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Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us

INTRODUCTION: 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 si...

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Autores principales: Bhattacharya Chakravarty, Aruna, Rangan, Sheela, Dholakia, Yatin, Rai, Sonu, Kamble, Swaran, Raste, Tejaswi, Shah, Sanchi, Shah, Shimoni, Mistry, Nerges
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336307/
https://www.ncbi.nlm.nih.gov/pubmed/30653523
http://dx.doi.org/10.1371/journal.pone.0209924
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author Bhattacharya Chakravarty, Aruna
Rangan, Sheela
Dholakia, Yatin
Rai, Sonu
Kamble, Swaran
Raste, Tejaswi
Shah, Sanchi
Shah, Shimoni
Mistry, Nerges
author_facet Bhattacharya Chakravarty, Aruna
Rangan, Sheela
Dholakia, Yatin
Rai, Sonu
Kamble, Swaran
Raste, Tejaswi
Shah, Sanchi
Shah, Shimoni
Mistry, Nerges
author_sort Bhattacharya Chakravarty, Aruna
collection PubMed
description INTRODUCTION: 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.
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spelling pubmed-63363072019-01-30 Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us Bhattacharya Chakravarty, Aruna Rangan, Sheela Dholakia, Yatin Rai, Sonu Kamble, Swaran Raste, Tejaswi Shah, Sanchi Shah, Shimoni Mistry, Nerges PLoS One Research Article INTRODUCTION: 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. Public Library of Science 2019-01-17 /pmc/articles/PMC6336307/ /pubmed/30653523 http://dx.doi.org/10.1371/journal.pone.0209924 Text en © 2019 Bhattacharya Chakravarty et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Bhattacharya Chakravarty, Aruna
Rangan, Sheela
Dholakia, Yatin
Rai, Sonu
Kamble, Swaran
Raste, Tejaswi
Shah, Sanchi
Shah, Shimoni
Mistry, Nerges
Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us
title Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us
title_full Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us
title_fullStr Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us
title_full_unstemmed Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us
title_short Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us
title_sort such a long journey: what health seeking pathways of patients with drug resistant tuberculosis in mumbai tell us
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336307/
https://www.ncbi.nlm.nih.gov/pubmed/30653523
http://dx.doi.org/10.1371/journal.pone.0209924
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