J Chikovore1, G Hart2, M Kumwenda3, G Chipungu4, N Desmond5, E L Corbett6. 1. HIV/AIDS, STIs & TB Program, Human Sciences Research Council, Durban, South Africa. 2. School of Life & Medical Sciences, University College London, London, UK. 3. Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Helse Nord TB Initiative, College of Medicine, Chichiri, Blantyre, Malawi. 4. Helse Nord TB Initiative, College of Medicine, Chichiri, Blantyre, Malawi. 5. Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Liverpool School of Tropical Medicine, Liverpool, UK. 6. Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, London School of Hygiene and Tropical Medicine, London, UK.
Abstract
SETTING: Urban Blantyre, Malawi. OBJECTIVE: To understand why men with tuberculosis (TB) in the community remain undiagnosed. DESIGN: A multi-method qualitative study applying a modified grounded theory approach. Data were gathered from March 2011 to March 2012 from 134 men and women taking part in 1) focus group discussions with community members (n = 6) and health care workers (n = 2), and 2) in-depth interviews with TB patients (n = 20, females n = 14) and chronic coughers (n = 20, women n = 8). Data were analysed inductively to identify, refine and consolidate, and verify emerging concepts and themes. RESULTS: Two emerging themes highlighting compound stigma in this high human immunodeficiency virus (HIV) prevalence, low-income setting are presented. First, cough or any illness that portended a 'serious' condition were accompanied by portrayals of cough, TB and HIV as being interchangeable. Chronic coughers and TB patients described their illness in ways that foregrounded bodily decimation and rupture of social life and masculine identity. Second, 'resistance strategies' entailed resisting classification as (seriously) ill by evading or ambivalently approaching health care, or acknowledging the 'ill' status then actively pursuing health-appropriate behaviours, including changing lifestyle or adopting non-normative gender roles. CONCLUSIONS: Managing patients requires 1) going beyond syndromic management based on vital signs and clinical indicators to recognising and intervening on health care-seeking related tensions to retain individuals in care, and 2) understanding and addressing TB stigma as it manifests and affects men and women differently in specific settings.
SETTING: Urban Blantyre, Malawi. OBJECTIVE: To understand why men with tuberculosis (TB) in the community remain undiagnosed. DESIGN: A multi-method qualitative study applying a modified grounded theory approach. Data were gathered from March 2011 to March 2012 from 134 men and women taking part in 1) focus group discussions with community members (n = 6) and health care workers (n = 2), and 2) in-depth interviews with TB patients (n = 20, females n = 14) and chronic coughers (n = 20, women n = 8). Data were analysed inductively to identify, refine and consolidate, and verify emerging concepts and themes. RESULTS: Two emerging themes highlighting compound stigma in this high human immunodeficiency virus (HIV) prevalence, low-income setting are presented. First, cough or any illness that portended a 'serious' condition were accompanied by portrayals of cough, TB and HIV as being interchangeable. Chronic coughers and TB patients described their illness in ways that foregrounded bodily decimation and rupture of social life and masculine identity. Second, 'resistance strategies' entailed resisting classification as (seriously) ill by evading or ambivalently approaching health care, or acknowledging the 'ill' status then actively pursuing health-appropriate behaviours, including changing lifestyle or adopting non-normative gender roles. CONCLUSIONS: Managing patients requires 1) going beyond syndromic management based on vital signs and clinical indicators to recognising and intervening on health care-seeking related tensions to retain individuals in care, and 2) understanding and addressing TB stigma as it manifests and affects men and women differently in specific settings.
Authors: M Armstrong-Hough; J Ggita; P Turimumahoro; A J Meyer; E Ochom; D Dowdy; A Cattamanchi; A Katamba; J L Davis Journal: Int J Tuberc Lung Dis Date: 2018-10-01 Impact factor: 2.373
Authors: Jamilah Meghji; Maia Lesosky; Elizabeth Joekes; Peter Banda; Jamie Rylance; Stephen Gordon; Joseph Jacob; Harmien Zonderland; Peter MacPherson; Elizabeth L Corbett; Kevin Mortimer; Stephen Bertel Squire Journal: Thorax Date: 2020-02-26 Impact factor: 9.139
Authors: Andrew D Kerkhoff; Kombatende Sikombe; Ingrid Eshun-Wilson; Izukanji Sikazwe; David V Glidden; Jake M Pry; Paul Somwe; Laura K Beres; Sandra Simbeza; Chanda Mwamba; Chama Bukankala; Cardinal Hantuba; Carolyn Bolton Moore; Charles B Holmes; Nancy Padian; Elvin H Geng Journal: PLoS Med Date: 2020-05-13 Impact factor: 11.069
Authors: Peter MacPherson; McEwen Khundi; Marriott Nliwasa; Augustine T Choko; Vincent K Phiri; Emily L Webb; Peter J Dodd; Ted Cohen; Rebecca Harris; Elizabeth L Corbett Journal: BMC Med Date: 2019-01-29 Impact factor: 8.775
Authors: Elysée Nouvet; Astrid M Knoblauch; Ian Passe; Andry Andriamiadanarivo; Manualdo Ravelona; Faniry Ainanomena Ramtariharisoa; Kimmerling Razafimdriana; Patricia C Wright; Jesse McKinney; Peter M Small; Niaina Rakotosamimanana; Simon Grandjean Lapierre Journal: BMJ Open Date: 2019-05-09 Impact factor: 2.692