title: Tuberculosis patients' knowledge and beliefs about tuberculosis: a mixed methods study from the Pacific Island nation of Vanuatu.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Secretariat of the Pacific Community, BP D5, 98848, Noumea Cedex, New Caledonia. kerri.viney@hotmail.com.
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Viney
authors.forename: Penelope
authors.initials: P
authors.lastname: Johnson
authors.forename: Markleen
authors.initials: M
authors.lastname: Tagaro
authors.forename: Saen
authors.initials: S
authors.lastname: Fanai
authors.forename: Nguyen N
authors.initials: NN
authors.lastname: Linh
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.forename: David
authors.initials: D
authors.lastname: Harley
authors.forename: Adrian
authors.initials: A
authors.lastname: Sleigh
mesh_terms: D000293:Adolescent; D000328:Adult; D003469:Culture; D057210:Delayed Diagnosis; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D012017:Referral and Consultation; D014376:Tuberculosis / Q000175:diagnosis / Q000628:therapy*; D009514:Vanuatu; D055815:Young Adult