Treatment-seeking for tuberculosis-suggestive symptoms: a reflection on the role of human agency in the context of universal health coverage in Malawi

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dc.contributor.authorKumwenda, Mosesen_ZA
dc.contributor.authorDesmond, Nicolaen_ZA
dc.contributor.authorHart, Grahamen_ZA
dc.contributor.authorChoko, Augustineen_ZA
dc.contributor.authorChipungu, Geoffrey Aen_ZA
dc.contributor.authorNyirenda, Deborahen_ZA
dc.contributor.authorShand, Timen_ZA
dc.contributor.authorCorbett, Elizabeth Len_ZA
dc.contributor.authorChikovore, Jeremiahen_ZA
dc.date.accessioned2016-10-31T07:44:00Z
dc.date.available2016-10-31T07:44:00Z
dc.date.issued2016en_ZA
dc.description.abstractTuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these employ survey-type approaches. Consequently, few address community or patient perspectives and experiences. At the same time, understanding of the mechanisms by which the health systems challenges translate into seeking or avoidance of formal health care remains limited. This paper applies the notion of human agency to examine the ways people who have symptoms suggestive of TB respond to and deal with the symptoms vis-à-vis major challenges inherent within health delivery systems. Empirical data were drawn from a qualitative study exploring the ways in which notions of masculinity affect engagement with care, including men's well-documented tendency to delay in seeking care for TB symptoms. The study was carried out in three high-density locales of urban Blantyre, Malawi. Data were collected in March 2011 -March 2012 using focus group discussions, of which eight (mixed sex = two; female only = three; male only = three) were with 74 ordinary community members, and two (both mixed sex) were with 20 health workers; and in-depth interviews with 20 TB patients (female = 14) and 20 un-investigated chronic coughers (female = eight). The research process employed a modified version of grounded theory. Data were coded using a coding scheme that was initially generated from the study aims and subsequently progressively amended to incorporate concepts emerging during the analysis. Coded data were retrieved, re-read, and broken down and reconnected iteratively to generate themes. A myriad of problems were described for health systems at the primary health care level, centring largely on shortages of resources (human, equipment, and drugs) and unprofessional conduct by health care providers. Participants consistently pointed out how the problems could drive patients from promptly reporting symptoms at primary healthcare centres. The accounts suggest that in responding to illness symptoms including those suggestive of TB, patients navigate their options taking into cognisance past and current experiences with formal health systems. Understanding and factoring in the mediating role of such 'agency' is critical when implementing efforts to promote timely response to TB-suggestive symptoms.en_ZA
dc.identifier.apacitationKumwenda, M., Desmond, N., Hart, G., Choko, A., Chipungu, G. A., Nyirenda, D., ... Chikovore, J. (2016). Treatment-seeking for tuberculosis-suggestive symptoms: a reflection on the role of human agency in the context of universal health coverage in Malawi. <i>PLoS One</i>, http://hdl.handle.net/11427/22379en_ZA
dc.identifier.chicagocitationKumwenda, Moses, Nicola Desmond, Graham Hart, Augustine Choko, Geoffrey A Chipungu, Deborah Nyirenda, Tim Shand, Elizabeth L Corbett, and Jeremiah Chikovore "Treatment-seeking for tuberculosis-suggestive symptoms: a reflection on the role of human agency in the context of universal health coverage in Malawi." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/22379en_ZA
dc.identifier.citationKumwenda, M., Desmond, N., Hart, G., Choko, A., Chipungu, G. A., Nyirenda, D., ... & Chikovore, J. (2015). Treatment-seeking for tuberculosis-suggestive symptoms: a reflection on the role of human agency in the context of universal health coverage in Malawi. PloS one, 11(4), e0154103-e0154103. doi:10.1371/journal.pone.0154103en_ZA
dc.identifier.ris TY - Journal Article AU - Kumwenda, Moses AU - Desmond, Nicola AU - Hart, Graham AU - Choko, Augustine AU - Chipungu, Geoffrey A AU - Nyirenda, Deborah AU - Shand, Tim AU - Corbett, Elizabeth L AU - Chikovore, Jeremiah AB - Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these employ survey-type approaches. Consequently, few address community or patient perspectives and experiences. At the same time, understanding of the mechanisms by which the health systems challenges translate into seeking or avoidance of formal health care remains limited. This paper applies the notion of human agency to examine the ways people who have symptoms suggestive of TB respond to and deal with the symptoms vis-à-vis major challenges inherent within health delivery systems. Empirical data were drawn from a qualitative study exploring the ways in which notions of masculinity affect engagement with care, including men's well-documented tendency to delay in seeking care for TB symptoms. The study was carried out in three high-density locales of urban Blantyre, Malawi. Data were collected in March 2011 -March 2012 using focus group discussions, of which eight (mixed sex = two; female only = three; male only = three) were with 74 ordinary community members, and two (both mixed sex) were with 20 health workers; and in-depth interviews with 20 TB patients (female = 14) and 20 un-investigated chronic coughers (female = eight). The research process employed a modified version of grounded theory. Data were coded using a coding scheme that was initially generated from the study aims and subsequently progressively amended to incorporate concepts emerging during the analysis. Coded data were retrieved, re-read, and broken down and reconnected iteratively to generate themes. A myriad of problems were described for health systems at the primary health care level, centring largely on shortages of resources (human, equipment, and drugs) and unprofessional conduct by health care providers. Participants consistently pointed out how the problems could drive patients from promptly reporting symptoms at primary healthcare centres. The accounts suggest that in responding to illness symptoms including those suggestive of TB, patients navigate their options taking into cognisance past and current experiences with formal health systems. Understanding and factoring in the mediating role of such 'agency' is critical when implementing efforts to promote timely response to TB-suggestive symptoms. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0154103 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Treatment-seeking for tuberculosis-suggestive symptoms: a reflection on the role of human agency in the context of universal health coverage in Malawi TI - Treatment-seeking for tuberculosis-suggestive symptoms: a reflection on the role of human agency in the context of universal health coverage in Malawi UR - http://hdl.handle.net/11427/22379 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0154103en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/22379
dc.identifier.vancouvercitationKumwenda M, Desmond N, Hart G, Choko A, Chipungu GA, Nyirenda D, et al. Treatment-seeking for tuberculosis-suggestive symptoms: a reflection on the role of human agency in the context of universal health coverage in Malawi. PLoS One. 2016; http://hdl.handle.net/11427/22379.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2016 Kumwenda et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherHealth care providersen_ZA
dc.subject.otherDrug interactionsen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.subject.otherCoughingen_ZA
dc.subject.otherHealth care facilitiesen_ZA
dc.subject.otherMalawien_ZA
dc.titleTreatment-seeking for tuberculosis-suggestive symptoms: a reflection on the role of human agency in the context of universal health coverage in Malawien_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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