Tuberculosis patients' knowledge and beliefs about tuberculosis: a mixed methods study from the Pacific Island nation of Vanuatu

Background: The setting for this study was the Pacific island nation of Vanuatu, an archipelago of 82 islands, located in the South Pacific Ocean. Our objective was to assess the knowledge, attitudes and practices of tuberculosis (TB) patients towards TB. Methods. This was a descriptive study using qualitative and quantitative methods. Quantitative analysis was based on the responses provided to closed questions, and we present frequencies to describe the TB patients' knowledge, attitudes and practice relating to TB. Qualitative analysis was based on open questions permitting fuller explanations. We used thematic analysis and developed a posteriori inductive categories to draw conclusions. Results: Thirty five TB patients were interviewed; 22 (63%) were male. They attributed TB to cigarettes, kava, alcohol, contaminated food, sharing eating utensils and "kastom" (the local term for the traditional way of life, but also for sorcery). Most (94%) did not attribute TB to a bacterial cause. However, almost all TB patients (89%) thought that TB was best treated at a hospital with antibiotics. Three quarters (74%) experienced stigma after their TB diagnosis.Seeking health care from a traditional healer was common; 54% of TB patients stated that they would first consult a traditional healer for any illness. When seeking a diagnosis for signs and symptoms of TB, 34% first consulted a traditional healer. Patients cited cost, distance and beliefs about TB causation as reasons for first consulting a traditional healer or going to the hospital. Of the TB patients who consulted a traditional healer first, there was an average of two weeks delay before they consulted the health service. In some cases, however, the delay was up to six years. Conclusion: The majority of the TB patients interviewed did not attribute TB to a bacterial cause. Consulting a traditional healer for health care, including while seeking a diagnosis for TB symptoms, was common and may have delayed diagnosis. People require better information about TB to correct commonly held misperceptions about the disease. Traditional healers could also be engaged with the national TB programme, in order to refer people with signs and symptoms of TB to the nearest health service

Ten Years On: Highlights and Challenges of Directly Observed Treatment Short-Course as the Recommended TB Control Strategy in Four Pacific Island Nations

Objectives: The internationally recommended tuberculosis (TB) control strategy, Directly Observed Treatment, Short course (DOTS) was implemented in most Pacific Island countries and territories during the year 2000, with expansion of DOTS into outer islands and rural areas over the past ten years. The objective of this study was to better understand successful strategies and challenges faced in implementing DOTS in outer islands and rural areas of selected high burden Pacific countries from the perspective of National TB Program (NTP) staff. Methods: National TB Program Managers or Coordinators from four Pacific countries, Solomon Islands, Vanuatu, Kiribati and Tuvalu, were surveyed and participated in in-depth interviews exploring what had been particularly effective and what challenges had emerged during DOTS implementation in outer islands and rural areas. Information from the interviews was analysed for shared experiences with data coded inductively using a thematic coding scheme. Results: The positive aspects of DOTS implementation in outer islands and rural areas were in three main themes: support from health workers and the community; enablers and incentives; and better treatment completion. The challenges could be categorised in five main themes: working with volunteers; stigma; traditional healers; distance and communication; and financial challenges. Local health workers, pastors, church leaders, chiefs and traditional healers were all key players in the TB Program in outer islands. Local health workers are integral to effective TB control due to accessibility and being known by the community. Conclusions: Reviewing the highlights and challenges of implementing DOTS in outer islands and rural areas in four Pacific countries has revealed some important issues. Increasing support to local health workers, actively engaging with pastors, church leaders, chiefs and traditional healers and addressing the barriers to communication and transport for people living in the outer islands are particular issues to address. Much has been achieved in TB control in outer islands but if the burden of TB is to be reduced and drug resistant TB is to be prevented, additional and ongoing investment is required

Traditional healers and the potential for collaboration with the national tuberculosis programme in Vanuatu: results from a mixed methods study

Background: This study was conducted in the Pacific island nation of Vanuatu. Our objective was to assess knowledge, attitudes and practice of traditional healers who treat lung diseases and tuberculosis (TB), including their willingness to collaborate with the national TB programme. Methods. This was a descriptive study using both qualitative and quantitative methods. Quantitative analysis was based on the responses provided to closed-ended questions, and we used descriptive analysis (frequencies) to describe the knowledge, attitudes and practice of the traditional healers towards TB. Qualitative analysis was based on open-ended questions permitting fuller explanations. We used thematic analysis and developed a posteriori inductive categories to draw original and unbiased conclusions. Results: Nineteen traditional healers were interviewed; 18 were male. Fifteen of the healers reported treating short wind (a local term to describe lung, chest or breathing illnesses) which they attributed to food, alcohol, smoking or pollution from contact with menstrual blood, and a range of other physical and spiritual causes. Ten said that they would treat TB with leaf medicine. Four traditional healers said that they would not treat TB. Twelve of the healers had referred someone to a hospital for a strong wet-cough and just over half of the healers (9) reported a previous collaboration with the Government health care system. Eighteen of the traditional healers would be willing to collaborate with the national TB programme, with or without compensation. Conclusions: Traditional healers in Vanuatu treat lung diseases including TB. Many have previously collaborated with the Government funded health care system, and almost all of them indicated a willingness to collaborate with the national TB programme. The engagement of traditional healers in TB management should be considered, using an evidence based and culturally sensitive approach

Ten years on: highlights and challenges of directly observed treatment short-course as the recommended TB control strategy in four Pacific Island nations

Objectives: The internationally recommended tuberculosis (TB) control strategy, Directly Observed Treatment, Short course (DOTS) was implemented in most Pacific Island countries and territories during the year 2000, with expansion of DOTS into outer islands and rural areas over the past ten years. The objective of this study was to better understand successful strategies and challenges faced in implementing DOTS in outer islands and rural areas of selected high burden Pacific countries from the perspective of National TB Program (NTP) staff. Methods: National TB Program Managers or Coordinators from four Pacific countries, Solomon Islands, Vanuatu, Kiribati and Tuvalu, were surveyed and participated in in-depth interviews exploring what had been particularly effective and what challenges had emerged during DOTS implementation in outer islands and rural areas. Information from the interviews was analysed for shared experiences with data coded inductively using a thematic coding scheme. Results: The positive aspects of DOTS implementation in outer islands and rural areas were in three main themes: support from health workers and the community; enablers and incentives; and better treatment completion. The challenges could be categorised in five main themes: working with volunteers; stigma; traditional healers; distance and communication; and financial challenges. Local health workers, pastors, church leaders, chiefs and traditional healers were all key players in the TB Program in outer islands. Local health workers are integral to effective TB control due to accessibility and being known by the community. Conclusions: Reviewing the highlights and challenges of implementing DOTS in outer islands and rural areas in four Pacific countries has revealed some important issues. Increasing support to local health workers, actively engaging with pastors, church leaders, chiefs and traditional healers and addressing the barriers to communication and transport for people living in the outer islands are particular issues to address. Much has been achieved in TB control in outer islands but if the burden of TB is to be reduced and drug resistant TB is to be prevented, additional and ongoing investment is required