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Knowledge of tuberculosis and associated health-seeking behaviour among rural Vietnamese adults with a cough for at least three weeks
Nguyen Phuong Hoa, Anna E. K. Thorson, Nguyen Hoang Long and Vinod K. Diwan Scand J Public Health 2003 31: 59 DOI: 10.1080/14034950310015121 The online version of this article can be found at: http://sjp.sagepub.com/content/31/62_suppl/59
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Nguyen Hoang Long2. The large amount of out-of-pocket expenditure on healthcare shows that families pay signiﬁcant user costs even Scand J Public Health 31(Suppl. It accounts for about 2. Gender-speciﬁc notiﬁcation rates in Vietnam show similar ratios to This paper has been independently peer-reviewed according to the usual SJPH practice and accepted as an original article. symptoms. health seeking. and curability of TB. Vietnam. 31(Suppl. Department of Public Health Sciences.sagepub.com INTRODUCTION Tuberculosis (TB) is one of the greatest public health problems in the world. Vietnam. with a male to female ratio of 2:1 (7).com by guest on November 19.4. Nguyen Phuong Hoa.879 TB cases detected in 1999. Results: A total of 559 people (1. 2012 . A large proportion of individuals with a cough for more than three weeks had limited knowledge of the causes. with a total of 88. There are an estimated 8. gender. Sweden. Hanoi.3. but efforts must be made to ensure that both men and women in different socioeconomic contexts can access the information. population-based. The reasons for this gender difference in case reporting are unclear. tuberculosis.4 million new TB cases every year (2). Vietnam ranks thirteenth among the world’s nations in terms of numbers of TB cases (2). Vietnam has developed a vast infrastructure of health facilities.832 adults aged 15 years or over. achieving a good density of service provision at all levels. Vietnam is one of only a few countries with a high TB burden that have reached the WHO targets on case ﬁnding and treatment success (2). e-mail: hoatuber@ yahoo.55). Hanoi.4 1 National Institute of Tuberculosis and Respiratory Diseases.5% of the global burden of disease and 26% of preventable deaths. about two-thirds of the reported TB cases are among men. transmission modes. ‘‘Doi Moi’’. Anna E K Thorson3.6%) reported coughing with a duration of three weeks or longer (259 men and 300 women). its cause and treatment is considered important for both prompt healthcare seeking and adherence to treatment. About 95% of all TB cases and 99% of deaths due to TB occur in low-income countries (1). Major healthcare reforms have included the introduction of hospital user fees and legalisation of private healthcare practices. 4Nordic School of Public Health.ORIGINAL ARTICLE Knowledge of tuberculosis and associated health-seeking behaviour among rural Vietnamese adults with a cough for at least three weeks Nguyen Phuong Hoa1. National Institute of Tuberculosis and Respiratory Diseases. 62) DOI: 10. knowledge. Discussion: Health education for TB thus seems to be useful. Methods: A population-based survey was carried out within a demographic surveillance site in Vietnam. Gothenburg. High political commitment in Vietnam is translated into high priority on TB control. Key words: cough. Cough cases were identiﬁed at household level and structured interviews were carried out with all cases of cough in person. In most low-income countries. The study population included 35.1080/14034950310015121 Downloaded from sjp. including hospitals and health centres (10). Karolinska Institute. 62): 59–65 Aims: Good general lay knowledge of tuberculosis (TB).3 and Vinod K Diwan3. 3Division of International Health (IHCAR). Men had a signiﬁcantly higher knowledge score than women (3. Sweden Scand J Public Health 2003.04 vs 2. # Taylor & Francis 2003. with only onethird among women (3). or under-diagnosis and underreporting of TB in females (4 – 6). The main aim of this study was to describe the knowledge of TB among men and women with a cough for more than three weeks and to see how their health seeking related to TB knowledge. the growing threat from HIV/AIDS (9) and the emergence of multi-drug resistant TB (7). Vietnam. 2Ministry of Health. Hanoi. There are two hypotheses to explain such a difference: either a real difference in incidence. Since 1986 an economic reform movement from planned to market-oriented economy. Better knowledge was signiﬁcantly related to seeking healthcare and seeking hospital care. Vietnam. Major obstacles to sustain effective TB control in Vietnam include the increasingly active but poorly regulated private health sector (8). More men than women did not take any health care action at all. has been implemented in Vietnam. ISSN 1403-4948 those globally. Stockholm.
04 and SPSS version 10. and knowledge of TB. without licences. then the level of schooling was used to classify education.893 inhabitants. This classiﬁcation is based on the amount of rice produced per capita. including rechecking all questionnaires submitted by ﬁeld supervisors. 2012 . TB control could improve signiﬁcantly if more consideration were given to knowledge and attitudes towards TB and related healthcare seeking among the population (16 – 18). otherwise the individual was categorized as illiterate. Less qualiﬁed providers were deﬁned as those less regulated by the government. Qualiﬁed health providers were deﬁned as those operating within the government healthcare system. smoking. about one-ﬁfth of the total district’s population (19). Expenditures on fees and drugs average US$2 visit to a commune health centre. Means and proportions to use subsidized public facilities. factors such as the stigma attached to TB (12. Potential cough cases were identiﬁed by a screening question. so. three intercommunal polyclinics and 32 commune health centres. In addition. all households were visited by specially trained interviewers. and (g) others. perceptions of TB as a ‘‘dirty’’ and incurable disease (14) and popular misconceptions are likely to have negative effects on the health-seeking behaviour of undiagnosed TB patients. one point was given.60 NP Hoa et al. most of them practised illegally. Female interviewers asked the household representative (most often the senior female head of the family) whether anyone in the family had a prolonged cough. To minimize recall bias. making it less accessible and less affordable. Some evidence indicates that economic reforms have affected the public healthcare system.547 households with 49.). 62) Downloaded from sjp. A structured questionnaire was developed and administered for all identiﬁed cough cases to collect socioeconomic and demographic variables (age. the mode of TB transmission. particularly for the poor (11). The public healthcare system in this district included a district hospital with 150 beds. (d) traditional healers. Healthcare actions and providers were classiﬁed as: (a) selftreatment. if Scand J Public Health 31(Suppl. in 1996 in Vietnam (13). METHODS The study was conducted within a longitudinal population-based demographic surveillance site called FilaBavi. (b) private practitioners.com by guest on November 19. gender. as recommended by the WHO. and about US$5 for a hospital outpatient visit (11). the individual was interviewed in person using a structured questionnaire. No person refused to take part in the interview study. skills in reading and writing were ﬁrst elicited. The population of Bavi District in 2000 was 242. However. During the survey.780. and. The sample size for FilaBavi included 67 randomly selected clusters comprising 11. The interviewees were also asked how and from which sources they had received information about TB. (c) pharmacies. 13). whether TB was contagious. means of transportation. healthcare-seeking behaviour from the onset of the cough symptoms. A medical record crosscheck was done in cases who had used healthcare at CHCs or hospitals. The main aim of this study was to describe the knowledge of TB among men and women with a cough for more than three weeks and how that knowledge affected their health-seeking behaviour. A local authority classiﬁcation was used to deﬁne socioeconomic status. A population-based cross-sectional survey was carried out during April – June 2000.sagepub. The cough cases were asked about the causes of TB. Some 15% of all cases were randomly selected to be re-interviewed by the study supervisor or by one of the investigators within a week of the original interview. Answers were categorized into correct (if matching the medically correct answer) or else incorrect and then in turn sorted into categories inspired by the qualitative studies by Long et al. whose quality of care has proved to be low (20. despite the fact that there are no ofﬁcial fees. symptoms other than cough. In Vietnam. in a northern rural area of Vietnam.0. Data were processed and analysed using Epi-Info 6. whether TB was curable and symptoms suggestive of TB. One point was given for each of the correct answers. One medical doctor supervised the data collection. To classify education. marital status. case detection is based on passive case ﬁnding using sputum smear microscopy. However. health insurance. The patients should themselves seek an adequate health facility. etc. 21). Considerable delays in healthcare seeking and TB diagnosis have been reported (15). The deﬁnition of a cough case was an individual who had had a cough for three or more weeks at the point of interview. All people aged 15 years or older in all 67 clusters of the FilaBavi were included in the study. (f) hospitals. The questionnaire was pre-tested in the ﬁeld to ensure that all questions were clear and understandable. the interviewers used calendars or individual events. in Bavi District. The knowledge questions were based on the medical perspective on TB promoted by the National Tuberculosis Control Programme (NTP). education. (e) communal health centres (CHCs). If literate. The questions asked were open-ended and several alternatives were allowed in the responses. there were more than one hundred private practitioners and some private pharmacies and drug outlets in the district. If several alternatives were given and at least one was deﬁned as correct.
health insurance. number of symptoms. Sweden.39 vs 2. Only 22% of the people reported that bacteria caused TB.832 people aged 15 or over.66 – 2. economic status.05) reported that TB is contagious. Chi-squared tests and 95% conﬁdence intervals for means or proportions were used to describe differences between groups.8) 210 (81. Socioeconomic and demographic characteristics of 300 women and 259 men in Vietnam with a cough for more than three weeks Characteristics Occupation: Farmer Student & Government staff Other Women n (%) Men n (%) 199 (66. pv0. and Karolinska Institutet.8) (1. age.6) (9.7) (18. pv0.547 households (covering 35. 2012 .001). and TB knowledge score.4) 244 (94.3) 97 (32. Non-parametric methods were used for some comparisons. 86% of the men and 79% of the women (pv0.7) (51.05).9) (4.Knowledge of TB and associated health-seeking behaviour were calculated as appropriate.9) (82.6%) than men (78. Signiﬁcantly more men than women gave the answer of a bacterial cause (pv0.7) 45 (17.3) 68 (26.7) (17.9) 10 214 23 12 25 51 134 46 3 (3.2) 15 (5.0) 6 or more 88 (29. being government staff. Vietnam.05 respectively.737 men and 19. pv0. Health-seeking behaviour More women (94.05. pv0.9) 66 (25.1) 31 (12.3) (53.6%) reported a cough with duration of three weeks or longer (prolonged cough) at the point of interview (259 men and 300 women).0) 80 (26. Signiﬁcantly more men than women thought that TB was curable if correct treatment were given (73% of men vs 59% of women.001).01).7) University or higher 6 (2. 62) Education: Illiterate 45 (15.3) 37 (12.095 women). People who reported television and radio as sources of information had higher knowledge scores compared with those who reported receiving information from friends or relatives (mean score: 3.3) High school 17 (5. Among those. but signiﬁcantly higher among men compared with women in the older age groups (54 years or over). 41% of the women and 57% of the men thought that TB was caused by hard work and 31% of the women and 36% of the men that it was hereditary (Table II).6) (8. pv0.001). A higher knowledge score was signiﬁcantly associated with higher education.90). The prolonged cough prevalence was similar among men and women in the age groups 15 – 54 years. The following variables were included as independent variables: gender. The illiteracy rate was signiﬁcantly higher among women (15%) than men (4%) (pv0.001).7) (19.sagepub. 559 people (1. cough duration. Knowledge about the mode of TB transmission (droplet spread) was lower among women (63%) than among men (73%).0) Economic classiﬁcation: Very poor Poor Average Upper average Rich Religion: Non-religious Buddhists and others Marital status: Married Single Separated. Knowledge and sources of information about TB Among the 559 people who reported a prolonged cough. RESULTS Prevalence of cough and background data A screening question was put to a total of 11.0) (19.7) 147 (56.0) 282 (94) 18 (6) 166 (55. and being a student (Table III). means of transportation. More men (22%) than women (13%) reported having health insurance (pv0. Men had a signiﬁcantly higher score than women (3.5) 125 (48.1) 61 16.8%) reported that they took healthcare action for their symptom of cough (pv0.55 respectively.3) 21 (7. pv0.2) Number of persons in household: 1–3 95 (31. age less than 65 years.0) 18 (6. The Research Ethics Committee at Umea University ˚ has given ethical approval for the FilaBavi household surveillance system.7) 4–5 117 (39. The mean knowledge score was 2. 46% of women. signiﬁcantly more women than men chose self-medication or a visit to the pharmacy as their ﬁrst Scand J Public Health 31(Suppl. education.0) (1.4) 67(25.001).001). However. Table I.78 (95% CI 2.001) (Table I). Logistic regression analyses were performed to study associations between background variables and healthcare action or hospital treatment.3) Downloaded from sjp.04 and 2.com by guest on November 19. divorced. being married.0) Primary and secondary school 232 (77. local authorities of the Bavi District. Commonly reported sources of information included television and radio (54% of men. Ethical permission for the study was obtained from the Ministry of Health. including data collection on vital statistics (reference number 02 – 420). friends and relatives (50% of men and 49% of women). The general healthcareseeking pattern was quite similar among men and women with a preference for private health providers. The most common reason for not taking action was that the disease symptoms were not considered serious (42%). More men than women reported being smokers (48% compared with 12%. widowed 26 55 159 57 3 (8.
Government staff Other n Knowledge score Mean SD pa 0.4) 190 (73. occupation. level of education.com by guest on November 19.91 1. modes of transmission.99 2. bp-values were calculated for the comparison of the proportions of men and women giving the correct answer.4) 177 (59.001 Notes: ap-values based on comparisons of two or several means using analysis of variance.5) Pb 0.8) 145 (56. Knowledge of TB symptoms Yesa No Women (n~300) n (%) 55 124 92 19 115 (18.7) 9 (3. Responses to questions on causes.001).04 1.4) 15 (5.30 1.34 1.5) 32 (13. being a woman (pv0.55).56 0.44 58 3. and knowledge of TB symptoms among Vietnamese adults with a cough for more than three weeks Response to questions 1.03 238 (79.59 1.3) Men (n~259) n (%) 67 148 93 35 66 (25. Knowledge score mean values did not differ signiﬁcantly between those who took any healthcare action and those who did not (2. possibility of cure.55 1.05) were signiﬁcantly associated with taking healthcare action.34 446 2.75 1.64 1. Sputum production was more common among men than among women (61% vs 50%.7) 150 (63. Table II.81 vs 2.3) (38.3) (30. and marital status among Vietnamese adults with a cough for more than three weeks Characteristics Gender: Male Female Age group: 15 – 24 25 – 44 45 – 64 65z Education: Illiterate Primary and secondary school High school or higher Occupation: Farmer Student.0) 20 (6. Table III.3) 12 (4.21 346 2.001 259 3.0 among women). pv0.48 1.77 1.8) 163 (73.59 0.08 Notes: Correct answers according to the National Tuberculosis Programme health education guidelines.005).3) 222 (85.2) 12 (5.59 300 2.) 183 2. but more people who knew TB symptoms than those who did not reported taking healthcare action (Table IV). The mean numbers of symptoms other than cough were not signiﬁcantly different between genders (3.96 2.34 1. Mode of transmission Infectious droplet spreada Other (sharing eating. in a logistic regression model taking healthcare action as the dependent variable and age. smoking) Do not know 4.2 weeks) (pv0.4) 47 (21.99 1. 62) healthcare action (33% vs 20%.3) 154 (51.0) 50 (16.62 NP Hoa et al.62 1. economic status. number of symptoms.001) and having a higher knowledge score (pv0.8) 54 (20. gender.001 0.001 Marital status: Married 376 2.69 2.1 among men and 3.39 1. etc. The mean duration of cough was signiﬁcantly longer among men (21. pv0.5) (25.7) 103 (34. education.1 weeks) than among women (16.54 147 2.3) 145 (48.02). divorced.04 0.sagepub.3) (41.34 Other (single. and signiﬁcantly more men (26%) than women (16%) sought care at a hospital at any point during their disease period (pv0. Possible to cure TB? Yesa No Do not know 5.001 0. Downloaded from sjp. Scand J Public Health 31(Suppl. cough duration. 2012 .003 55 1.1) (35.0) 114 (44. Factors that could inﬂuence healthcare seeking among men and women were also investigated. Is TB transmissible? Yesa No Do not know 3. However. and TB knowledge score as independent variables.0) 0.52 0.9) (13.0) 56 (23. TB knowledge scores by gender.01).5) 28 (10. means of transportation. communicable nature.48 51 156 157 195 2.04 0. Cause of TB Germ/bacillusa Hard work Hereditary TB Other Do not know 2.38 66 3.9) (57. age group.7) (6.
The NTP in Vietnam considers modern (biomedical) actual knowledge in the population important for TB control. However.666 166 (86. and if equal opportunities to education and media access are not forthcoming. 23).005).0) 0. and highlight the complexity of successful health communication. Despite these campaigns knowledge levels were low.35 47 (19.1) 84 (22. economic status. A qualitative study from Vietnam reported beliefs in four types of TB: hereditary TB – congenital transmission. 2012 .0%) used less-qualiﬁed healthcare providers (such as self-medication. 62) Downloaded from sjp. In a logistic regression model with visiting a hospital as the dependent variable. studies that have assessed health seeking in relation to knowledge are less common. and curability of TB was low: 82% of the women and 74% of the men did not know that TB is caused by bacteria.716 304 (87. Our ﬁndings indicate an association between knowledge levels and education. TB globally is most common among the socioeconomically disadvantaged.180 Others 20 (89.3) 0. To be successful.9) 265 (91. and having health insurance (pv0.15 compared with 2. In this context.001 37 (13. means of transportation) were not signiﬁcantly associated with going to hospital. In the group who had visited a hospital. since the Vietnamese NTP has used health education and communication campaigns speciﬁcally to educate the population in medical knowledge of TB.004 372 (85.7) 0.4) 0. private practitioners.1) 0. transmission routes.70 among those who did not visit a hospital (pv0.2) 102 (22. The concept of knowledge has many aspects and the deﬁnition of what is right or wrong is not self-evident. 22.001).9) 0.6) 80 (27.002).002 223 (82.4) Curable disease: Yes No/unknown 322 (87.01).0) 25(15. Our study reports similar ﬁndings.6) 0. Hospital care seeking was signiﬁcantly related to mean knowledge score (Table IV). People’s expressed traditional beliefs may in some respects relate to correct perceptions of the disease. In total. longer cough duration (pv0. symptoms. and pharmacies) for their ﬁrst healthcare action than people who knew TB symptoms (68.3) 70 (22. and curability of TB plays a critical role. (pv0. This means that individuals who suspect TB infection have to initiate the ﬁrst patient-health provider contact. differences between men and women in TB diagnosis and health-seeking delays. media access.001). and gender.05). 15. physical TB – caused by hard work. To understand traditionally held beliefs in causes and characteristics of TB is important for facilitating communication about the disease to the population. A generally good knowledge level is wished for in order to minimize patients’ delay in receiving healthcare and to reduce TB-related stigma.600 88 (88. modes of transmission. we chose to study this aspect. and lung TB – caused by a germ (13).Knowledge of TB and associated health-seeking behaviour Table IV.12 33 (17. and factors inﬂuencing these delays (12.9) Seeking hospital care (n~559) Yes (%) pa 7 (13.2) 0. A large proportion reported that TB is caused by hard work or that it is a hereditary disease.024 85 (24.2) 0. symptoms. health communication may fail despite good intentions. We found that knowledge of causes. Traditional beliefs in the causes and transmission patterns of TB have been reported from many parts of the world (17. Promoting health education through radio and television may not be enough if the wish is to reach and inﬂuence potential TB cases.3%) (pv0.com by guest on November 19.sagepub. 30% among those who knew TB symptoms compared with 17% of those who did not visited a hospital.5) 0.13 15 (15. the mean knowledge score was 3. Other variables (gender. seeking hospital care was signiﬁcantly associated with having a higher knowledge score.2) 63 Knowledge Score: 0 1–2 3–5 TB symptoms: Yes No Cause of TB: Bacteria Others TB transmission: Yes No/unknown Mode of transmission: Droplet spread 268 (85. 21). Hard work or Scand J Public Health 31(Suppl. as recommended by the WHO.9) 116 (95. 17. more disease symptoms (pv0. One reason for this could be that the NTP’s message about TB is not contextualized in traditionally held beliefs. Individuals who did not know any symptoms suggestive of TB more commonly (80.8) 33 (27.1) 400 (87. knowledge of causes. Several studies have reported long delays in TB diagnosis. However.05 84 (19. any educational programme must begin with an understanding of the knowledge base of participants and relate traditional beliefs to modern medical knowledge. mental TB – caused by too much thinking. age.7) 0. DISCUSSION Most countries in the world nowadays apply passive case-ﬁnding approaches for TB detection.5) Notes: ap-values are based on chi-squared tests.9) 136 (85.7) 0. Knowledge of TB among potential TB cases in Vietnam and subsequent healthcare actions Healthcare action (n~559) Yes (%) pa 48 (88.
18. Chuc NTK. 1: 33 – 51. Diwan VK. Diwan VK. 77: 178 – 83. 15. beliefs and feeling about tuberculosis. Soc Sci Med 1999.64 NP Hoa et al.com by guest on November 19. 62): 3 – 7. WHO/TB/01. 16. 2012 . Hausler H. Hoa NP. 1997. Health-seeking inherited TB were both more often stated as causes of TB than bacteria. Vietnam. 21. Trop Med Int Health 1997. Nunn P. Johansson E. Hanoi: Ministry of Health. which was related to lack of knowledge of TB. Huong ND. Professional surveyors and supervisors were carefully trained.sagepub. and compliance. but could be discussed also in relation to other populations with a similar gender structure and educational situation. Nunn P. 17. 19. MCNV-KNCV mission. World Health Organization – Western Paciﬁc Region Cases notiﬁed in 1999. Steen TW. 7: 165 – 9. 12. Washington. Borgdorff WM. Gender inequalities in tuberculosis: aspects of infection. Alvarez-Gordillo GC. 8. Knowledge. Women sought less qualiﬁed care than men. Availability of antibiotics as over-the-counter drugs in pharmacies: a threat to public health in Vietnam. WHO Report 2001. Vietnam. Hanoi: MCNV/KNCV. Delay ¨ and discontinuity – a survey of TB patients’ search of a diagnosis in a diversiﬁed health care system. 2000. 9. Ngaka ya setswana. Lonnroth K. Salud publica Mex 2000. Johansson E. 2. Health Educ Res 1989. planning. FilaBavi. women had a poorer knowledge of TB and sought healthcare from less qualiﬁed providers. Binns CW. ﬁnancing. a large proportion of individuals with a cough for more than three weeks had limited knowledge of TB. 5. World Health Organization 2002. Van Le T. Linh PD. Ho Chi Minh City: Author. Health Policy 2000. Diwan VK. ngaka ya sekgoa or both? Health seeking behaviour in Botswana with pulmonary tuberculosis. DorantesJimenez JE. Int J Tuberc Lung Dis 1999. Different tuberculosis in men and women: beliefs from focus groups in Vietnam. 1995. 20. REFERENCES 1. Ministry of Health. Geneva: WHO. 49: 815 – 22. had a lower knowledge level. A review of sex differences in the epidemiology of tuberculosis.5. Bosman MCJ. Gender and tuberculosis control: perspectives on health seeking behaviour among men and women in Vietnam. Divan VK. The authors are grateful for valuable advice and comments given by Prof. Report 2002. Long NH. Lonnroth K. WHO – WPR Report 2000. DC: World Bank. 2: 1133 – 9. Holmes CB. Staff and patient attitudes to tuberculosis and compliance with treatment: an exploratory study in a district in Vietnam. 6. 3: 388 – 93. National TB Control Programme. Tuber Lung Dis 1996. World Bank. Scand J Public Health 31(Suppl. an epidemiological ﬁeld laboratory in Vietnam. Int J Tuberc Lung Dis 1998. Healthcare seeking is a complex process. Stockholm. Thorson A. 7. Health Statistics Yearbook 1997. Soc Sci Med 1999. Diwan V. 4. 62) Downloaded from sjp. 2001. Gender and tuberculosis: a comparison of prevalence surveys with notiﬁcation data to explore sex differences in case detection. In conclusion.295. notiﬁcation rate. 2001. Cross-checked and repeated questions in the different sections of the questionnaire were used in order to check the internal consistency. In general. Only 24% of the potential TB cases in this district had gone to hospital. 11. Long NH. Westaway MS. 13. Mexico. Van Duong D. recall bias is considered to have been minimized. Scand J Public Health 2003. The study was ﬁnancially supported by Sida/SAREC. Thorson A. 2001. Long NH. Eriksson B. inﬂuenced by many external and internal factors. Vietnam.4. To minimize bias. ACKNOWLEDGEMENTS This study was conducted within the epidemiological ﬁeld laboratory for Health Systems Research (FilaBavi) in Vietnam. Winkvist A. WHO-WPR/TB/00. Int J Tuberc Lung Dis 1999. Longer delays in tuberculosis diagnosis among women in Vietnam. Vietnam: poverty assessment and strategy. report no 23. Long NH. Alvarez-Gordillo JF. Diwan V. and less often reported having health insurance. Peter Allebeck. This area needs to be further explored and informative interventions within different societal levels need to be studied. Review of the National Tuberculosis Programme for the period 1996 – 2000. It seems that the level of medical knowledge is the common denominator steering health-seeking behaviour among potential TB cases in this community. Johansson E. 4: 205 – 11. 2: 96 – 104. Thuong LM. Dye C. Halperin-Frisch D. 31(Suppl. World Health Organization. Ahlberg BM. Curr Opin Pulm Med 2001. 3. Winkvist A. Manila: WHO-WPR. 3: 992 – 1000. 42: 520 – 8. With the multiple-stage supervisory system in FilaBavi and direct interviewing of the cases. National Tuberculosis Programme. Johansson E. We found knowledge to be associated with taking healthcare action as well as with the quality and type of provider sought. 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