Health Policy and Planning, Vol 12, 77-85, Copyright © 1997 by Oxford University Press
D Nair, A George and K Chacko
This study explores the health seeking behaviour of poor male and female
tuberculosis patients in Bombay, and examines their perceptions of the
causes and effects of the disease on their personal lives. Sixteen patients
who attended an NGO's tuberculosis clinic were interviewed in-depth. Almost
equal numbers of respondents stated germs and worry as the cause of
tuberculosis. Men worried about loss of wages, financial difficulties,
reduced capacity for work, poor job performance, and the consequences of
long absence from work. Women were concerned about rejection by husband,
harassment by in-laws, and the reduced chances of marriage (for single
women), in addition to their concerns about dismissal from work.During the
first two months of symptoms most patients either did nothing or took home
remedies. When symptoms continued, private practitioners were the first
source of allopathic treatment; they were generally unable to correctly
diagnose the disease. Respondents shifted to municipal and NGO health
services when private treatment became unaffordable. Respondents shifted
again to NGO-based services because of the poor quality of municipal
tuberculosis control services.The wage-earning capacity of both men and
women was affected, but women feared loss of employment whereas men, being
self-employed, lost wages but not employment. Married men and single women
perceived a greater level of family support to initiate and complete
treatment. Married women tried, often unsuccessfully, to hide their disease
condition for fear of desertion, rejection or blame for bringing the
disease. Women dropped out from treatment because of the pressure of
housework, and the strain of keeping their condition secret particularly
when the reasons for their movements outside the home were routinely
questioned.Health programmes will have to be sensitive to the different
needs and concerns of urban men and women with tuberculosis in the case of
women, health care providers will have to make particular efforts to
identify and treat married women with tuberculosis completely.
ARTICLES
Research report. Tuberculosis in Bombay: new insights from poor urban patients
Aga Khan Health Service, Mazagoan, India; Independent Consultant, Pune, India; PATH, Bombay, India
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