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.
Highlights
Malawi is a low-income country with high Tuberculosis (TB) burden
The consequences are severer in countries with high prevalence of TB/Human immunodeficiency virus (HIV) co-infection that 30–50% HIV/Acquired Immune Deficiency Syndrome (AIDS) cases die of TB [1]
Characteristics of the study participants In total, 57 healthcare providers, including 6 TB officers, 4 clinical officers, 3 TB nurses, 2 laboratory technicians and 42 Health Surveillance Assistant (HSA) participated in the Focus Group Discussion (FGD)
Summary
Malawi 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. TB diagnosis delay leads to increased infectivity, disease burden and fatality. A systematic review in sub Saharan Africa revealed that delayed TB diagnosis could be due to long travel time to a healthcare provider or seeking help from a traditional healer [10]. Recent findings in Malawi indicated a longer median health system delay of 59 days (IQR 26–108) as being due to clients’ initial visits to a lower level health facility [2]. Such delay was due to clients’ initial visits to less qualified health facilities [2]
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