ArticleBMJ open2021
Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Systematic review of barriers to and enablers of tuberculosis diagnosis, notification, and intervention for designing customised intervention package to minimise 'missing millions' in tribal communities of India.Journal of global health · 2025Pooled it
- End-user perspectives on design and implementation of a novel SkinScan3D (SS3D) device for monitoring Kaposi Sarcoma in East Africa: a qualitative study.medRxiv : the preprint server for health sciences · 2026Article
- Delays in Tuberculosis Treatment Among People With Pulmonary Tuberculosis in East Africa: Findings From a Prospective Cohort Study.Open forum infectious diseases · 2026Article
- Barriers to compliance with hepatitis B vaccination: sociocultural and socioeconomic perspectives of pregnant women in the Bono East Region of Ghana.BMC pregnancy and childbirth · 2026Article
- "Fragmented care pathway in a layered TB care system": a grounded theory approach to understand care pathways and delays in TB care in Odisha.BMC health services research · 2026Article
- Multilevel Determinants of Tuberculosis Treatment Interruption in Rural South Africa: Insights from Primary Healthcare Nurses.International journal of environmental research and public health · 2026Article
- Development and Psychometric Evaluation of a Novel Medication Adherence Scale for Patients with Chronic Diseases in Low- and Middle-Income Countries.Patient preference and adherence · 2026Article
- Factors contributing to low tuberculosis diagnosis among children aged 0-14 years in Gem Sub County in Siaya County, Kenya.PloS one · 2026Article
- The burden of tuberculosis and drug resistance in 22 Sub-Saharan African countries, 1990-2021: a GBD 2021 analysis and progress towards WHO 2035 targets with projections to 2050.Frontiers in microbiology · 2025Article
- Experiences of children and their caregivers affected by multidrug-resistant tuberculosis in Cape Town, South Africa.PloS one · 2025Article
- Lived experiences of persons on tuberculosis treatment in Nairobi County, Kenya: a mixed methods study.BMC public health · 2024Article
- Gendered gaps to tuberculosis prevention and care in Kenya: a political economy analysis study.BMJ open · 2024Article
- Factors related to the utilization of digital adherence technologies in tuberculosis care: A qualitative study among adults in DS-TB treatment, health care providers and other key actors in Tanzania.PLOS global public health · 2024Article
- Article
- Ending tuberculosis: challenges and opportunities.Frontiers in tuberculosis · 2024Review
- Gender-related factors affecting access to TB services and treatment outcomes in the Philippines.Public health action · 2023Article
- FACTORS CONTRIBUTING TO PULMONARY TB TREATMENT LOST TO FOLLOW-UP IN DEVELOPING COUNTRIES: AN OVERVIEW.African journal of infectious diseases · 2023Article
- Health care for people with tuberculosis/HIV co-infection from the multidisciplinary team's perspective.Revista brasileira de enfermagem · 2023Article
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Authors and funding
16 authors at 7 institutions in 5 countries.
Funding
Abstract
objectivesEarly diagnosis and timely treatment are key elements of a successful healthcare system. We assessed the role of socioeconomic and cultural norms in accelerating or decelerating uptake and utilisation of health technologies into policy and practice.
settingSecondary and tertiary level healthcare facilities (HCFs) in three East African countries. Level of HCF was selected based on the WHO recommendation for implantation of tuberculosis (TB) molecular diagnostics.
participantsUsing implementation of TB diagnostics as a model, we purposively selected participants (TB patients, carers, survivors, healthcare practitioners, community members, opinion leaders and policy-makers) based on their role as stakeholders. In-depth interviews, key informant interviews and focus group discussions were held to collect the data between 2016 and 2018. The data were transcribed, translated, coded and analysed by thematic-content analysis.
resultsA total of 712 individuals participated in the study. Socioeconomic and cultural factors such as poverty, stigma and inadequate knowledge about causes of disease and available remedies, cultural beliefs were associated with low access and utilisation of diagnostic and treatment tools for TB. Poverty made people hesitate to seek formal healthcare resulting in delayed diagnosis and resorting to self-medication and cheap herbal alternatives. Fear of stigma made people hide their sickness and avoid reporting for follow-up treatment visits. Inadequate knowledge and beliefs were fertile ground for aggravated stigma and believing that diseases like TB are caused by spirits and thus cured by spiritual rituals or religious prayers. Cultural norms were also the basis of gender-based imbalance in accessing care, 'I could not go to hospital without my husband's permission', TB survivor.
conclusionOur findings show that socioeconomic and cultural factors are substantial 'roadblocks' to accelerating the uptake and utilisation of diagnostic and treatment tools. Resolving these barriers should be given equal attention as is to health system barriers.
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