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Online Program

335067
Knowledge, attitudes and beliefs of caregivers for children with tuberculosis in Gaborone and its surrounding districts, Botswana


Tuesday, November 3, 2015

Christian Stillson, MPH, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA
Rosemary Frasso, PhD, MSc, CPH, Center for Public Health Initiatives, University of Pennsylvania School of Medicine, Philadelphia, PA
Harriet Okatch, PhD, MPH(c), Chemistry, University of Botswana, Gaborone, Botswana
Loeto Mazhani, MD, University of Botswana, Gaborone, Botswana
Thuso David, University of Botswana, Gaborone, Botswana
Tonya Arscott-Mills, MD, Botswana-UPenn Partnership, Gaborone, Botswana
Malebogo Ntshimane, RN, Botswana-UPenn Partnership, Gaborone, Botswana
Andrew P. Steenhoff, MBBCh, Botswana-UPenn Partnership, Gaborone, Botswana
Background: The length and complexity of treatment for tuberculosis (TB) pose specific challenges for infected children too young to manage their own care. This leaves the responsibility for treatment delivery on their caregivers. Previous studies have shown that caregivers face multiple challenges in provisioning care including low health literacy and the availability of pediatric-friendly drug formulations. 

 Objective: To investigate caregivers’ knowledge, attitudes and beliefs regarding TB in children and it’s treatment in Gaborone and the surrounding districts, and to explore caregivers’ experiences with health care staff, perceived challenges, unmet needs and barriers to successful treatment.

 Methods: We conducted semi-structured interviews with 28 caregivers of children currently on anti TB treatment. Interviews were conducted in Setswana or English at the interviewees’ discretion, audio taped, transcribed and translated. Transcripts were uploaded into a qualitative research program (NVivo 10) to facilitate a systematic thematic analysis. Each transcript was double-coded and intercoder reliability was assessed. 

 Results: Nineteen (68%) of the 28 respondents did not suspect their child had TB before diagnosis. Respondents reported a host of barriers to timely diagnosis and effective TB treatment for their children. These included multiple misdiagnoses before beginning TB treatment, low levels of TB health education at the time of diagnosis, inconsistent access to medication at their point of care, and difficulty administering the medication.

 Conclusions:  Caregivers identified unique barriers in the timely diagnosis and treatment of pediatric TB in this setting. Health system challenges included difficulty diagnosing TB in children, lack of TB education during treatment, as well as inconsistent availability of medications. The barriers identified by caregivers in administering the tablets highlights the need for pediatric drug formulations. In this setting, efforts to improve TB outcomes in children should be focused on improving diagnosis, consistent provision of quality education, and ensuring pediatric formulations of anti TB drugs are available.

Learning Areas:

Assessment of individual and community needs for health education
Chronic disease management and prevention
Provision of health care to the public
Public health or related research

Learning Objectives:
Describe the experiences reported by caregivers for children on treatment for tuberculosis in Botswana.

Keyword(s): Tuberculosis, Caregivers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been intimately involved with the creation, implementation, and analysis of this study. It has served as my capstone thesis for a masters degree in public health. I have previously lived and worked in Southern Africa for over two years prior to completing this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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