Post-2015, why delay to seek healthcare? Perceptions and field experiences from TB healthcare providers in northern Malawi: a qualitative study

Abstract

BackgroundMalawi is a low-income country with high Tuberculosis (TB) burden. TB diagnosis delay and untimely initiation of treatment is still a major problem in Malawi which could increase the risk of tuberculosis transmission in the communities. This study investigated factors related to the diagnostic delay of tuberculosis from TB healthcare providers in the northern region of Malawi.MethodsNine focus group discussions were conducted with 57 participants in total. The participants were healthcare cadres including district TB officers, clinical officers, TB nurses, laboratory technicians and Health Surveillance Assistants (HSAs). NVivo (11.0) software was used for data analysis.ResultsThe factors related to diagnostic delay were categorized into three themes: client factors, institutional factors and healthcare provider related factors. Client’s stigma and fear for HIV test, resource shortage within healthcare institutions and the healthcare workers’ poor attitude against potential patients were among the most influential factors behind the TB diagnostic delay.ConclusionsThe TB control strategies should aim to reduce HIV stigma, improve resource supply and improve TB healthcare workers’ morale in order to achieve timely TB diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0279-1) contains supplementary material, which is available to authorized users.

Factors associated with treatment delay among newly diagnosed tuberculosis patients in Dessie city and surroundings, Northern Central Ethiopia: a cross-sectional study

“…In Ethiopia, Temesgen et al [ 39 ] also showed that more than 80% of healthcare professionals were not trained on tuberculosis infection control. Moreover, a health care provider not specialized in TB [ 37 ] and healthcare workers’ poor attitude towards potential patients [ 40 ] were found to be among the most influential factors behind the health system’s delay. Thus, further research on level of attitude, experience, knowledge and practice of health care professionals, and providing TB related training of all health professionals is warranted in the study area.…”

Perceptions of drones, digital adherence monitoring technologies and educational videos for tuberculosis control in remote Madagascar: a mixed-method study protocol

“…FGD-based qualitative data collection is taking place in three of the 61 DrOTS participating villages as well as with the NTP–DrOTS mobile health team. Villages for the running of FGDs are selected based on1 participation in the DrOTS project for at least 3 months2; accessibility for the qualitative research team, meaning within a day’s hike from the closest vehicle-accessible town3 and willingness to host the DrOTS perception team. Collecting data in three villages enables comparison of reported perceptions and acceptability of new technologies across villages, the possibility for diversity in perceptions to be captured.…”

“…One issue that requires managing in such a study is the risk of social stigma for participants. TB and association with TB are stigmatised in contexts around the world, and well documented in sub-Saharan Africa (eg,3 4 23–25 While there is no evidence of TB stigma in the Malagasy context of our research, we are adopting strategies to mitigate the risk of TB-related stigma developing for participants in our TB-focused study. In our initial meeting with CHWs in each village, we are stressing our interest in speaking with DrOTS-enrolled patients (TB active) but also our commitment to keeping the TB-active status of these patients private.…”

“…To meet the End TB Strategy goal of reducing incidence by 90% and mortality by 95% before 2035, the WHO has called for intensified research and innovation including the rapid uptake of new tools, interventions and strategies 2. In low-income and middle-income countries (LMIC) that are disproportionately more affected by disease, TB control can be hindered by any number of social and structural factors, including limited access to centralised facilities for populations living outside the capital, understaffed healthcare infrastructures, poor development of laboratory diagnostic networks or stigma influencing healthcare seeking behaviours and treatment adherence 3 4. In such contexts, diagnosis may be delayed or fail to occur at all, and implementation of TB control essential strategies such as case finding, access to laboratory diagnosis, directly observed therapy and contact tracing by national tuberculosis control programmes (NTPs) becomes particularly challenging, increasing secondary transmission and fatalities 5…”

A study of knowledge, experience and beliefs about hepatitis B virus (HBV) infection in south western Uganda

“…Studies from Asia have reported stigma and limited knowledge among health practitioners as obstacles in the uptake of preventive, diagnostic and treatment services among HBV patients (4,23). Delayed health seeking behaviour has been widely reported in tuberculosis and is a result of several factors such as lack of symptoms, low patient knowledge, practising self-medication, and the use of traditional healing methods (24)(25)(26). In our study, the asymptomatic nature of HBV, poverty and lack of knowledge (including among healthcare workers) were challenges in accessing timely and appropriate healthcare (27).…”