Perceptions of tuberculosis and health seeking behaviour in rural Inner Mongolia, China.

PURPOSE This study aimed to explore perceptions of TB, and health care seeking pathways, among poor rural communities in Inner Mongolia. METHODOLOGY Twenty focus group discussions (FGDs) were held and 105 farmers were included. Six hundred and fourteen randomly selected respondents were surveyed through interview questionnaire, in three poor rural counties with a high TB prevalence. MAIN FINDINGS A substantial proportion of community members were unclear or misinformed as to how TB was transmitted. Sixty percent of respondents identified prolonged cough as a main symptom of TB, while only 40% perceived TB to be caused by 'close interaction with TB patient'. In addition, 70% could not afford TB treatment and fell into debt as a result of having to seek medical care. Social stigma associated with TB influenced marriage prospects and impeded important social interactions within the community. Respondents' perceptions of TB were associated with their socio-economic status. Women, young people, low-income groups and those with less education tended to be less knowledgeable about TB. All farmers in the study reported only seeking health care after they failed to treat themselves; and most of them then sought care from less qualified village level health care providers. Less educated people, low-income groups and old people were identified as less likely to seek care, or more likely to seek care at village level where it is cheaper. Both financial and structural barriers were found to stop farmers seeking health care. CONCLUSIONS AND POLICY IMPLICATIONS: Perceptions of TB and social stigma associated with the disease, together with socio-economic factors, shape the health seeking behaviour of poor farmers. Accessibility and affordability of TB health care issues should be dealt with through a multi-pronged approach, including health promotion in addition to expansion of the DOTS strategy and rural health insurance schemes.