




































                     American International Journal of Multidisciplinary Scientific Research 

Vol. 7, No. 1; 2021 

                                       ISSN 2638-1249   E-ISSN 2638-1273 

Published by CRIBFB, USA 

 

1 

ANALYSIS OF HEALTH-SEEKING BEHAVIOR OF 

TUBERCULOSIS PATIENTS IN NIGERIA 
 

 

Oluwadamisi Tayo-Ladega 

CEO His Marvellous Grace Support Foundation, Nigeria 

Ph.D. Student 

Bangor University, UK 

 

Taye Mohammed Abdullahi 

Master Student 

Department of Chemical Pathology 

University of Ibadan, Nigeria 

 

 

ABSTRACT 

Among several forms of infectious diseases, tuberculosis (TB) cannot be exempted. Even though 

the treatment of TB is free in Nigeria, the costs incurred by most patients do not reveal the 

significance of free treatment, and this affects the behavioral pattern of TB patients as a result of 

the numerous visits of patients to the hospital during the treatment of TB which may or may not 

yield their expected result. The objective of this study is to examine the behavior of TB patients 

towards seeking help for their health conditions. The study focused on Kwara and Kebbi States, 

Nigeria. The findings revealed that most of the Tuberculosis patients were more likely to search 

for treatment and seek medical advice from secondary health facilities, and they sought 

treatment first at the out-patient services. The out-patient services are among the secondary 

health facilities. It is therefore recommended that there is a need for health stakeholders (private 

and public) to ensure primary health coverage for all patients to prevent the exclusion of certain 

persons from treatment. This is referred to as inclusiveness. 

 

Keywords: Tuberculosis (TB), TB Patients, Health Seeking, Behavior. 

 

JEL Classification Codes: A19, B10, B25, C10, C53. 

 

INTRODUCTION 

Nigeria is highly burdened with numerous infectious diseases such as human immunodeficiency 

virus (HIV), tuberculosis (TB), and multi-drug-resistant TB (MDR-TB), (WHO, 2019) and was 

globally ranked as fourth among the twenty-two countries in the world with the high rate of TB 

disease. WHO (2017) Even though the treatment of TB is free in Nigeria, the costs incurred by 

most patients do not reveal the significance of free treatment. This is because of the numerous 

visits of patients to the hospital during the treatment of TB. 

The economic costs could be a significant factor militating against the effective 

utilization of TB patients’ ability to manage TB towards accessing anti-tuberculosis treatment. 

Various studies carried out on the costs of treating tuberculosis have established the direct 



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2 

expenses taken care of by patients from transportation, medical charges, and food costs during 

the process of seeking care solutions (WHO, 2015). 

The strategies for controlling tuberculosis entails two major workings, these are: 

 Case finding which can either be active or passive; and  

 Case holding  

The active case finding attempts to screen populations at large or to focus on specific 

populations. It is not generally adopted as the passive case finding. The passive case finding 

attempt to screen only those that come to the health facilities for diagnosis (Murray, 1994).  

Effective control of tuberculosis requires case finding at a tender stage of illness, both for 

the proper management of the patient and to reduce the transmission of the disease. It also helps 

to develop drug resistance, and not more than lesser financial costs are required for the patient. It 

is pertinent to note that majority of the TB patients are poor, hence if additional money is 

requested for diagnosis, case finding may eventually militate against case holding.  

This compromising state implies that the ability of the TB patient to wait in treatment 

may be compromised. Several persons with symptoms of tuberculosis will first come within 

reach of a private doctor (Pathania, Almeida, & Kochi, 1997). The process of varied and multiple 

help-seeking may be referred to as ‘shopping’ for diagnosis; thereafter, treatment of TB begins. 

Nair, George, and Chacko (1997) revealed that poor patients often end up in public health 

services, simply because they often find it difficult to pay for long-lasting care in the private 

health provider. The process of moving from one provider to another often causes delays in the 

TB diagnosis and the commencement of treatment, and thus involves considerable costs for 

patients.  

Shopping is the aftermath that is influenced by the need of patients to explore substitutes to 

health service providers, most especially when the indications persist. Another influencing factor 

is the lack of public trust in the public health services. The constraint associated with finance is 

another factor that requires patients to shift from high-priced providers to those that are price-

favorable. 

In the same study, Kemp et al. discovered that TB patients spend about US$13 which 

corresponds to about 18 days’ wages of patients. It is pertinent to note that in the process of 

treating TB, other indirect costs such as man-hour loss and manpower loss at work could be 

higher. Umar et al. (2004) conducted another study in Nigeria revealed that TB patients tried to 

find treatment at an average of three different facilities before their diagnosis. The study exposed 

the expenses incurred by TB patients particularly on consultation and transportation (Viney, 

Islam, Hoa, Morishita, & Lönnroth, 2019) 

Ukwaja et al. revealed that many families with TB patients usually fall in the category of 

‘poverty medical trap’ because of the costs of treatment which is direct (Wingfield, Boccia, 

Tovar, Gavino, Zevallos, & Montoya, 2014). Their study also found that TB patients do 

encounter indirect costs such as job losses because of TB. In China, Long et al. observed the 

crucial obstruction instituted by health care providers in the course of continual investigations 

and follow-up. In the study that was carried out in the Ministry of Health in Uganda, the loss of 

income was estimated at US$333.30.  

In the study by Umar et al. (2004), the time value for the hours spent seeking treatment 

for hospitalized and non-hospitalized patients were estimated to be US$517.98 and US$79.13 

respectively. The study of (Wingfield et al., 2014) on MDR-TB patients in Ethiopia found that 

patients repeatedly take responsibility for financing their costs of health care. To manage and 

handle this scenario, many patients have been identified to further weaken their strategies by 



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3 

selling and/or leasing their assets, in addition to the receipt of vouchers to cater for some 

fundamental costs such as food, shelter, and transportation (Ministry of Health, 2017; Wingfield, 

et al., 2014; Sari et al., 2019). 

Even as it has been recognized that patients accessing anti-tuberculosis treatment are 

burdened with both costs (direct and indirect costs), and the effects are yet to be adequately 

considered. This study examines the behavior of TB patients towards seeking help for their 

health conditions. This study is crucial because of the cost challenges incurred by TB patients 

and their households in Nigeria. It is a form of the social impact of TB and is referred to as the 

effect of TB on patients’ employment status, marital status, and educational status including the 

well-being of their children and their sexual relationships. 

 

METHOD 

The study area is Nigeria; it is made up of 36 states including the Federal Capital Territory 

(FCT), Abuja. All the states and FCT are subdivided into six geo zones, from which two geo 

zones were drawn: the North-Central and North-West Kwara and the Kano States were then 

randomly selected from each of the two zones.  

From each Senatorial District in the states under study consideration, three local 

government areas (LGAs) were randomly selected. From the local government areas, two DOTS 

centers were purposefully selected. The DOTS have a low case-load and a high case load 

respectively. From the DOTS centers, qualified respondents were identified and selected for 

inclusion in the study. Table 1 below shows the requisite number of study locations and 

respondents in each study state. 

From the fundamental units of analysis in this study, TB patients were systematically 

identified from the TB registers in the facilities of the study area in the LGAs. The criteria for 

being eligible were TB patients in the first and second category aged 15-65 years who were 

enrolled on treatment during the process of data administration. In Nigeria, standard anti-

tuberculosis treatment is given a duration of 6 months, the sampled respondents of TB patients 

enrolled in treatment between January and June 2019. Probability proportion size (PPS) was used 

to determine the number of respondents from each state. 

 

Table 1. Study areas and sample size 

   Respondents 

States LGAs DOTS 

Centers 

Category Category Total 

Kwara 3 6 57 4 61 

Kebbi 3 6 114 9 123 

Total 6 12 171 13 184 

LGAs: Local Government Areas 

 

Based on three Local Government Areas (LGAs) in the two states under consideration a 

total number of one hundred and eighty-four (184) respondents were included in the study. These 

are the number of TB patients that took part in the survey. To select the number of respondents 

which is required for the study from the sampling frames, patients were drawn from the facility 

register in the LGAs, and this category of respondents from each patients’ category were drawn 

with the use of systematic random sampling as shown in Table 1.  



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Primary data were extracted from eligible respondents through face-to-face interviews at 

a single point, and responses were obtained through the use of a standardized and an adapted 

questionnaire. Tuberculosis control officers in the states and external agents assisted in the data 

collection process. The World Health Organization (WHO), KNCV Tuberculosis Foundation 

(KNCV), and the Japan Anti-Tuberculosis Association (JATA) developed a tool for estimating 

patients’ costs. This tool was adapted for the study.  

Direct costs to TB patients before and during diagnosis of tuberculosis, indirect costs to 

TB patients before and during diagnosis of tuberculosis, patient and health system delays, direct 

costs to TB patient costs during treatment of tuberculosis, indirect costs during treatment of 

tuberculosis, guardian costs, additional health costs including other infectious diseases that may 

arise as a result of tuberculosis, income and affordability of tuberculosis and health care, 

willingness and ability to pay for tuberculosis treatment, health insurance, productivity, coping 

costs, gender/social costs of TB, total costs of TB to patients, and socio-economic variables are 

the indices that are measured with the tool. 

Data entry was achieved with the Statistical Package for Social Sciences (SPSS) version 

21 to describe code relevant variables and analyze. Primary data was employed to achieve 

descriptive statistics for all variables. This entails percentages and frequencies for categorical 

variables, and mean and standard deviation for continuous variables. The financial calculations 

were presented in Naira (₦).  

 

RESULTS 

Demographic characteristics of respondents 

From the survey that was targeted at one hundred and eighty-four (184) tuberculosis patients, 

demographic characteristics of respondents were shown in Table 2. The majority of the TB 

patients were male representing 56.5 percent and are between the age of 20 and 49 years 

(67.4%). More of the respondents were male representing 56.5 percent resided in the rural areas 

(44%), while 31 percent of the entire respondents reside in the urban areas, and 19 percent 

resided in urban slums.  

Regarding the education qualification, the majority of the patients had secondary 

education representing 46.7 percent, while 25.5 percent of the respondents were illiterate (had no 

formal education), and a little above a quarter of the patients (18.5%) were graduates. The 

majority of the patients representing 52.7 percent were engaged in the informal nature of 

employment; only 14.1 percent had formal employment, 11.4 percent were involved in 

housework and 7.1 percent were students. The income level of participants per month indicated 

that a little below half (37%) were not earning income, 50.7 percent had earnings less than 

₦100,000 per month, while others (22.3%) earned more than ₦100,000) per month.  

 

Table 2. Demographic characteristics of respondents 

 

Indices Frequencies  Percentages 

Gender 

Male 

Female 

 

104 

80 

 

56.5 

43.5 



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Age (Years) 

15-19 

20-29 

30-39 

40-49 

50-59 

60 and above 

 

12 

42 

48 

34 

23 

25 

 
6.52 
22.8 
26.1 
18.5 
12.5 
13.6 

Residence 

Urban area 

Urban slum area 

Rural area 

Others 

 

57 

35 

81 

11 

 

31 

19 

44 

6 

Education Qualification 

Illiterate (No education) 

Primary 

Secondary 

Tertiary 

 

47 

17 

86 

34 

 

25.5 

9.3 

46.7 

18.5 

Nature of Employment 

Formal 

Informal 

House labor 

Student 

Others 

 

26 

97 

21 

13 

27 

 

14.1 

52.7 

11.4 

7.1 

14.7 

Income (Monthly ₦) 

<₦25,000 

₦26,000 - ₦50,000 

₦51,000- ₦100,000 

>₦100,000 

No income 

 

20 

24 

31 

41 

68 

 

10.9 

13 

16.8 

22.3 

37 

Ethnic group 

Yoruba 

Hausa 

Igbo 

Others 

 

41 

63 

58 

22 

 

22.3 

34.2 

31.5 

12 

Mean of individuals in TB 

household 

Urban 

Urban slum 

Rural 

 

 

57 

41 

86 

 

 

31 

22.3 

46.7 

Source: Author’s Survey 

Health-seeking behavior of tuberculosis patients 

The major issue concerning the management of Tuberculosis is the delay encountered in seeking 

and obtaining treatment after the inception of symptom, because this can result in an increase in 



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6 

the level of infection of the patient and result in more protracted and severe illness which will 

also result in extra costs. It is pertinent to note that there were delays in the report of 

Tuberculosis among TB patients when in quest of better treatment. The mean time before TB 

patients could seek treatment is between the ranges of 20 days; this is for cough with blood. The 

mean time to seek for treatment of Tuberculosis that has a cough without blood symptoms ranges 

from 38 days. For the delay that was observed among TB patients before the commencement of 

treatment, a total mean delay of up to 15 days was observed in the study. 

From the study, it was revealed that 46 percent of respondents (Tuberculosis patients) 

thought that was more likely to search for treatment and seek medical advice from secondary 

health facilities, while 15 percent and 17 percent of respondents believed that they were more 

likely to seek treatment from private hospitals or clinics and primary health care providers 

respectively. Also, about 10 percent of respondents were that they were more likely to search for 

treatment and seek medical advice from herbalists; also about 10 percent of respondents were 

that they were more likely to search for treatment and seek medical advice from pharmacy/ 

patent medicine vendors (PMVs).  

Furthermore, the study found that 50 percent of respondents sought treatment first at the 

out-patient services, while about 13 percent and 11 percent of respondents sought treatment first 

at the private hospitals and at the pharmacy respectively. From the study, the respondents that 

clicked visiting non-government-owned facilities rooted their basis of the decision on the facts 

that they believe in the health facilities and the health facilities is nearby. 

 

CONCLUSION 

Infectious diseases often pose a significant burden on persons and their households, which results 

into economic, social, and physical instability. Among several forms of infectious diseases, 

tuberculosis (TB) cannot be exempted. Even though the treatment of TB is free in Nigeria, the 

costs incurred by most patients do not reveal the significance of free treatment, and this affects 

the behavioral pattern of TB patients as a result of the numerous visits of patients to the hospital 

during the treatment of TB which may or may not yield their expected result. The objective of 

this study is to examine the behavior of TB patients towards seeking help for their health 

conditions. 

The findings revealed that most of the Tuberculosis patients were more likely to search 

for treatment and seek medical advice from secondary health facilities, and they sought treatment 

first at the out-patient services. The out-patient services are among the secondary health 

facilities. It is therefore recommended that there is a need for primary health stakeholders 

(private and public) to ensure health coverage for all patients to prevent the exclusion of certain 

persons from treatment. 

 

ACKNOWLEDGMENTS 

The authors acknowledged the support of BUTY GLOBAL Research Network for providing a 

platform to network and share ideas among other scholars. Authors contributed equally to the 

study. Special thanks to Mr. Adeniran, Adetayo for technical guide in manuscript preparation. 

 

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