An emic perspective of the health-seeking behaviour of adult extensively drug- resistant Tuberculosis in-patients in a public health setting in KwaZulu-Natal.

Abstract

Across the globe and in South Africa specifically, there have been myriad research findings that have contributed to the reduction of TB. However, despite these innovative approaches, health service researchers concur that gains in tuberculosis control are threatened by the emergence of resistance to anti-tuberculosis drugs (Dheda et al., 2017), namely multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. In this article, we examine the health-seeking behaviour of adult in-patients with XDR-TB (previous history of MDR-TB) in a public health sector setting. Data transcripts were acquired from an overarching research study (MDR TB treatment non-adherence in KwaZulu-Natal Project - Principal Investigator, Dr S. Valjee) conducted in a district hospital in Durban. The data transcripts were subjected to theme analysis, with comparisons between gender were explored. According to the findings in this research, a range of individual, community, and institutional-based characteristics, which have historically been described as "treatment delay" and "poor patient adherence," impact health-seeking behaviors. This situation is aggravated by the widespread lack of information and knowledge regarding MDR -TB and XDRTB, lack of insight into the model of decentralized primary care, mistrust of information received, social stigma and community’s’ failure to recognise symptoms. Cultural beliefs that influence individuals’ use of dual healing systems, and multiple treatments further compound this predicament. As a consequence, tuberculosis patients develop MDR-TB and/or XDR-TB. The “ivory tower” of medical administration evident at the institutional level that subjects patients to an antagonistic, disempowering experience, further undermines adherence behavior and positive health actions. Practical staff-centered and patient-centered treatments are proposed in the context of many systemic recommendations. This is followed by a discussion of the study's shortcomings and recommendations for further investigation.