Perceptions,stigma and treatment pathways among tuberculosis patients in West Pokot county, Kenya

Abstract

Despite being a curable disease, tuberculosis (TB) is the leading cause of death among infectious diseases globally, surpassing malaria and HIV and AIDS. Delay in TB diagnosis and initiation of treatment is a major obstacle that hinders the success of TB control. The delays increase the infectiousness of the disease thus sustaining transmission within the community. Lack of awareness and stigma associated with TB are some of the main reasons why people delay to seek treatment. This study was carried out among a selected sample of TB patients in West Pokot County, Kenya. The objectives of the study were: to assess the knowledge and perceptions of tuberculosis among TB patients; to examine the level of stigma associated with tuberculosis and how it exemplifies itself among TB patients; to document the treatment pathways experienced by TB patients and to determine the level of delay and factors associated with the TB diagnostic delays. The Health Belief Model and Model of Pathways to Treatment were used as the empirical lens to understand perceptions, stigma and treatment pathways among tuberculosis patients. A mixed methodological approach was engaged to collect the data used in this study. The specific techniques used in data collection include an interviewer administered questionnaire which was administered to 208 purposively sampled TB patients in four public health facilities between July 2015 and March 2016, focus group discussions, longitudinal follow-ups and in-depth interviews. The study revealed that 68 % of the respondents had poor knowledge of TB however 76% of the respondents correctly perceived as a contagious and curable disease. The study revealed that TB patients held a lot of misperceptions about the cause and transmission of TB, as only 24% identified germs as its main cause. Majority of the respondents 73(35%) thought that TB was caused by smoking and drinking. Similarly, the study found high level of both perceived and felt sigma among the TB patients which was manifested through self and community isolation of TB patients, association with HIV and inadequate of social support. The study further revealed that health care system was pluralistic in nature with different players including herbalist, drug shops/chemist, traditional healers, private clinic and the public health care facilities. The patients experienced dynamic and complex health seeking trajectories as they switched from one provider to the other which resulted in delay in TB diagnosis and treatment. Three factors were identified as the main causes of delay: one, individual factors which include lack of knowledge, misinterpretation of symptoms, stigma and poor health seeking behaviour; two, socio-cultural factors which include cultural beliefs, gender roles, masculinity and male dominance and three, structural factors which include inadequate diagnostic facilities, distance to health facilities and lack of finances. In conclusion, the study found gaps in TB knowledge, high level of stigma and high level of diagnostic delay in the study area. There is a need for the TB program to heighten patient education to improve patient knowledge and awareness on TB as well as implement more innovative approaches such as intensive case finding and sensitisation of the informal health care providers in order to enhance early patient presentation in the health facilities. There is also need to improve the diagnostic capacity of the health facilities in the County.