title: Chronic cough and its association with TB-HIV co-infection: factors affecting help-seeking behaviour in Harare, Zimbabwe.
abstract: OBJECTIVE
  To qualitatively investigate reasons why individuals who reported chronic cough of 2 weeks or more in a cross-sectional prevalence survey had not accessed community-based outreach or other diagnostic services.
  
  
  METHODS
  This study was nested into a cluster randomised trial comparing two methods of providing community-level diagnosis for tuberculosis (TB). Twenty individuals (12 males) with previously unreported chronic cough, because of undiagnosed pulmonary TB in five cases, were interviewed. An additional 20 individuals who had attended clinical services participated in two focus group discussions. Data were coded and analysed using grounded theory principles.
  
  
  RESULTS
  Participants described cough, and specifically their own symptoms, as having many possible causes other than TB. People avoided care-seeking for cough to avoid a possible diagnosis of 'TB2' (HIV-related TB). Waiting in the hope of spontaneous resolution was common. Delaying treatment-seeking was also a strategy for deferring costs. Another common theme was negative perceptions of health facilities, as places where people anticipated discourteous treatment and being put at risk of contracting TB and HIV. Expectations that they should be in control of their own health further contributed to delayed health-seeking in men.
  
  
  CONCLUSIONS
  Some individuals remain reluctant to be investigated for chronic cough even when provided with community-level services, with fear of the connotations of being diagnosed with TB and an aversion to contact with health providers among the dominant themes. In men, deferred acceptance that a chronic cough should be investigated may be related to concepts of masculinity, especially when symptoms are mild.
authors.affiliation: Department of Community Medicine, University of Zimbabwe, 92 Prince Edward Road, Harare, Zimbabwe. wmavhu@gmail.com
authors.forename: Webster
authors.initials: W
authors.lastname: Mavhu
authors.forename: Ethel
authors.initials: E
authors.lastname: Dauya
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Bandason
authors.forename: Shungu
authors.initials: S
authors.lastname: Munyati
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.forename: Graham
authors.initials: G
authors.lastname: Hart
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Chikovore
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003371:Cough / Q000209:etiology / Q000523:psychology*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D008297:Male; D057228:Masculinity; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D012737:Sex Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D055815:Young Adult; D015030:Zimbabwe