Experiences of the diagnosis and management of tuberculosis: a focused ethnography of Somali patients and healthcare professionals in the UK

Gerrish, Kate; Naisby, Andrew; Ismail, Mubarak

doi:10.1111/jan.12112

Cited by 35 publications

(70 citation statements)

References 14 publications

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“…The presence in the household of long-term visitors from high incidence countries, lack of awareness about TB, stigma resulting in obstacles to access healthcare/treatment, and lack of willingness to disclose information about contacts could also play a part. There is evidence that stigma, fear of discrimination, social exclusion and deportation, and other sociocultural factors can be barriers to Somali patients accessing TB services and disclosing their TB status to facilitate contact tracing [17–20], but less research has been performed on obstacles faced by other communities. Interestingly, we found that UK-born cases of South Asian ethnicity were more likely to be household transmitters compared to those born in South Asia.…”

Section: Discussionmentioning

confidence: 99%

Recent household transmission of tuberculosis in England, 2010–2012: retrospective national cohort study combining epidemiological and molecular strain typing data

Lalor

Anderson

Hamblion

et al. 2017

BMC Med

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Background: We estimate the proportion of tuberculosis (TB) in England due to recent household transmission, identify factors associated with being a household transmitter, and investigate the impact that identification of a case has on time to treatment of subsequent cases. Methods: TB cases notified between 2010 and 2012 in England in the same household as another case were identified; 24 locus MIRU-VNTR strain typing (ST) was used to identify household cases with likely recent transmission. Treatment delay in index and subsequent cases was compared. Risk factors for being a household transmitter were identified in univariable and multivariable analyses.Results: Overall, 7.7% (1849/24,060) of TB cases lived in a household with another case. We estimate that 3.9% were due to recent household transmission. ST data was unavailable for 67% (1242) of household pairs. For those with ST data, 64% (386) had confirmed, 11% probable (66) and 25% (155) refuted household transmission. The median treatment delay was 65 days for index cases and 37 days for subsequent asymptomatic cases. Risk factors for being a household transmitter included being under 25 years old, UK-born with Black African, Indian or Pakistani ethnicity, or born in Somalia or Romania. Conclusions:This study has a number of implications for household TB contact tracing in low incidence countries, including the potential to reduce the diagnostic delay for subsequent household cases and the benefit of using ST to identify when to conduct source contact tracing outside the household. As 25% of TB cases in households had discordant strains, households with multiple TB cases do not necessarily represent household transmission. The additional fact that 25% of index cases within households only had extra-pulmonary TB demonstrates that, if household contact tracing is limited to pulmonary TB cases (as recently recommended in UK guidelines), additional cases of active TB in households will be missed. Our finding that no lineage of TB was associated with recent household transmission and with no increased transmissibility in the Beijing lineage compared to others, suggests that the lineage need not impact contact tracing efforts. Improvements in contact tracing have the potential to reduce transmission of TB in low incidence countries.

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Section: Discussionmentioning

confidence: 99%

Recent household transmission of tuberculosis in England, 2010–2012: retrospective national cohort study combining epidemiological and molecular strain typing data

Lalor

Anderson

Hamblion

et al. 2017

BMC Med

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“…Since symptoms were attributed to causes for which participants would not ordinarily seek medical attention, such as drug and alcohol withdrawal, tiredness attributed to poor diet for economic reasons, and other long term conditions, indicates the ease with which serious illness can be missed by those living with complex health and social issues. For this reason, perhaps, the TB stigma reported in other studies as a barrier to health care [34] was not cited as a factor (although it was discussed in terms of a fear of disclosure of illness to others in the Somalian community by one Somali refugee). Our research supports the intensification of outreach initiatives to identify groups at risk of TB and the development of structured care pathways to support people into prompt diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

‘Complex’ but coping: experience of symptoms of tuberculosis and health care seeking behaviours - a qualitative interview study of urban risk groups, London, UK

2014

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BackgroundTuberculosis awareness, grounded in social cognition models of health care seeking behaviour, relies on the ability of individuals to recognise symptoms, assess their risk and access health care (passive case finding). There is scant published research into the health actions of ‘hard-to-reach’ groups with tuberculosis, who represent approximately 17% of the London TB caseload. This study aimed to analyse patients’ knowledge of tuberculosis, their experiences of symptoms and their health care seeking behaviours.MethodsQualitative interviews were conducted with 17 participants, predominantly homeless and attending a major tuberculosis centre in London, UK. Most had complex medical and social needs including drug and alcohol use or immigration problems affecting entitlement to social welfare. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions.ResultsAlthough participants demonstrated some knowledge of tuberculosis their awareness of personal risk was low. Symptoms commonly associated with tuberculosis were either not recognised or were attributed to other causes for which participants would not ordinarily seek health care. Many accessed health care by chance and, for some, for health concerns other than tuberculosis.ConclusionsHealth education, based on increasing awareness of symptoms, may play a limited role in tuberculosis care for populations with complex health and social needs. The findings support the intensification of outreach initiatives to identify groups at risk of tuberculosis and the development of structured care pathways which support people into prompt diagnosis and treatment.

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“…As noted, when diagnosed with TB, patients will often hide the fact of the disease from others and, thus, isolate themselves to avoid negative public perceptions, disruption of work, and bringing shame to families and friends, which can have an impact on their physical, financial, social and mental health. These impacts are especially severe in terms of the maintenance of physical functions and emotions, and the occurrence of a mental illness, such as depression, can be found in as many as 70% of patients with TB (Doherty et al, 2013;Gerrish et al, 2013;Kibrisli et al, 2015;McArthur et al, 2016;Moya & Lusk, 2013;Murray et al, 2013;Zuñiga, Muñoz, Johnson, & Garcia, 2014).…”

Section: Objectivesmentioning

confidence: 99%

“…Research indicates that patients with TB often experience psychological distress, for example, stigma and depression, which adversely affects their ability to cope with stress, the side effects of treatment and daily life (Chang & Cataldo, ; Doherty et al., ; Duko, Gebeyehu, & Ayano, ; Gerrish, Naisby, & Ismail, ; Ige & Lasebikan, ; Masumoto et al., ; McArthur, Bali, & Khan, ; Moya & Lusk, ; Pan et al., ; Sagili, Satyanarayana, & Chadha, ; Shen et al., ; Singh, Pardal, & Prakash, ).…”

Section: Introductionmentioning

confidence: 99%

Perceived stigma and depression in initially diagnosed pulmonary tuberculosis patients

Lee

Tung

Chen

et al. 2017

Journal of Clinical Nursing

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Experiences of the diagnosis and management of tuberculosis: a focused ethnography of Somali patients and healthcare professionals in the UK

Cited by 35 publications

References 14 publications

Recent household transmission of tuberculosis in England, 2010–2012: retrospective national cohort study combining epidemiological and molecular strain typing data

Recent household transmission of tuberculosis in England, 2010–2012: retrospective national cohort study combining epidemiological and molecular strain typing data

‘Complex’ but coping: experience of symptoms of tuberculosis and health care seeking behaviours - a qualitative interview study of urban risk groups, London, UK

Perceived stigma and depression in initially diagnosed pulmonary tuberculosis patients

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