Parents' Experiences and Perspectives Toward Tuberculosis Treatment Success Among Children in Malaysia: A Qualitative Study

Abstract

Introduction: The trends of tuberculosis (TB) treatment success rate among children in Malaysia plateaued at 90% from 2014 to 2017. Malaysia sets a higher treatment success target of 95% to be achieved in line with an affordable, accessible, and holistic approach in managing TB among children.Objective: This study aims to explore the parents' experiences and perspectives toward achieving treatment success among children who were diagnosed with TB in two districts in Selangor state, Malaysia.Methods: The study was conducted using phenomenology study design via an in-depth interview of 15 mothers who were purposively sampled from the list of pediatric TB cases in the MyTB version 2.1 database in Klang and Petaling Districts of Selangor state. The R-based qualitative data analysis package of R version 0.2-8 was used to perform the thematic analysis.Results: Two main themes were identified from this study. The first theme was trust toward the healthcare services with the subthemes of acceptance, self-efficacy, holistic care, and perceived benefits. The second theme was the motivation to take or continue medication. The subthemes were support from family, healthcare workers' (HCWs') support, the convenience of healthcare services, community support, personal strength, and child's character.Conclusion: TB treatment success for children can be achieved when parents develop trust in healthcare services and have strong motivational factors to remain steadfast in achieving a successful treatment goal. Psychosocial support should be provided to the primary caregiver who faced any difficulty, while good relationships between parents and HCWs should be maintained. These results will inform the TB program managers to strengthen the holistic approach and identify the motivational factors among parents of children with TB disease.

Treatment Outcomes of Childhood TB Patients in Four TB High Burden States of Malaysia: Results from a Multicenter Retrospective Cohort Study

“…Likewise, the treatment success rate among childhood TB patients (85.5%) has been reported by a study conducted in Addis Ababa. However, the treatment success rate in the current study was comparatively higher than that observed among childhood TB patients in studies conducted in Malawi (54%) [ 16 ], Botswana (67%) [ 17 ], Thailand (72%) [ 13 ], and Lagos, Nigeria (79.2%) [ 18 ]. As the treatment default is often the main contributing factor for poor treatment outcomes in adult TB patients [ 19 , 20 ], the comparatively high treatment success rate in the current study could be attributed to a comparatively low default rate (4.4%) than that observed in studies conducted in Thailand, Malawi, and Lagos, Nigeria (>12%) [ 7 ].…”

“…Possible differences in parents’ level of education and awareness about TB and programmatic efforts at the current study sites to trace TB patients with delays in scheduled visits on the phone and [ 21 ] home visits by nurses to ensure patients’ adherence to the treatment could be possible reasons for the relatively low default rate. In the current cohort, the mortality rate observed (6.3%) was lower than that recently reported for TB patients of all ages from Malaysia (9.3%), but comparable to studies conducted among childhood TB patients in Lagos, Nigeria (6%) [ 16 ], Thailand (6%) [ 15 ], and Southern Ethiopia (5.3%) [ 22 ]. However, studies in Malawi (17%) and Botswana (10.5%) [ 23 ] have reported comparatively higher mortality rates among childhood TB patients [ 23 ].…”

Mothers' perspectives of physical and psychological issues associated with caring for Ghanaian children living with tuberculosis: A qualitative study

“…For instance, the mothers of hospitalized children living with TB in high‐income countries may not be required to run the tiring medical errands described by participants of this study. Nonetheless, the results suggest that mothers of children living with TB require adequate practical support from their relatives or friends (such as spouses and siblings) so as not to be overwhelmed by their caregiving and home keeping roles (Awaluddin et al, 2020b). Furthermore, healthcare providers of the children living with TB may have to regularly assess the physical well‐being of the accompanying mothers to be able to promptly identify and manage their health issues such as body pains, fatigue, insomnia and weight loss.…”

“…It is therefore important that the fears, thoughts and worries of mothers about their children's diagnosis and well‐being are assessed and managed adequately by healthcare providers through appropriate parental involvement, counselling and education (Aarthun et al, 2019; Choudhary & Ahmed, 2019). Such interventions have the potential to promote acceptance and address the fears and guilt mothers have regarding their children's ill health and treatment options (Awaluddin et al, 2020b; da Silva et al, 2014; Das et al, 2021).…”

“…Even though the children's care may not be the direct cause of any mothers' sicknesses (such as diabetes mellitus and gastrointestinal ulcers), the stress associated with their caregiver roles can predispose them to ill health (American Psychological Association, 2018). Consequently, when diagnosing childhood TB, the mothers of children living with TB must be encouraged to activate the social support available to them within their social networks and communities (Awaluddin et al, 2020b).…”