Tuberculosis Treatment Completion for Tribal Patients in Kerala: Needs Constant Push!

Abstract

Introduction: Tuberculosis (TB) incidence among tribal patients is high owing to their social and geographic vulnerability. Ensuring adherence to TB treatment among them remains a challenging task as it is dependent on socio-cultural and environmental factors. Objective: 1) To know the individuals’ perception of TB disease and anti-TB treatment; 2) To explore the personal, social, family and cultural factors influencing on patient’s treatment adherence; 3) To identify the challenges faced by health care providers in delivering services to the tribal population. Material and Methods: A descriptive qualitative study conducted among tribal patients (n = 16) and health providers (n = 6) of Manathavady TB unit, Wayanad District of Kerala. The data were collected through in-depth interviews (IDIs), audio-recorded in Malayalam, transcribed verbatim and translated into English. Transcripts were analysed using manual descriptive content analysis. Results: Most of the patients were oriented about the importance of completing TB treatment though lacked awareness about its causation. The supportive attitude of the community further encouraged them to continue TB treatment. However, substance abuse emerged as the biggest challenge to treatment adherence particularly among males. While accessibility to the health system, animal confrontation, and disaster risk emerged as barriers owing to the geographic landscape of the community, health services were found to be acceptable, available and affordable to all the patients. No stigma or discrimination was perceived by the patients at family, community and health system level. However, their beliefs in herbal medicines and conduct of certain rituals delayed them for seeking care. The personal commitment of the health care staff helped the TB patients to adhere better with the treatment thereby yielding best results. Conclusion: The TB treatment adherence among the tribal population was satisfactory due to personal, social and health system support. However, alcoholism and geographic vulnerability were perceived as the challenges in ensuring treatment adherence.