Comprehensive understanding of health-seeking behaviour among pulmonary tuberculosis patients in China

In China, there were 918 000 tuberculosis (TB) cases in 2015 alone. The primary challenge facing TB control is the allocation of limited health care resources.

To gain a comprehensive understanding of the first choice of health care facility among Chinese patients with suspected pulmonary TB (PTB) and the number of visits required to make the diagnosis.

Relevant full-text articles in three Chinese and one English literature databases up to November 2016 were reviewed. Meta-analyses were performed using Stata v12.0.

Among 1257 potentially relevant selected articles, 27 cross-sectional studies involving 9891 patients were included in the final analyses. Most PTB patients chose county-level hospitals (40%, 95%CI 33-46) and village clinics (34%, 95%CI 27-42); only 13% (95%CI 10-16) of patients chose to visit PTB dispensaries first. Before obtaining the correct diagnosis, 28% (95%CI 11-44) of patients had to visit health facilities more than three times.

Patients with suspicion of PTB were more likely to visit low-level facilities than dispensaries. Repeated visits resulted in both overall delay and high risk of PTB transmission. These findings suggest that a shift in government policy for PTB is required.