ‘poor quality of care’ as the reason for not generally preferring public health services were more likely (OR = 1.48, 95% CI = 1.19–1.65; P = 00) to access private treatment. conclusion The study provides insights for efforts to involve the private health sector for accurate surveillance and patient groups requiring targeted interventions for linking them to the national programme.