Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Care seeking and attitudes towards treatment compliance by newly enrolled tuberculosis patients in the district treatment programme in rural western Kenya: a qualitative study

Authors: John G Ayisi, Anna H van't Hoog, Janet A Agaya, Walter Mchembere, Peter O Nyamthimba, Odylia Muhenje, Barbara J Marston

Published in: BMC Public Health | Issue 1/2011

Login to get access

Abstract

Background

The two issues mostly affecting the success of tuberculosis (TB) control programmes are delay in presentation and non-adherence to treatment. It is important to understand the factors that contribute to these issues, particularly in resource limited settings, where rates of tuberculosis are high. The objective of this study is to assess health-seeking behaviour and health care experiences among persons with pulmonary tuberculosis, and identify the reasons patients might not complete their treatment.

Methods

We performed qualitative one-on-one in-depth interviews with pulmonary tuberculosis patients in nine health facilities in rural western Kenya. Thirty-one patients, 18 women and 13 men, participated in the study. All reside in an area of western Kenya with a Health and Demographic Surveillance System (HDSS). They had attended treatment for up to 4 weeks on scheduled TB clinic days in September and October 2005.
The nine sites all provide diagnostic and treatment services. Eight of the facilities were public (3 hospitals and 5 health centres) and one was a mission health centre.

Results

Most patients initially self-treated with herbal remedies or drugs purchased from kiosks or pharmacies before seeking professional care. The reported time from initial symptoms to TB diagnosis ranged from 3 weeks to 9 years. Misinterpretation of early symptoms and financial constraints were the most common reasons reported for the delay.
We also explored potential reasons that patients might discontinue their treatment before completing it. Reasons included being unaware of the duration of TB treatment, stopping treatment once symptoms subsided, and lack of family support.

Conclusions

This qualitative study highlighted important challenges to TB control in rural western Kenya, and provided useful information that was further validated in a quantitative study in the same area.
Appendix
Available only for authorised users
Literature
1.
Figueroa-Munoz J, Palmer K, Poz MR, Blanc L, Bergström K, Raviglione M: The health workforce crisis in TB control: a report from high-burden countries. Hum Resour Health. 2005, 3 (1): 2-10.1186/1478-4491-3-2.CrossRefPubMedPubMedCentral
2.
The Republic of Kenya. Ministry of Public Health and Sanitation: Division of Leprosy, Tuberculosis and Lung disease. Annual report. 2007, Nairobi, Kenya
3.
Kasse Y, Jasseh M, Corrah T, Donkor SA, Antonnio M, Jallow A, Adegbola RA, Hill PC: Health-seeking behaviour, health system experience and tuberculosis case finding in Gambians with cough. BMC Public Health. 2006, 6: 143-10.1186/1471-2458-6-143.CrossRefPubMedPubMedCentral
4.
Ford CM, Bayer AM, Gilman RH, Onifade D, Acosta C, Cabrera L, Vidal C, Evans CA: Factors associated with delayed tuberculosis test-seeking behavior in the Peruvian Amazon. Am J Trop Med Hyg. 2009, 81: 1097-1102. 10.4269/ajtmh.2009.08-0627.CrossRefPubMedPubMedCentral
5.
Ward H, Mertens TE, Thomas C: Health seeking behaviour and the control of sexually transmitted disease. Health Policy Plan. 1997, 12: 19-28. 10.1093/heapol/12.1.19.CrossRefPubMed
6.
Calnan M: Towards a conceptual framework of lay evaluation of health care. Soc Sci Med. 1988, 27: 927-933. 10.1016/0277-9536(88)90283-3.CrossRefPubMed
7.
Rubel AL, Garo LC: Social and cultural factors in the successful control of tuberculosis. Public Health Rep. 1992, 107: 626-636.PubMedPubMedCentral
8.
Kleinman A: Illness meanings and illness behaviour. Illness behaviour: A multidisplinary model. Edited by: McHugh S & Villis M. 1980, New York: Plenum, 146-160.
9.
Farquhar SA, Parker EA, Schulz AJ, Israel BA: Application of qualitative methods in program planning for health promotion interventions. Health Promot Pract. 2006, 7: 234-242. 10.1177/1524839905278915.CrossRefPubMed
10.
Ndeti K: Socio-cultural aspects of Tuberculosis defaulting: a case study. Soc Sci Med. 1972, 6: 397-412. 10.1016/0037-7856(72)90110-2.CrossRefPubMed
11.
Liefooghe R, Baliddawa JB, Kipruto EM, Vermeire C, De Munynck AO: From their own perspective: a Kenyan community's perception of tuberculosis. Trop Med Int Health. 1997, 2: 809-821. 10.1046/j.1365-3156.1997.d01-380.x.CrossRefPubMed
12.
Phillips-Howard PA, Nahlen BL, Alaii JA, ter Kuile FO, Gimnig JE, Terlouw DJ, Kachur SP, Hightower AW, Lal AA, Schoute E, Oloo AJ, Hawley WA: The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya I. Development of infrastructure and description of study site. Am J Trop Med Hyg. 2003, 68: 3-9.PubMed
13.
Adazu K, Lindblade KA, Rosen DH, Odhiambo F, Ofware P, Kwach J, Van Eijk AM, Decock KM, Amornkul P, Karanja D, Vulule JM, Slutsker L: Health and demographic surveillance in Rural western Kenya: a platform for evaluating interventions to reduce morbidity and mortality from infectious diseases. Am J Trop Med Hyg. 2005, 73: 1151-1158.PubMed
14.
Government of Kenya: Geographic dimensions of well-being in Kenya: Who and where are the poor? Volume II Nairobi: Central Bureau of Statistics. 2003, Ministry of Finance and Planning
15.
Steckler A, McLeroy KR, Goodman RM, Bird ST, McCormick L: Towards integrating qualitative and quantitative methods: an introduction. Health Educ Q. 1992, 19: 1-8.CrossRefPubMed
16.
Poss JE: Developing an instrument to study the tuberculosis screening behaviors of Mexican migrant farm workers. J Transcult Nurs. 1999, 10: 306-319. 10.1177/104365969901000409.CrossRefPubMed
17.
Macq J, Solis A, Martinez G: Assessing the stigma of tuberculosis. Psychol Health Med. 2006, 11: 346-352. 10.1080/13548500600595277.CrossRefPubMed
18.
Strauss A, Corbin J: Basics of Qualitative Research. 1990, Sage Publications, Newbury Park, CA
19.
Glaser B, Strauss A: The Discovery of Grounded Theory: Strategies for Qualitative Research. 1967, Aldine Press, Chicago
20.
Ailinger RL, Dear MR: Latino immigrants' explanatory models of tuberculosis infection. Qualitative Health Research. 1997, 7: 521-531. 10.1177/104973239700700406.CrossRef
21.
Lin HH, Ezzati M, Murray M: Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med. 2007, 4 (1): e20-10.1371/journal.pmed.0040020.CrossRefPubMedPubMedCentral
22.
World Health Organization: Global tuberculosis control surveillance, planning, financing. 2003, WHO report
23.
Wandwalo ER, Morkve O: Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania. Int J Tuberc Lung Dis. 2000, 4: 133-138.PubMed
24.
Lambert ML, Van der Stuyft P: Editorial: delays to tuberculosis treatment: shall we continue to blame the victim?. Trop Med Intern Health. 2005, 10: 945-946. 10.1111/j.1365-3156.2005.01485.x.CrossRef
25.
Watkins RE, Plant AJ: Pathways to treatment for tuberculosis in Bali: patient perspectives. Int J Tuberc Lung Dis. 2004, 8: 218-225.PubMed
26.
Igun UA: Stages in Health-seeking: a descriptive model. Social Science and Medicine. 1979, 13A: 445-456.PubMed
27.
Zhang T, Liu X, Bromley H, Tang S: Perceptions of tuberculosis and health seeking behaviour in rural Inner Mongolia, China. Health Policy. 2007, 81: 155-165. 10.1016/j.healthpol.2005.12.009.CrossRefPubMed
28.
Rubel AJ, Moore CC: The contribution of medical anthropology to a comparative study of culture: susto and tuberculosis. Med Anthropol Q. 2001, 15: 440-454. 10.1525/maq.2001.15.4.440.CrossRefPubMed
29.
Murray CJL, Styblo K, Rouillon A: Tuberculosis in developing countries: burden, intervention and cost. Bull Int Union Tuberc Lung Dis. 1990, 65: 6-24.PubMed
30.
Malmborg R, Mann G, Thomson R, Squire SB: Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable?. Bull World Health Organ. 2006, 84: 752-758.PubMedPubMedCentral
31.
Fox W: Tuberculosis case-finding and treatment programmes in the developing countries. British Medical Bulletin. 1988, 44: 717-737.PubMed
32.
Ayuo PO, Diero LO, Owino-Ong'or WD, Mwangi AW: Causes of delay in diagnosis of pulmonary tuberculosis in patients attending a referral hospital in western Kenya. East Afr Med J. 2008, 85: 263-268.CrossRefPubMed
33.
Thomson EM, Myrdal S: Tuberculosis -- the patients' perspective. South African Medical Journal. 1986, 70: 263-264.PubMed
34.
Eastwood SV, Hill PC: A gender-focused qualitative study of barriers to accessing tuberculosis treatment in the Gambia, West Africa. Int J Tuberc Lung Dis. 2004, 8: 70-75.PubMed
35.
Bond V, Nyblade L: The importance of addressing the unfolding TB-HIV stigma in high prevalence settings. J Comm Applied Social Psychol. 2006, 16: 542-561.CrossRef
36.
Godfrey-Faussett P, Ayles H: Can we control tuberculosis in high HIV prevalence settings? Tuberculosis. 2003, 83: 68-76.
37.
Giorgianni SJ: The health repercussions of stigma. The Pfizer Journal. 2004, 5: 13-23.
38.
Sonnenberg P, Glynn JR, Fielding K, Murray J, Godfrey-Faussett P, Shearer S: HIV and pulmonary tuberculosis: the impact goes beyond those infected with HIV. AIDS. 2004, 18: 657-662. 10.1097/00002030-200403050-00010.CrossRefPubMed
39.
Sagbakken M, Frich JC, Bjune G: Barriers and enablers in the management of tuberculosis treatment in Addis Ababa, Ethiopia: a qualitative study. BMC Public Health. 2008, 8: 11-10.1186/1471-2458-8-11.CrossRefPubMedPubMedCentral
40.
Khan A, Walley J, Newell J, Imdad N: Tuberculosis in Pakistan: socio-cultural constraints and opportunities in treatment. Soc Sci Med. 2000, 50: 247-254. 10.1016/S0277-9536(99)00279-8.CrossRefPubMed
41.
Donovan JL, Blake DR: Patient non-compliance: deviance or reasoned decision-making?. Soc Sci Med. 1992, 34: 507-513. 10.1016/0277-9536(92)90206-6.CrossRefPubMed
42.
Tekle B, Mariam DH, Ali A: Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia. Int J Tuberc Lung Dis. 2002, 6: 573-579.PubMed
Metadata
Title
Care seeking and attitudes towards treatment compliance by newly enrolled tuberculosis patients in the district treatment programme in rural western Kenya: a qualitative study
Authors
John G Ayisi
Anna H van't Hoog
Janet A Agaya
Walter Mchembere
Peter O Nyamthimba
Odylia Muhenje
Barbara J Marston
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-515

Other articles of this Issue 1/2011

BMC Public Health 1/2011 Go to the issue

Research article

An observational study of the discrediting of COX-2 NSAIDs in Australia: Vioxx or class effect?

Research article

Evaluation of Stepping Stones as a tool for changing knowledge, attitudes and behaviours associated with gender, relationships and HIV risk in Karnataka, India

Research article

Socio-demographic and AIDS-related factors associated with tuberculosis stigma in southern Thailand: a quantitative, cross-sectional study of stigma among patients with TB and healthy community members

Research article

Subjective social status predicts long-term smoking abstinence

Research article

Researchers' experience with project management in health and medical research: Results from a post-project review

Research article

Religious subgroups influencing vaccination coverage in the Dutch Bible belt: an ecological study