Perceptions of Adolescents and Health Workers Towards Adolescents’ TB Diagnosis in Central Uganda: A Cross-Sectional Qualitative Study

Figures & data

Table 1 Emerging Themes and Quotes from the Focus Group Discussions

Themes	Quotes
Adolescents
Knowledge and risk of TB	“Some of our friends engage in drinking alcohol and smoking which can lead to contracting TB.” 19-year-old Male; Entebbe Hospital “The places we move in such as bars, slums, and crowded people eg in hospitals exposes someone to TB.” 17-year-old Female; Entebbe Hospital “For me when I got the cough, I used herbal medicine and I became ok.” 15-year-old Male; Entebbe Hospital
Conflicting school schedules	“Musawo, as I said it may be a chance, you may come early …. like now I came at around 9 am, but by now (1:30 pm), the pharmacy is still closed thus you cannot get medication so I have been here waiting, by now I cannot go to school so I have missed school today.” 18-year-old Male; Luwero Health Centre IV “If they don’t work on me, I may take my time because I also have to go to school, probably I will come back in the next holidays because I have tried to come in this holiday when it has just started” 18-year-old Female; Luwero Health Centre IV
The limited capacity of the school health system to diagnose TB	“ …. another thing, some of us find ourselves at school. When that cough gets you…..you know at school we have the health workers cough can get you and gets you for a long period or even when it has just got you and you go to say the school nurse, they do not care knowing much, they just ask you what is paining you and you say cough then she gives you drugs and then you stay there and they do not even allow you to go home to get to a hospital.” 17-year-old Female; Gombe hospital
Health systems challenges	“ …. the problem is that when you reach hospital, every health worker has their attitude, some are easy, and others are difficult. For some you describe your situation and how you feel, then they back at you that you have taken long without going to hospital and how you have been going to die. This demotivates for one to come back.” 18-year-old male from Nakaseke Health Centre IV “ …. for me if I get the right guidance and counselling, providing sputum may not be a problem as long as I have it, so the counselling would help to know why am giving the sputum” 17-year-old Female; Entebbe Hospital
Fear of a TB diagnosis	“I was told I don’t have TB. But also on giving me the results, I was fearful……but they checked when I was fine, because I thought if they find me having TB, I may also have HIV” 16-year-old Female; Entebbe Hospital “For me the way they talk about TB treatment; I fear going for TB check-up. In our village they say that they inject you 60 injections as medicine for TB. Eehheehhheehh, people fear TB treatment that’s why I fear.” 16-year-old Male; Nakaseke Health Centre “for the adolescents, people don’t want to see them holding the sputum container, you even hide behind buildings to try and produce the sputum” 18-year-old Male; Nakaseke Health Centre
Loss of trust in public health care systems	“ …. for me what took me to the clinic is that when you go to government hospitals, they tell you there is no medicine and tell you to go buy at private pharmacies, and usually the medicines are very expensive, and also the lines there are long and you find yourself coughing in people, they all look at you and you feel out of place. So a person who goes to the clinic may be better because, they get the services faster though they have to pay money.” 17-year-old Female; Entebbe Hospital
Role of parents	“For me they support me, even today they pushed me to come for checkup.” 16-year-old Male; Luwero hospital “for me, its self-initiated, my parents seem not to care.” 19 year-old Male; Luwero hospital “they should sensitize and educate parents about adolescent TB, they can also go to schools…….Parents are key educators of their children.” 19 year old female; Entebbe hospital
Health care workers
TB exposure at schools	“Adolescents most cases are at school, they are always at school, imagine at school there is a biggest exposure, they are at risk, the dormitory is overcrowded, someone may be coughing without knowing whether he/she has TB. So all those children are at risk of getting TB, they are sleeping in the same dormitory, the dormitory is congested, may he/she does not know because they are lacking knowledge concerning TB.” Out Patient Department (OPD) TB nurse.
Uncooperative adolescents	“At times when they come to the hospitals, they do not say all. At times they hide this away from their parents. Even where they stay at times you find they have lived with someone who has ever had TB. Even as you take their history…ok at times as you take their history, you find they are reserved. Even when you request for a lab test, some of them are a bit hesitant to give a sample. At times they want to be followed up all the way.” OPD Nurse. “………in trying to provide a mask, they look at it as being stigmatizing. Even when we explain why the we use a mask. Even when you give them and they are not escorted by an adult, he will have to pocket his mask……he asks why is it only me putting on a mask. He may even reach the lab and sit down.” A TB nurse mentioned.
Health worker inadequacies regarding TB diagnosis in adolescents	“ I also think that we people who diagnose TB miss out on adolescents who have TB because we always think that one for someone to have TB, they must have low immunity or other accompanying factors, which is not easily thought of about adolescents. I can only think about TB when the adolescent has HIV otherwise, you be like nowhere this little girl may have TB so we normally treat other upper respiratory infection not thinking about TB.” A clinician said. “This is a big hospital, patients come with a burden of diseases, so these patients need to find us (health workers) with a sober mind, not in disorganised mode.” A nurse said. “The biggest challenge I see since I came here is low interest in TB among staff, you find that every time you get the TB patient, you call the TB focal person, every time the TB focal person, most of these our colleagues, I do not know, but we fear a lot TB, we are not comfortable handling TB patients.” A nurse at OPD said. “Also one of the things they worry about is the treatment, because there is still a myth in a community that treatment for TB takes a whole year, and it is tough, so it’s usually their fears, for how long am I going to take medicine”. A clinical officer reported.