Factors associated with delay in seeking care by tuberculosis patients

<div><p>ABSTRACT Objective: To identify social, clinical and behavioral factors of tuberculosis patients that are associated with delay in the search for primary health care. Method: This is a cross-sectional, quantitative study conducted with 56 people on treatment for pulmonary tuberculosis in the city of Natal, in the state of Rio Grande do Norte, Brazil. The data were collected through a structured instrument. The Chi-square and Fisher tests were applied to test the association between independent and dependent variables (search time). A value of p <0.05 was set as statistically significant. Results: No social or clinical variables were statistically associated with patient delays in the search for primary health care. Among the behavioral variables, self-medication and the first health service sought had a statistically significant association with the time for seeking care (p = 0.020, and p = 0.033, respectively). Conclusion: Self-medication contributes to the delay in the search for primary health care by tuberculosis patients.</p></div

Patients' Perceptions on the Performance of a Local Health System to Eliminate Leprosy, Paraná State, Brazil

<div><p>Background</p><p>In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income.</p><p>Methodology/Principal Findings</p><p>A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community.</p><p>Conclusions/Significance</p><p>The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.</p></div

Performance of a local health system to eliminate leprosy according to the domains longitudinality-relational and interpersonal communication, Londrina, State of Paraná, Brazil (2013).

<p>Performance of a local health system to eliminate leprosy according to the domains longitudinality-relational and interpersonal communication, Londrina, State of Paraná, Brazil (2013).</p

Performance of a local health system to eliminate leprosy according to the domains first contact, access to diagnosis and treatment, Londrina, State of Paraná, Brazil (2013).

<p>Performance of a local health system to eliminate leprosy according to the domains first contact, access to diagnosis and treatment, Londrina, State of Paraná, Brazil (2013).</p

Performance of a local health system to eliminate leprosy according to the domains comprehensiveness of services and coordination and collaborative health actions, Londrina, State of Paraná, Brazil (2013).

<p>Performance of a local health system to eliminate leprosy according to the domains comprehensiveness of services and coordination and collaborative health actions, Londrina, State of Paraná, Brazil (2013).</p

Performance of a local health system to eliminate leprosy according to the domains family centeredness and community orientation, Londrina, State of Paraná, Brazil (2013).

<p>Performance of a local health system to eliminate leprosy according to the domains family centeredness and community orientation, Londrina, State of Paraná, Brazil (2013).</p

Assessment of the domains by the leprosy patients according to their income stratus, Londrina, State of Paraná, Brazil (2013).

<p>**p-value is statistically significant.</p><p>Assessment of the domains by the leprosy patients according to their income stratus, Londrina, State of Paraná, Brazil (2013).</p

Sociodemographic characteristics of leprosy patients selected for the study, Londrina, State of Paraná, Brazil (2013).

<p>**Minimum Wage at the time equivalent to U$ 304.00.</p><p>Sociodemographic characteristics of leprosy patients selected for the study, Londrina, State of Paraná, Brazil (2013).</p

Sociodemographic and clinical profile of the leprosy cases according to operational classification.

<p>City in the state of São Paulo, Brazil (2006–2013).</p

Spatial clusters of leprosy cases, controlled by population of census sectors by gender and age.

<p>City in the state of São Paulo, Brazil (2006–2013).</p