title: Tuberculous meningitis: barriers to adherence in home treatment of children and caretaker perceptions.
abstract: BACKGROUND
  In-hospital treatment of children with tuberculous meningitis (TBM) is not a feasible option in many resource-poor countries. Home-based treatment has shown to be a viable alternative. Adherence is an important factor determining success of treatment.
  
  
  OBJECTIVE
  Identify possible barriers to adherence of home-based treatment and caretaker perception of the disease.
  
  
  METHODS
  A qualitative study consisting of 11 in-depth semi-structured interviews was performed based on principles of the health belief model.
  
  
  RESULTS
  Barriers of adherence identified include poor understanding of the disease and transmission route, difficulty with medication administration and side effects, lack of access to the health-care facility, long waiting times and hidden costs of transportation. Caretakers showed good appreciation of the adverse effects of noncompliance and benefits obtained from taking treatment in the home environment.
  
  
  CONCLUSIONS
  Improved doctor-patient communication, information brochures, structural changes to hospital settings, provision of financial and peer support all contribute to optimal TBM home-based treatment.
authors.affiliation: Department of Pediatric Infectious Diseases, Immunology and Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands. s.vanelsland@vumc.nl
authors.forename: Sabine L
authors.initials: SL
authors.lastname: van Elsland
authors.forename: Priscilla
authors.initials: P
authors.lastname: Springer
authors.forename: Ingrid H M
authors.initials: IH
authors.lastname: Steenhuis
authors.forename: Ronald
authors.initials: R
authors.lastname: van Toorn
authors.forename: Johan F
authors.initials: JF
authors.lastname: Schoeman
authors.forename: A Marceline
authors.initials: AM
authors.lastname: van Furth
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010465:Perception; D011368:Professional-Family Relations; D036301:Qualitative Research; D012959:Socioeconomic Factors; D013019:South Africa; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents