title: Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon.
abstract: METHODS
  Lambaréné, Gabon.
  
  
  OBJECTIVE
  To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB.
  
  
  METHODS
  Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic.
  
  
  RESULTS
  Patients generally described TB as a natural and/or magical disease. The majority of the patients combined treatment at the hospital with (herbal) self-treatment and traditional/spiritual healing. Despite the free availability of anti-tuberculosis treatment in principle, patient adherence was problematic, hindering effective TB control. Most patients delayed or defaulted from treatment due to financial constraints, stigmatisation, ignorance about treatment, change of health care service or use of non-prescribed antibiotics. The situation was occasionally complicated by drug stockouts.
  
  
  CONCLUSIONS
  There is an urgent need to bridge the gap between patients and the hospital by avoiding drug shortages, intensifying culturally sensitive TB health education, embedding TB care into the cultural context and enhancing cooperation between hospitals, patients, traditional healers and communities.
authors.affiliation: Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon ; Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: A L
authors.initials: AL
authors.lastname: Cremers
authors.affiliation: Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
authors.forename: S
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
authors.forename: M A M
authors.initials: MA
authors.lastname: Huson
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
authors.forename: G
authors.initials: G
authors.lastname: Bikene
authors.affiliation: Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
authors.forename: S
authors.initials: S
authors.lastname: Bélard
authors.affiliation: Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: R P M
authors.initials: RP
authors.lastname: Gerrets
authors.affiliation: Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
authors.forename: M P
authors.initials: MP
authors.lastname: Grobusch
keywords: adherence; public health; stigma; tuberculosis