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.
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...
Background: Road Traffic Injuries (RTIs) cause approximately 1. 35 million deaths annually, and is the leading cause of death among people between ages 5 and 29. Law Enforcement Officers (LEOs) deal with Road Traffic Collisions (RTCs) and have contact with RTI victims at a daily basis, they possess an excellent perspective on preventing RTI. This study aimed to explore LEOs perceptions on risk factors and preventive measures of RTI in Vanuatu.Methods: This study employed qualitative methods that used Focus Group Discussions (FGDs) to gather data from 25 LEOs between October 14th and November 30th, 2020. Self-identified Ni-Vanuatu LEOs who have been serving for over 6 months and residing at the study setting were included in this study. Purposive sampling was used to recruit study participants from three municipalities in Vanuatu. A semi-structured open ended questionnaire was designed to guide the FGDs. Data obtained were sorted out using thematic analysis processed with some preconceived themes based on theory, and also allowing the data to determine new themes.Results: Data saturation was reached from conducting 5 FGDs with 25 LEOs who were traffic officers and municipal wardens. Five main themes and sixteen subthemes were generated from the study. The main themes include driving and alcohol, the challenges to effective enforcement, barriers to effective care and support for RTI victims, measures for road traffic control and promoting road traffic safety. The respondents perceived that addressing resources issues and the legislations on road traffic control act and vehicle regulation act will enhance prevention of RTI.Conclusion: This study explored the risk factors of RTI and the barriers to effectively prevent RTI in Vanuatu. The study also generated suggestions of a combination of road traffic control measures that could be implemented to prevent RTI. Future research should look at effective strategies of preventing RTIs in resource deficit settings.
Purpose Road Traffic Injury (RTI) is major public health concern globally and is excessively affecting vulnerable road users in the pacific Island nations. This study aimed to explore and understand the perception of Public Transport Drivers (PTDs) on risk factors and the existing prevention strategy of RTI in Vanuatu. Methods This study employed qualitative methods that used 31 In-Depth Interviews (IDIs) to gather data from PTDs from 14 October to 30 November 2020. Purposive sampling was used to recruit PTDs from three main municipalities, Luganville, Port Vila and Lenakel. Semi-structured open-ended questionnaire were used to gather data. Interview data was transcribed and manual thematic analysis was performed to analysis the data. Results Data saturation was reach from interviewing 31 PTDs who were all male. Five main themes were generated from the study including the trend of RTI, the determinants of RTI, high-risk road users, traffic law enforcement and public education. The respondents perceived that the best measures for preventing RTI include community education, enforcement of road traffic control laws and addressing specific road infrastructure issues. Conclusions Changing driver behaviours, community education on road safety and enforcement of traffic laws are essential for preventing RTI in Vanuatu.
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