BackgroundThe setting for this study was the Pacific island nation of Vanuatu, an archipelago of 82 islands, located in the South Pacific Ocean. Our objective was to assess the knowledge, attitudes and practices of tuberculosis (TB) patients towards TB.MethodsThis was a descriptive study using qualitative and quantitative methods. Quantitative analysis was based on the responses provided to closed questions, and we present frequencies to describe the TB patients’ knowledge, attitudes and practice relating to TB. Qualitative analysis was based on open questions permitting fuller explanations. We used thematic analysis and developed a posteriori inductive categories to draw conclusions.ResultsThirty five TB patients were interviewed; 22 (63%) were male. They attributed TB to cigarettes, kava, alcohol, contaminated food, sharing eating utensils and “kastom” (the local term for the traditional way of life, but also for sorcery). Most (94%) did not attribute TB to a bacterial cause. However, almost all TB patients (89%) thought that TB was best treated at a hospital with antibiotics. Three quarters (74%) experienced stigma after their TB diagnosis.Seeking health care from a traditional healer was common; 54% of TB patients stated that they would first consult a traditional healer for any illness. When seeking a diagnosis for signs and symptoms of TB, 34% first consulted a traditional healer. Patients cited cost, distance and beliefs about TB causation as reasons for first consulting a traditional healer or going to the hospital. Of the TB patients who consulted a traditional healer first, there was an average of two weeks delay before they consulted the health service. In some cases, however, the delay was up to six years.ConclusionThe majority of the TB patients interviewed did not attribute TB to a bacterial cause. Consulting a traditional healer for health care, including while seeking a diagnosis for TB symptoms, was common and may have delayed diagnosis. People require better information about TB to correct commonly held misperceptions about the disease. Traditional healers could also be engaged with the national TB programme, in order to refer people with signs and symptoms of TB to the nearest health service.
BackgroundThis study was conducted in the Pacific island nation of Vanuatu. Our objective was to assess knowledge, attitudes and practice of traditional healers who treat lung diseases and tuberculosis (TB), including their willingness to collaborate with the national TB programme.MethodsThis was a descriptive study using both qualitative and quantitative methods. Quantitative analysis was based on the responses provided to closed-ended questions, and we used descriptive analysis (frequencies) to describe the knowledge, attitudes and practice of the traditional healers towards TB. Qualitative analysis was based on open-ended questions permitting fuller explanations. We used thematic analysis and developed a posteriori inductive categories to draw original and unbiased conclusions.ResultsNineteen traditional healers were interviewed; 18 were male. Fifteen of the healers reported treating short wind (a local term to describe lung, chest or breathing illnesses) which they attributed to food, alcohol, smoking or pollution from contact with menstrual blood, and a range of other physical and spiritual causes. Ten said that they would treat TB with leaf medicine. Four traditional healers said that they would not treat TB. Twelve of the healers had referred someone to a hospital for a strong wet-cough and just over half of the healers (9) reported a previous collaboration with the Government health care system. Eighteen of the traditional healers would be willing to collaborate with the national TB programme, with or without compensation.ConclusionsTraditional healers in Vanuatu treat lung diseases including TB. Many have previously collaborated with the Government funded health care system, and almost all of them indicated a willingness to collaborate with the national TB programme. The engagement of traditional healers in TB management should be considered, using an evidence based and culturally sensitive approach.
Background Past studies show relationships between disaster-related displacement and adverse psychosocial health outcomes. The development of psychosocial interventions following displacement is thus increasingly prioritized. However, data from low- and middle-income countries (LMICs) are lacking. In October 2017, the population of Ambae Island in Vanuatu, a lower-middle income country, was temporarily displaced due to volcanic activity. We analyzed distress among adults displaced due to the event and differences based on the psychosocial support they received. Methods Data on experiences during displacement, distress and psychosocial support were collected from 443 adults 2–3 wk after repatriation to Ambae Island. Four support categories were identified: Healthcare professional, Traditional/community, Not available and Not wanted. We analyzed differences in distress by sex and group using one-way ANOVA and generalized linear models. Results Mean distress scores were higher among women (1.90, SD=0.97) than men (1.64, SD=0.98) (p<0.004). In multivariate models, psychosocial support group was associated with distress among women (p=0.033), with higher scores among women who reported no available support compared with every other group. Both healthcare professional and traditional support networks were widely used. Conclusions Women might be particularly vulnerable to distress during disaster-related displacement in LMICs, and those who report a lack of support might be at greater risk. Both healthcare professional and traditional networks provide important sources of support that are widely used and might help to ameliorate symptoms.
Global implementation of the DOTS strategy has resulted in a decline in tuberculosis (TB) incidence rates. 1 However, total patient numbers have not declined, and rates remain high in areas affected by human immunodeficiency virus (HIV) infection, poverty and drug-resistant TB. 2 Despite the adoption of the DOTS strategy in 1999-2000, progress towards global TB control targets has been slow in the Pacific region, with 16 534 cases (165 per 100 000 population) notified in 2011 compared to 4017 (68/100 000) in 1990. 1 TB remains a major public health threat in the region. The risk of Mycobacterium tuberculosis transmission is elevated in islands with a high population density, while vulnerability to developing TB is affected on one hand by malnutrition and food insecurity and on the other by rising rates of diabetes. 3 There has been growing concern over the possible emergence of drug-resistant TB in the Pacific. To date, 11 Pacific Island countries and territories have reported cases of multidrug-resistant TB (MDR-TB), but no formal prevalence surveys have been conducted. 1 A Pacific-wide supranational laboratory referral system was established in 2004 to provide ongoing surveillance for drug-resistant TB. 4 The Pacific TB laboratory (PATLAB) network links countries to reference laboratories where M. tuberculosis confirmation, strain typing and comprehensive drug susceptibility testing (DST) can be performed.Delayed sputum smear conversion has been identified as a risk factor for TB treatment failure and drug-resistant TB, 5,6 and may indicate prolonged infectiousness. Sputum smear status is typically recorded at the end of the intensive phase of treatment (i.e., after 2 months), and patients who still have smear-positive sputum at this time are regarded as delayed converters. In Vanuatu, there has been concern that TB incidence rates are not declining as expected and that increasing numbers of sputum smear-positive TB patients fail to convert to smear-negative within 2 months of treatment. However, the frequency of sputum non-conversion at 2 months and the profile of these patients have not been established.In the present study, we aimed to assess TB trends, compare the characteristics of 2-month non-converters (delayed converters) with those of converters and assess the potential contribution of drug-resistant TB. METHODS Study designThis retrospective cohort study included all sputum smear-positive TB cases who remained sputum smear-positive after 2 months of anti-tuberculosis treatment over a 9-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). For logistical reasons, 2-month sputum non-converters (delayed converters) were compared with those with smear conversion at 2 months (converters) diagnosed during 2011-2012. Results of specimens sent to the Supranational Reference Laboratory (SRL; Queensland Mycobacterium Reference Laboratory) in Brisbane, QLD, Australia, were reviewed to assess for drug-resistant TB. Study settingThe study was conducted in the Republic of Vanuatu, a Pacific Island na...
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