Anti-tuberculosis treatment defaulting: an analysis of perceptions and interactions in Chiapas, Mexico

Abstract

Objective. To analyze the perceptions and interactions of the actors involved in anti-tuberculosis treatment, and to explore their influence in treatment defaulting in Los Altos region of Chiapas, Mexico. Material and Methods. From November 2002 to August 2003, in-depth interviews were administered to patients with PTB, patients' family members, institutional physicians, community health coordinators, and traditional medicine practitioners. Results. We found different perceptions about PTB between patients and their families and among health personnel, as well as communication barriers between actors. Defaulting is considered to be mainly due to the treatment's adverse effects. Conclusions. It is necessary to conduct research and interventions in the studied area with the aim of changing perceptions, improving sensitization, quality and suitability of management of patients with PTB in a multicultural context, and promoting collaboration between institutional and traditional medicine.

Pulmonary Tuberculosis in Latin America: Patchwork Studies Reveal Inequalities in Its Control – The Cases of Chiapas (Mexico), Chine (Ecuador) and Lima (Peru)

“…Additionally, we found that the sensitivity of the smear testing was slightly lower than 50% in the primary care centers and in communities, and that the proportion of patients with active PTB that was receiving treatment was only 50% in the primary care centers, and 10.5% in the studied communities [10]. Also, we found high rates of anti-TB treatment defaulting [11], and very high levels of PTB multidrug-resistance (MDR): 4.6% and 29.2% primary and secondary MDR-TB, respectively. In fact, 14% of all studied PTB patients had MDR.…”

“…It is therefore necessary to reduce the cultural and socioeconomic barriers between health care providers and people [10]. Not surprisingly, some results of our investigations show that apart from cultural barriers, there are also structural barriers [11].…”

Tuberculosis (TB) and Human Rights in Chiapas, Mexico

“…The women's health is affected by structural problems in the health system, for example, they not participate at all in planning of health services and the high levels of poverty in the majority of them in rural and indigenous areas, constitutes a serious obstacle to enjoyment their rights [9] Mexico's Constitution prohibits discrimination in the enjoyment of all rights, including the right to health protection, and recognizes that every person in the country shall enjoy the guarantees granted by this Constitution, and that "men and women are equal before the law", but in practice, in Chiapas it is not occurring. People with TB often are discriminated with exclusion and rejection, by both society and health personnel [10,15,17,19,20,31], mainly because they are considered as source of infection [10,23]. Health personnel avoid contact with patient with consequences in adequate timely diagnosis, treatment and follow up, and even refusal to provide health care [43].…”

“…Although DOTS has been the landmark of TB control, many people with TB remain undiagnosed or are diagnosed only after long delays. This strategy was developed only from a biomedical orientation without including other dimensions such as social, economic, cultural, linguistic and physical access to TB services as well as migration and stigmatization [10,17,19,21,23,26].…”

“…Furthermore, the study also highlighted that patients with PTB did not seek health care due to lack of money, great walking distance to nearest clinic, denial of health service, and mistreat by health personnel [9]. Whether TB patients receive free and adequate treatment by health services, their socioeconomic conditions (poverty, malnutrition, overcrowding, marginalization, etcetera) makes them at high risk for defaulting treatment, either by the need to work and support their family, or by the adverse effects of anti-TB drugs [10,19,23,90].…”