title: Factors Influencing Delayed Health Care Seeking Among Pulmonary Tuberculosis Suspects in Rural Communities in Ntcheu District, Malawi.
abstract: Delayed diagnosis and treatment of tuberculosis (TB) among individuals suspected of having TB may lead to continued transmission of Mycobacterium tuberculosis in communities, higher mortality rates, and increase in government health expenditure because of prolonged illness due to late diagnosis and treatment initiation. The study explored factors leading to delayed health care seeking among individuals living in Ntcheu District, Malawi. Two key informant interviews, 16 in-depth interviews, and three focus group discussions were conducted. Participants were aged 18 years and older and never had TB. Data were analyzed using content analysis and factors were identified: inadequate knowledge about cause and transmission of TB, low self-awareness of personal risk to TB, cultural and traditional beliefs about sources of TB, stigma, and strong belief in witchcraft as a cause of illness. The TB Control Program needs to invest in social mobilization and education of communities to mitigate early health care seeking.
authors.affiliation: Department of Public Health, School of Health Sciences, Monash, South Africa School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa peter.nyasulu@monash.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Nyasulu
authors.affiliation: Girls Empowerment Network, Blantyre, Malawi.
authors.forename: Faith
authors.initials: F
authors.lastname: Phiri
authors.affiliation: Pakachere Institute of Health and Development Communication, Blantyre, Malawi.
authors.forename: Simon
authors.initials: S
authors.lastname: Sikwese
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Tobias
authors.initials: T
authors.lastname: Chirwa
authors.affiliation: Johns Hopkins Research Project, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Isaac
authors.initials: I
authors.lastname: Singini
authors.affiliation: Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi.
authors.forename: Hastings T
authors.initials: HT
authors.lastname: Banda
authors.affiliation: National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi.
authors.forename: Rhoda
authors.initials: R
authors.lastname: Banda
authors.affiliation: Department of Public Health, School of Health Sciences, Monash, South Africa.
authors.forename: Tichaona
authors.initials: T
authors.lastname: Mhembere
authors.affiliation: Health Promotion Services Department, Ministry of Health, Lilongwe, Malawi.
authors.forename: Henry
authors.initials: H
authors.lastname: Chimbali
authors.affiliation: Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Bagrey
authors.initials: B
authors.lastname: Ngwira
authors.affiliation: Centre for Social Research, University of Malawi, Zomba, Malawi.
authors.forename: Alister C
authors.initials: AC
authors.lastname: Munthali
mesh_terms: D006801:Humans; D008295:Malawi; D016488:Medicine, African Traditional; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D014376:Tuberculosis; D014397:Tuberculosis, Pulmonary / Q000628:therapy*
keywords: Malawi; Tuberculosis; health-seeking behavior; qualitative