Estimating and explaining the differences in healthcare seeking by symptom burden among persons with presumptive tuberculosis. Findings from a population-based tuberculosis prevalence survey in a high-burden setting in India

There is lack of research evidence on the quantitative relationship between symptom burden and healthcare-seeking among individuals with presumptive tuberculosis. Data was derived from a cross-sectional population-based tuberculosis survey conducted between February 2021 to July 2022 in 32 districts of India. Eligible and consented participants (>15 years) underwent TB symptom screening and history elicitation. Fairlie decomposition analysis was used to estimate the net differences in healthcare seeking due to varied symptom burden [from 1+ burden (>1 symptom) to 4+ burden (> 4 symptoms] and decomposed using observable covariates based on logit models with 95% confidence intervals. Of the 130932 individuals surveyed, 9540 (7.3%) reported at least one TB symptom recently, of whom 2,678 (28.1%, 95% CI 27.1-28.9) reportedly sought health care. The net differences in healthcare-seeking between persons with symptom burden of 1+ to 4+ ranged from 6.6 percentage points (95% CI,4.8 to 8.4) to 7.7 percentage points (95% CI, 5.2- 10.2] as compared to persons with less symptom burden. The presence of expectoration, fatigue, and loss of appetite largely explained healthcare seeking (range 0.9 to 3.1 percentage points or 42.89% to 151.9%). The presence of fever, cough, past TB care seeking, weight loss and chest pain moderately explained (5.3% to 25.3%) healthcare seeking. Increased symptom burden and symptoms other than the commonly emphasized cough and fever largely explained healthcare seeking. Orienting TB awareness and risk communications towards symptom burden and illness perceptions could help address population gaps in healthcare seeking for TB.