Caretakers' perspectives of paediatric TB and implications for care-seeking behaviours in Southern Mozambique

Abstract

BackgroundTuberculosis (TB) remains an important public health concern, especially in poorly resourced settings. TB diagnosis is challenging, particularly for children, who are the most vulnerable to its′ impacts. Lack of knowledge and awareness of the disease compromises prompt diagnosis and treatment compliance.ObjectiveTo gain insights regarding caretakers′ knowledge of the aetiology and prevention of paediatric TB in southern Mozambique, to describe their care-seeking behaviours and to assess the acceptability of diagnostic procedures.MethodsA total of 35 caretakers were interviewed, all of which had children with TB compatible symptoms. Eleven were caretakers of children diagnosed with TB at the health facility, 11 of children for whom TB was excluded as a diagnosis at the health facility and 13 of children with TB compatible symptoms identified in the community. The first two groups took part in a TB incidence study, while the third group did not. All underwent the same semi-structured interviews, the results of which were analysed and compared using content analysis.ResultsEven when confronted with signs suggestive of TB, most caretakers never suspected it or misinterpreted the signs, even among caretakers with TB and TB contacts. There was limited knowledge of TB, except among those undergoing treatment. The transgression of social norms was often presented as an explanation for TB in parallel to medically sound causes. The use of traditional care for prevention is widespread, but it varied for treatment purposes. TB diagnostic procedures were considered painful but were unanimously tolerated.Conclusions and significanceMisconceptions of paediatric TB, associated complex care-seeking itineraries and negative feelings of the diagnostic procedures may result in delays, low adherence and lost to follow-up, which needs to be addressed by adequately framed health promotion approaches.

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

“…The problem for me is the language because I can't speak Thai." [143] Bangladesh [113,114], Brazil [129], Cambodia [115], China [132][133][134], Ethiopia [108][109][110], India [113,[116][117][118][119][120], Indonesia [121,122], Mozambique [111], Nigeria [123], Philippines [124], Russia [135,136], South Africa [137,138,[140][141][142], Tanzania [112], Zambia [125], Zimbabwe [126] Long chains of care seeking through multiple providers and the lack of trust in the health care system providing TB care led to delay in care seeking and TB diagnosis "Government doctor did not show any interest, neither he responded to my questions. They never spoke to me at all.…”

“…[123] Brazil [127], China [132,133], Ethiopia [108,110], India [119], Indonesia [121], Philippines [124], Russia [136], South Africa [138,140], Tanzania [112], Zambia [125], Zimbabwe [126] Poor knowledge regarding TB symptoms and treatment, and the availability of free treatment policy were barriers to early healthcare seeking "TB is not yet a disease that people recognize, then any respiratory problem is associated with virus diseases, flu, smoke, dust of the street, all but a disease like TB." [127] "Some participants in rural areas were skeptical whether free treatment actually existed" [121] Bangladesh [113], Cambodia [44,115], Ethiopia [108], India [113,117], Indonesia [122], Mozambique [111], Philippines [124] [115] "For all patients that had initially thought they were cursed, the fact that their disease was diagnosed in the hospital was perceived as a proof that TB is a punishment of God rather than caused by witchcraft forces. Now I realize it has nothing to do with witchcraft, like I thought in the past.…”

“…Several studies in Africa [108,111,112] highlighted superstitious beliefs that TB is caused by divine retributions of past misdeeds, sinful behaviors, and curses; thus, help is first sought from traditional or spiritual healers instead of a health provider. Besides, studies in Asia reported the misconception that TB is hereditary [115,124].…”

Exploring challenges faced by parents of children with tuberculosis to achieve treatment success

“…Parents or caregivers who were looking after a child with TB experienced many challenges such as delay in their child diagnosis and stockout of TB medication as reported by previous exploratory studies [10][11][12]. Poor TB knowledge among parents was highlighted in many studies as one of the common challenges [10,11,[13][14][15]. Lack of knowledge on TB disease and TB treatment caused parents to seek unnecessary traditional alternatives instead of taking modern medication [16,17].…”

“…Poor TB knowledge among parents was highlighted in many studies as one of the common challenges [10,11,[13][14][15]. Lack of knowledge on TB disease and TB treatment caused parents to seek unnecessary traditional alternatives instead of taking modern medication [16,17]. Parents claimed that they did not receive adequate TB education from the healthcare workers (HCWs) [11].…”