Delays in TB hospital diagnosis – a major threat for the HIV/AIDS situation in a society: A study of TB as an opportunistic infection in southern Malawi

Abstract

HIV/AIDS and TB cases in Malawi have been increasing simultaneously since the first case of HIV/AIDS was reported in 1985. Cure rates for TB treatment are rated good in Malawian hospitals but TB suspects delay going to hospital for diagnosis. This study aims at exploring the reasons why the TB suspects delay or are unwilling to go for hospital diagnosis and thus for effective treatment. A comparative study was undertaken in Zomba and Mangochi Districts in Southern Malawi using methodological pluralism during data collection and analysis. Results show that the main reasons for hospital delay were: TB stigma due to HIV/AIDS prevalence, lack of TB knowledge, geographical factors (climate, accessibility, occupations, and culture), and use of traditional healers to treat TB. Zomba people delayed more despite having higher educational levels than those in Mangochi. Gender and marital status had a significant impact in delaying TB suspects in Mangochi but not in Zomba. The study concludes that differences between places and socio-cultural groups need to be considered in studies of diseases such as the TB/HIV epidemic and taken into account for intervention to be effective. Furthermore, close collaboration between TB/HIV experts and traditional healers is recommended.

Keywords:

• geographical variation
• opportunistic infection
• patient's delay
• prevalence and incidence
• TB diagnosis

Acknowledgements

The authors wish to thank the Department of Geography at the Norwegian University of Science and Technology (NTNU) for technical support. We are grateful for the external support from the Norwegian Government through the Norwegian Agency for Development Cooperation (NORAD) for financing the fieldwork. NORAD also funded the second author on a study tour on the HIV/AIDS situation in Malawi, a tour which was successfully organized by Monica Djupvik (UNAIDS) in Lilongwe. We also thank the Malawi Government, through the University of Malawi, College of Medicine Research and Ethical Committee (COMREC) on behalf of the Ministry of Health and Population (MOHP), for granting the ethical clearance for access to the two hospitals for data collection. Thanks are also due to the Malawi National Tuberculosis Control Program, Lilongwe, for the technical support and literature and also to all those who participated in this study during data collection and analysis. The anonymous reviewers are also thanked for their valuable comments.