An ethnographic study of Knowledge, Attitudes and Health Seeking Behaviours of Patients, Healthcare Worker (HCWs) and Community Members towards Pulmonary Tuberculosis in Akure, Ondo State, Nigeria

Abstract

This ethnographic study is an exploration of a research study conducted on Pulmonary Tuberculosis (PTB) infection that has claimed many lives. The incidence of TB in Nigeria in 2016 was estimated to be 219 cases per 100,000 population, which accounts for about 4% of the TB incidence globally. Nigeria holds the highest TB burden in West Africa with Nigeria among the 30 countries with the highest burden for pulmonary TB (PTB) and TB/HIV Multiple drug resistant-tuberculosis (MDR-TB) is prevalent in Africa. The management of PTB in Nigeria has been affected by the lack of funding, poor human resources, and weak health systems that are unable to support an efficient scale-up of TB services. Despite a high prevalence of MDR-TB in Nigeria, to date, there have been few or no qualitative studies which have sought to explore the knowledge, attitudes, and health-seeking behaviours that could influence the high prevalence of the disease. Aim: The aim of this study is to investigates the knowledge, attitudes, and health-seeking behaviours of patients, HCWs, and community members that comprises (Palace chiefs, religious leaders, traditional healers), in regard to PTB in Akure South, Ondo State, Nigeria. Methods: This ethnographic study adapted the health belief model and social ecological model as a theoretical framework. This ethnographic study used multiple methods of data collection methods, namely, semi structured interviews, focus groups, and participant observation in a PTB clinic and community DOTS site clinic. The purposive samples comprised of 2 community nominated leaders, 2 palace chiefs, 2 traditional healers, 2 religious’ leaders, 5 patients, 5 carers/relatives, and 12 healthcare workers. The focus groups who participated in the study comprised seven Muslim men, seven Muslim women, seven church groups and seven university students. The total sample size was 58 participants, and analysis of the data was performed using the NVivo programme. Findings: The study identified four themes:•Barriers to accessing healthcare services•Knowledge and perceptions of PTB•The socio-cultural context of PTB•Health promotion and preventionThe fear of PTB by society led to imposition of a social–physical distance of the community from PTB sufferers. Within the HCWs system, the fear of PTB affected the attitudes and behaviour of the HCWs towards the patients and the work with PTB. The doctors indicated that TB clinics were not adequately equipped to enable the provision of quality services. For accessing services, the fear of stigmatisation, traditional beliefs, and the implications of poverty resulted in people reporting to the hospital only after a prolonged period of self-medication. Many participants highlighted that religious and traditional beliefs resulted in a reluctance or refusal to accept PTB test results. The prevention and management of PTB in Nigeria is inadequate due to a lack of funding and human resources. Implications: The findings provide a baseline for the government to set up health promotion and disease prevention programmes in partnership with the community and non-governmental organisations (NGOs). Healthcare workers and NGOs can participate in promoting health education and prevention messages through mass media to the community to aid understanding of the disease. PTB services should be integrated into the curriculum to all schools, colleges, and universities, as well as religious programmes. The national tuberculosis and leprosy control programme (NTBLCP) is well placed to provide a monitoring and evaluation of progress.