Knowing and working on care-seeking barriers are vital towards ending TB by 2035: Lessons from a qualitative study on stakeholders’ perceptions and experiences of the social and financial consequences of Tuberculosis Care-seeking in Mbeya and Songwe Regions, Tanzania

Abstract

Background: Tuberculosis (TB) remains among the top infectious and killer diseases both globally and in Tanzania. However, research on its social determinants and the consequences of the disease on patients, survivors and their families in Tanzania are limited. More studies are needed in order to narrow the evidence gap for policy and program benefits, both in Tanzania and beyond. Methods: A qualitative research study was undertaken in two regions of Tanzania: Mbeya and Songwe. In-depth interviews were undertaken with individual TB patients and survivors. An interview guide with open ended questions was used. The interviews were recorded and transcribed verbatim. Field notes were also taken, and thematic analysis were performed to identify key themes and sub-themes.Results: A total of 18 TB patients and 12 TB survivors took part in the interviews. Most participants reported financial and social strains; being mutually reinforcing, these strains influenced their treatment-seeking behaviours. Financial difficulties related to transportation or for actual medical services contributed to late treatment initiation or deferred TB clinic attendance. Money spent for care at the referred facility, and lost income and/or lost food generation activity while seeking care, were found to result in family food insecurity and shortage of cash for other essential needs, including (but not limited to) non-TB-related illnesses. Many community members associated TB with HIV. As a result, TB patients often experienced social stigma and discrimination, which resulted in additional financial and psychological strain. Some individuals chose traditional and spiritual medicines for TB care. This approach was found to cost the respective clients, both financially and psychologically.Conclusion: This study suggests that it is essential to understand and address the social and financial challenges experienced by TB patients and TB survivors during treatment. TB is a manageable condition. Improved medical treatment needs to be coupled with improved and sustained public education about the disease, its negative outcomes, and the need to take preventive and curative measures. This study also confirms the need to consider access to food; free treatment of other co-morbidities, such as diabetes; and reducing the duration of TB treatment if at all possible.