Primary health care staff's perceptions of childhood tuberculosis: a qualitative study from Tanzania

Abstract

BackgroundDiagnosing tuberculosis in children remains a great challenge in developing countries. Health staff working in the front line of the health service delivery system has a major responsibility for timely identification and referral of suspected cases of childhood tuberculosis. This study explored primary health care staff's perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania.MethodsWe conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis.ResultsPrimary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely differential diagnosis. Long duration and severe signs of disease together with known exposure to tuberculosis were decisive for the staff to suspect tuberculosis in children and refer them to hospital. None of the staff felt equipped to identify cases of childhood tuberculosis and they experienced lack of knowledge, applicable tools and guidelines as the main challenges. They expressed the need for more training, supervision and referral feedback to improving case identification.ConclusionsInadequate awareness of the burden of childhood tuberculosis, limited knowledge of the wide spectrum of clinical presentation and lack of clinical decision support strategies is detrimental to the health staff's central responsibility of suspecting and referring children with tuberculosis especially in the early disease stages. Activities to improve case identification should focus on skills required by primary health care staff to fulfil their responsibility and reflect primary health care level capacities and challenges.

An overview of qualitative research methodology for public health researchers

“…The phenomenon being studied is explained by themes which are substantiated by participants' quotations. These quotations are classically embedded within the text [35] or can be presented in a table. [36,37] Whichever way it is presented, the qualitative researcher's goal is to identify public issues and solutions from private problems.…”

A cross-sectional study of sputum handling by and supervision of patients with pulmonary tuberculosis treated at home in China

“…Supervision with specific aims is more effective, which may be explained by the fact that doctors who have received clear guidelines are better able to supervise management of TBrelated waste (23,24). Defining the supervision of waste management by patients with TB results in health workers who are better able to effectively and efficiently supervise the management of TB-related waste.…”

Opinião dos profissionais de saúde sobre os serviços de controle da tuberculose

“…(9) Because patients with tuberculosis have contact with other individuals, the World Health Organization recommends prophylaxis in, recording of, and control of those who had direct contact with such patients as a strategy for detecting new cases; this strategy includes the request for tests to investigate contacts. (10,11) Health professionals need to explain clearly how the exam will be done and its importance for the patient and contacts in helping to completely eliminate the disease in the community. (3) Therefore, the professional needs to completely understand the disease, in order the patient trust on his/her guidance.…”

“…(3) Therefore, the professional needs to completely understand the disease, in order the patient trust on his/her guidance. (12) In agreement with this recommendation, the Brazilian National Program for Tuberculosis Control foresaw that primary care should be the main environment for diagnosis of the disease, (10,13) particularly because counts with the Family Health Strategy as a partner in identifying respiratory symptoms and following up families. This program also foresaw that, at home visits, when any individuals with symptoms or other factors are identified, the health community agent should refer the individual for health service in order to investigate the disease, especially considering the decentralization and making ease the access of patients.…”