Comprehensive understanding of health-seeking behaviour among pulmonary tuberculosis patients in China.

Setting: In China, there were 918 000 tuberculosis (TB) cases in 2015 alone. The primary challenge facing TB control is the allocation of limited health care resources.

Objective: To gain a comprehensive understanding of the first choice of health care facility among Chinese patients with suspected pulmonary TB (PTB) and the number of visits required to make the diagnosis.

Design: Relevant full-text articles in three Chinese and one English literature databases up to November 2016 were reviewed. Meta-analyses were performed using Stata v12.0.

Results: Among 1257 potentially relevant selected articles, 27 cross-sectional studies involving 9891 patients were included in the final analyses. Most PTB patients chose county-level hospitals (40%, 95%CI 33-46) and village clinics (34%, 95%CI 27-42); only 13% (95%CI 10-16) of patients chose to visit PTB dispensaries first. Before obtaining the correct diagnosis, 28% (95%CI 11-44) of patients had to visit health facilities more than three times.

Conclusion: Patients with suspicion of PTB were more likely to visit low-level facilities than dispensaries. Repeated visits resulted in both overall delay and high risk of PTB transmission. These findings suggest that a shift in government policy for PTB is required.