From their own perspective. A Kenyan community's perception of tuberculosis

Early passive case finding and treatment compliance are the cornerstones of tuberculosis (TB) control programs. As human behaviour plays a critical role in both strategies, a better understanding of it is important for the planning and implementation of a successful TB programme, especially for the health education component. Our qualitative study in Uasin Gishu, Kenya, aimed at a better understanding of the community's beliefs and perceptions of TB, recognition of early symptoms and health-seeking behaviour. Five focus groups with a total of 49 people were held: one with hospitalised TB patients, two with rural and two with urban participants. Tuberculosis is well known in the communities and many vernacular names for the disease exist. TB is perceived as a contagious, 'sensitive' disease difficult to diagnose and treat. Community members believe that TB should be diagnosed and treated in a hospital or by a medical doctor and nor at the peripheric level. TB treatment is perceived as long, agonising and cumbersome. Traditional treatment is considered a valid alternative to modern treatment, believed to be as effective and much shorter. Initial symptoms such as cough and fever are often overlooked and/or confused wit malaria or a common cold. Symptoms associated with the disease refer to the later stage of TB. TB is attributed to causes such as smoking, alcohol, hard work, exposure to cold and sharing with TB patients. Many participants believe TB is hereditary. Prolonged self treatment and consultation with the traditional health sector as well as the social stigma attached to the disease increase patient's delay. Only after symptoms persist for some rime and/or the suspect's health deteriorates, are modern health services consulted. These social conditions necessitate culturally sensitive health education, taking into account local perceptions of TB.