Vol.1, No.3, 29-36 (2013) Journal of Tubercul osis Resear ch
Factors affecting TB case detection and treatment in
the Sissala East District, Ghana*
Collins K. Ahorlu1#, Frank Bonsu2
1Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana;
#Corresponding Author: cahorlu@noguchi.mimcom.org
2National TB Control Programme, Ghana Health Service, Accra, Ghana fabonsu@gmail.com
Received 16 July 2013; revised 24 August 2013; accepted 10 September 2013
Copyr i g ht © 2013 Collins K. Ahorlu, Frank Bonsu. This is an ope n access articl e d is tr ib ut e d u nde r the C rea t iv e C omm on s At tr ib ut ion
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Tuber culosis remains a major heal-
th problem affecting about a third of the world
population despite a number of preventive and
control measures taken in the past few decades.
Eighty-five percent of all tuberculosis cases are
concentrated in Asia and Africa due to lack of
education and health care infrastructure. Objec-
tive: To determine factors affecting low tuber-
culosis case detection in the Sissala East dis-
trict in the Upper West Region of Ghana. Meth-
ods: This was a descriptive study where semi-
structured questionnaire was administered to 61
respondents; six focus group discussions and
20 in-depth interviews were conducted to gen-
erate both qualitative and quantitative data for
analysis. Results: Tuberculosis, known locally
as Kesibine was identified as a major problem in
the district. The two most frequently reported TB
related distresses were coughing (96.7%) and
chest pains (95.0%). However, these distresses
were reported more after probing for them. The
most frequently spontaneously reported dis-
tress was reduced income (60.7%) for patients.
The most prominent cause reported was sexual
pollution (72.2%). Suspected tuberculosis pa-
tients are stigmatized and are denied sex by
their partners as shown in the following narra-
tive; I will not eat or have sex with her or eat any
leftover from her plate (male local h ealer, In-dep-
th interview). Case detection and treatment is
hampered by lack of communication between
sub-district facilities and the district hospital to
aid laboratory diagnosis. Conclusion: There is
therefore the need for vigorous health education
to inform the people about the biomedical
causes of TB and the availability of appropriate
treatment for the disease at health facilities.
However, the education should not aim at chang-
ing the “wrong beliefs” but focus on making
people aware of the biomedical causes and see
TB as treatable infection, which could be con-
Keyw ords: TB; Treatment; Case Detection; Ghana
Tuberculosis (TB) remains a major health problem af-
fecting about a third of the world population despite a
number of preventive and control measures taken in the
past few decades. It is responsible for an estimated 8.8
million cases and 1.4 million deaths globally [1,2].
Eighty-five percent of these TB cases are concentrated in
Asia and Africa where there is a lack of education, health
care infrastructure, poverty an d overcrowding [1 -5 ] .
It is estimated that Africa contributes about 29% and
34% of all TB related morbidity and mortality to the
global burden. In Ghana, TB remains a major cause of
preventable adult morbidity and mortality [6-11] and in
2007, WHO has estimated that 50,000 new TB cases
occurred in Ghana, making it the 19th most TB burden
country in Africa. However, TB has remained a fearful
disease among the Ghanaian population as demonstrated
by the local Akan name for it—“Nsamanwa”, which con-
notes both fear and death. The term “Nsamanwa” liter-
ally means “ghost cough”, which suggests that once you
get the disease, you have literally become a ghost or a
dead person [7-11]. The linguistic difference between the
Akan speaking and the Sissala speaking people notwith-
standing, TB patients are generally stigmatized across the
globe [10-12]. With this seriousness and fear associated
to TB, it is expected that suspected cases will seek for
*Competing Interest: We declare that we have no competing interest in
writing this paper.
Copyright © 2013 SciRes. OPEN ACC ESS
C. K. Ahorlu, F. Bonsu / Journal of Tuberculosis Research 1 (2013) 29-36
treatment early at the health facility. But this was not the
case in the Sissala East District in the Upper West district
of Ghana where virtually no TB cases were being diag-
nosed. This could be due to massive stigma associated
with the disease among other things [6-16].
The main strategy for TB treatment globally is the di-
rectly observed treatment short course (DOTS) which
relies on case detection and treatment with multiple an-
timicrobial drugs for at least six months. It is anticipated
that this strategy will enhance treatment compliance and
thereby improve treatment outcome. Central to this stra-
tegy however is laboratory diagnosis to confirm clinical
cases before treatment is initiated [1,5,7,12]. This is
where the attitude of health workers toward patients in
terms of stigmatization could negatively influence the
health seeking behaviour among suspected patients [10,
Social factors that are known to be driving the global
increase in TB cases include; overcrowding, especially in
urban centres, late reporting and diagnosis, non-compli-
ance to treatment schedule, lack of commitment on the
part of national control programme in developing coun-
tries, lack of education, health care infrastructure and
poverty [2,3,6].
Despite increased efforts at prevention and the wide-
spread availability of effective short-course anti-tuber-
culosis chemotherapy in the past few decades, the inci-
dence of tuberculosis is on the increase both in devel-
oped and developing countries. The emergence of ex-
tremely drug resistant tuberculosis (XDR-TB) from
South Africa is going to be a major threat to TB control
in Africa (http://allafrica.com/stories/200610180119.html).
This is because, in sub-Saharan Africa, case detection
rates are still low and the period from first symptom to
diagnosis and treatment could be quite long [21].
This study was designed to determine factors affecting
low TB case detection in the Sissala East District in the
Upper West Region of Ghana. This operational study
became necessary to generate information for the Ghana
national TB control programme for appropriate remedial
actions to be taken to forestall any catastrophe that may
result from untreated TB cases in the study area.
2.1. Study Area
The study was conducted in the Sissala East, a rural
district located in the north-eastern part of the Upper
West Region of Gh ana with Tumu as its capital. The dis-
trict shares about 300 kilometer border with Burkina
Faso. According to the 2010 population and housing
census, there are 56,528 people living in the district [22].
The district is predominantly rural where over 75% of
the people are engaged in subsistence agriculture
(DHMT annual report, 2010). The formal health system
in the district con sists of 1 district hospital, 5 health cen-
ters (HC). However, low health service utilization was
reported in the district (DHMT, annual report, 2010). The
national TB control program initiated this research to
ascertain why very little or no TB cases were being re-
corded in the district in recent years.
2.2. Data Collection Techniques
This was a descriptive study employing both qualita-
tive and quantitative techniques for data collection.
EMIC (insider perspective) interviews were conducted
with 61 persons to generate quantitative data. EMIC in-
terviews are instruments used for assessing representa-
tions of illness or specified health problems from the
perspective of affected persons, their family or commu-
nity members. The instrument blends qualitative and
quantitative approaches to study illness-related experi-
ences, meanings and behaviours [23]. The EMIC tool
was designed to generate relevant representations and
categories of distress, perceived causes, help-seeking
behaviours and perceived or experienced TB related
sti gma. Respondents were enrolled into the stu dy th rou gh
purposive sampling, using the snowball technique, where
each person identified also brought at least one other
person with similar condition. An initial screening was
done on each person brought to be sure that they meet
the inclusion criterion, which is coughing continuously
for 14 days or more before they were enrolled into the
study after receiving their consent to participate. This
technique was adopted we could not generate a list of
suspected TB cases and the district hospital has no recent
patients list to select the sample from. However, commu-
nity leaders were able to refer some suspected cases to
the researchers who were then asked to refer at least one
person with similar condition (coughing for 14 or more
To allow for group interactions and to generate diver-
gent locally valid TB representations and categories, Six
FGDs (three for each sex) were conducted with selected
adults aged 18 years and above. Also, 20 in-depth inter-
views were conducted (three chiefs, three queen mothers
or women representatives, six health workers and eight
traditional healers). These qualitative techn iques allowed
us to determine the ethnographic features of TB in the
2.3. Analysis
Qualitative data were analysed using Maxqda software
after the data were entered into Microsoft word in a for-
mat that allows importation to Maxqda in a preformatted
Copyright © 2013 SciRes. OPEN ACCE SS
C. K. Ahorlu, F. Bonsu / Journal of Tuberculosis Research 1 (2013) 29-36
Copyright © 2013 SciRes. OPEN ACC ESS
coded form. Content analysis was then performed on
relevant segments to generate representative narratives
for presentation to complement and clarify quantitative
findings. The quantitative data was entered into EpiInfo
version 3.3.2, which was also used to perform descriptive
analysis for presentation.
2.4. Ethical Considerations
The study was reviewed by the Institutional Review
Board of the Noguchi Memorial Institute for Medical
Research, University of Ghana. Each participant was
informed of the objectives, methods, anticipated benefits
and potential hazards of the study. Participants were as-
sured that all information collected for the study would
be kept confidential, and that in an y resulting publication
it would not be possible to link the data to individuals
and families in the study. Written inform consent was
obtained from all participants and none have declined
participation in the stud y. Participants signed/thump print
the consent form together with a witness to accept par-
ticipation in the study.
3.1. Socio-Demographic Characteristics of
Survey Respondents
EMIC interview participants were made up of 30
males and 31 females with the mean (±Std) age of 39.6
years. Majority of the survey respondents were Muslim
(73.8%) and most of them were married (67.2%). Major-
ity (67.2%) of them had no education and were mainly
farmers (70.5%) and petty traders (16.4%).
3.2. Common Illnesses
Malaria/fever (98.4%) was the most common illness
mentioned by respondents. The rest were coughing
(62.3%), stomach pains (54.1%), diarrhoea (26.2%) and
chest pains (21.3%). However, among all these health
problems the two most troubling reported were ma-
laria/fever (45.9%) and coughing (22.9%). Almost all
(95.1%) survey respondents said persistent cough or sus-
pected TB was a problem in the district. The most pro-
minent local name/term for TB reported was Kesibine
(85.2%). Kesibine was also mentioned as the local name
for TB during in-depth interview with traditional healers
and community leaders as well as during focus group
discussion (FGD) with the general adult population. All
related names/terms for TB have meanings attached to
them, for example, the term Kesibine or kesibelle was
explained to mean “black cough or prolong cough with
blood in the sputum”, the term Boye was explained to
mean “coughing with blood” and Kukuezine means
“coughing till blood comes out”.
3.3. Distresses Suffered by Suspected TB
Various distresses associated with TB were reported
by suspected TB patients, prominent distress reported
spontaneously was reduced income (60.7%) while the
two most frequently reported distresses after probing
were coughing (96.7%) and chest pains (95.0%) (Table 1)
Table 1. Distresses reported either spontaneously or probed*.
Spontaneous Responses Probed Responses Total
Constraining Factors (Variables)** Frequency (%) Frequency (%) %
Blood in sputum
Chest pains
Concern about cours e of illness
Difficulty finding partner
Loss of appetite
Loss of job/wage
Marital Problems
Reduced income
Reduced social status
Sadness, anxiety or worry
Side effect of dr ugs
Social isolation
Weight loss
10 (16.4)
18 (29.5)
7 (11.4)
25 (41.0)
7 (11.5)
14 (23.0)
16 (26.2)
23 (37.7)
13 (21.3)
19 (31.1)
11 (18.0)
37 (60.7)
15 (24.6)
35 (57.4)
18 (29.5)
18 (29.5)
24 (39.3)
17 (27.9)
22 (36.1)
30 (49.2)
51 (83.6)
7 (11.5)
52 (85.2)
11 (18.0)
25 (41.0)
27 (44.3)
18 (29.5)
1 (1.6)
13 (21.3)
3 (4.9)
14 (23.0)
14 (23.0)
1 (1.6)
11 (18.0)
27 (44.3)
31 (50.8)
Multiple choices allowed; **Sorted alphabetically in column 1.
C. K. Ahorlu, F. Bonsu / Journal of Tuberculosis Research 1 (2013) 29-36
The following representative narratives confirmed the
importance of the distresses reported:
TB may lead to reduction in the income of the patient
and this in itself can lead to death. …affects both the
economic and physical live of the patients which make
them feel miserable (Male traditional healer, IDI).
…TB in the family can disturb other family members
as they waste a lot of money and time on the patient. In
this community TB patients are not allowed to have sex
with their husbands and this make life difficult for the
family and in some cases the man will go and marry an-
other wife while keeping the original wife in isolation
(female traditional healer, IDI).
Majority of the survey respondents (80.3%) main-
tained that women who h ave TB suffer from it more than
men in the district for various reasons, some of which
were represented in the following narratives:
There are some differences…the truth is that women
with suspected TB find it more difficult to live with the
disease. …a woman with TB will never get a partner to
marry in this community, but a man with TB can easily
get a partner to marry (Female, FGD).
...people relate to male and female patients differ-
ently…a man with suspected TB is never suspected of
having AIDS but every woman with suspected TB is taken
to be AIDS patient and this makes life very difficult we
the women (Female suspected patient, EMIC interview).
3.4. Causes of TB
Varied causes of TB were reported and the most
prominent cause reported was sexual pollution (72.2%).
Thus, spontaneously (45.9%) and after probing (26.3%)
(Table 2). The following representative narratives ex-
plained some of the causes in detailed:
Kessibine (TB) is transmitted through sexual inter-
course with an infected person. …drinking fresh milk
from infected animals could also cause it (male opinion
leader, IDI).
The disease is transmitted through exchange of saliva
with an infected person. …when shared a handkerchief
with infected persons and through sexual intercourse,
especially when the woman coughs during sex (female,
When you sleep with a woman and she carelessly
cough on you, you could develop TB. You can also get TB
from eating cat meat or other infected animas. It is in the
air but it can also be caused when one partner during
sexual intercourse cough very deeply. It can also be
caused by over working and drinking of bad water (Male
traditional Healer , IDI).
Table 2. Perceived causes reported either spontaneously or after probing*.
Spontaneous Responses Probed Responses
Perceived Causes (Variables)** Frequency Percentage Frequency Percentage
Total %
Drugs abused
Air borne/exposure
Blood-related problems
Constitutional weakness
Contact with Affected Person
Evil spirits/gods
Fate (star)
Insect bite
Lack of personal hygiene
Lack of sanitation
Mental/emotional stress
Neglected previous illness
Physical exertion/hard work
Pregnancy/child bir th
Prescribed medicines
Previous illness
Sexual pollution
6 (9.8)
16 (26.2)
12 (19.7)
18 (29.5)
13 (21.3)
14 (23.0)
15 (24.6)
14 (23.0)
8 (13.1)
7 (11.5)
7 (11.5)
17 (27.9)
6 (9.8)
10 (16.4)
11 (18.0)
11 (18.0)
12 (19.7)
8 (13.1)
17 (27.9)
8 (13.1)
16 (26.2)
28 (45.9)
14 (23.0)
6 (9.8)
12 (19.7)
23 (36.1)
16 (26.2)
13 (21.3)
4 (6.6)
11 (18.0)
6 (9.8)
4 (6.6)
17 (27.9)
11 (18.0)
12 (19.7)
2 (3.3)
16 (26.2)
5 (8.2)
9 (14.8)
6 (9.8)
3 (4.9)
21 (34.4)
10 (16.4)
4 (6.6)
16 (26.3)
22 (36.1)
18 (29.5)
*Multiple choices allowed; **Sorted alphabetically in column 6.
Copyright © 2013 SciRes. OPEN ACCE SS
C. K. Ahorlu, F. Bonsu / Journal of Tuberculosis Research 1 (2013) 29-36 33
3.5. Traditional Healers and TB Treatment
Five out of the six traditional healers interviewed said
that they are able to treat and cure TB completely. They
however admitted that, just like biomedicine, some sus-
pected TB patients who came to them did not receive
complete cure. They were of the view that some of the
patients require being on treatment for very long time in
order to get cured, which was not affordable to the pa-
tients both in terms of time and money. The following
narratives vividly captured these po sitions:
In some TB cases, our herbal medications are more
effective and better than biomedicines. …they are some-
times treated badly at the hospital…th ey prefer coming to
us ...so instead of condemning us, we should be sup-
ported to help treat TB p atients (Male Traditional healer,
3.6. Health Seeking for Suspected TB
Most of the survey respondents (85.2%) sought help
when they suspected that they have TB and they report-
edly went to the Government hospital/clinics (84.6%).
However, they maintained that no sputum sample was
taken from them for laboratory analysis, even though
they had reported that they were coughing for more than
two weeks. Also, all survey respondents admitted that
they had consulted traditional healers at one time or the
other for their prolong coughing. The following narra-
tives vividly echoed that position:
I went to the clinic at the beginning of my problem, but
I must say that the way suspected TB patients are treated
in this community makes it difficult for me to keep going
to the clinic to avoid being labelled as an IDS patient
(Middle aged lady, FGD).
Health workers interviewed were of the view that TB
patients have lukewarm attitude towards treatment as
indicated in the following representative narratives:
During intensive treatment period, they (patients) usu-
ally complain about the injections or drugs as being too
much (A Nurse at the District Hospital).
Patients that were diagnosed in the past did not come
to the clinic regularly to collect or take their medications
and this affected the progress of the programme (District
TB focal person).
Majority of respondents (91.8%) said th ey will sup port
the idea of community DOT provided the “providers” are
trained community members who they can trust. They
maintained that they will readily utilise the services of
the community DOT providers but will be happy if they
would come to their homes with the medicines.
3.7. Stigma
Majority (63.9%) of the survey respondents said they
have never tried to prevent other people from knowing
about their persistent cough (suspected TB). However,
29.5% of them said they have tried to hide their condi-
tion from other people. Also, majority (75.4%) of them
have discussed their condition with persons they consid-
ered intimate. For those who discussed their problem
with close relatives, most of them talked to either their
spouse (47.8%) or parents (37.0%). The following narra-
tives explained why some respondents will not want to
talk about their condition to others:
...TB is viewed in this community as a bad and dan-
gerous disease, so if you have it, people will not want to
associate with you, they will not wan t to eat with you and
this makes you feel uncomfortable (lady FGD).
Those with TB will not declare it publicly because
people in this commu nity see TB patients as co rps (living
but dead, they are not even allowed to have sex with their
partners (male FGD).
The following narratives revealed how community
members will relate to their spouses when they are diag-
nosed with TB;
I will not eat with her or eat any leftover from her
plate (male local healer, IDI).
…not have sex with h er and I will not sh are a drinking
cup with her, though I will support her to attend clinic
for treatment (male FGD).
will relate nicely to him but I will not eat with him
because it is not good to get too closer to him (female
About halve of the survey respondents (50.8%) said
they think less of themselves because of their persistent
coughing. Also, majority (52.5%) said they were some-
times made to feel shame because of their condition.
Moreover, 54.1% of them said they were less respected
in the district because of their condition. The following
narratives explained these positions;
In this community, once people know that you have TB,
they will not want to have anything to do with you. They
will start to look at you as a good for nothing person
who is awaiting death; they will be careful not to con-
tract the disease (lady suspected TB patient, EMIC).
Some people will be sympathetic with you and try to
help you but others will think less of you because they
will continue to think that you got the disease through
sexual pollution (lady suspected TB patient, EMIC).
About halve (49.2%) of the survey respondents said
that they never suspected that people were trying to
avoid them. However, 26.2% reported that people have
tried to avoid them because of their conditions while
21.3% were not sure. On the other hand, health workers
interviewed reported that patients who came to them in
the past were worried that others would get to know
about their TB status. These patients were then assured
of confidentiality of their clinical records. Health work-
ers also maintain that the fear of stigmatisation may be
Copyright © 2013 SciRes. OPEN ACC ESS
C. K. Ahorlu, F. Bonsu / Journal of Tuberculosis Research 1 (2013) 29-36
the cause of low TB case reporting to the health facility
for diagnosis and treatment. These positions were aptly
explained in the following narrative:
People always think that if you have TB it means that
you have carelessly coughed during sexual intercourse
and therefore shun your company and this have nega-
tively affected the confidence of suspected TB patients to
come to the clinic for fear that they will be exposed to
public ridicule (Nurse, ID I) .
3.8. Defaulter Rate
Treatment default rate was reportedly high as captured
in the following narratives:
Some people do stop going for their medications be-
cause they do not want others to find out that they have
TB …some do not start at all…in my case, I am planning
to go but I am yet to discuss it with my husband (Female
suspected patient, EMIC).
We have seen only a few cases here and once they are
getting better or saw some improvement in their health,
they stop coming for medications (Nurse, IDI).
People stop coming for TB medication because of their
preference for traditional healers and self medications as
a way of keeping other people away from knowing about
their TB status. Some people do complain about the side
effects of the medication and I think that may be one of
the reasons why they default on treatment (District TB
focal person, IDI).
...Dropping out of treatment do not happened only
with the orthodox medication but also with our herbal
medication too. ...the reason is that when the patients are
treated for some time, their condition imp roves then they
think that they a re cured. ...some people natura lly do not
like taking medicine and have to be forced to take it. For
such people, once their condition gets better they will
definitely stop coming for the medication (Male Tradi-
tional Healer, IDI).
3.9. Reasons for Not Attending
clinic/Hospital with TB
Formal health workers interviewed reported that sus-
pected TB cases were going to traditional healers instead
of the clinic/hospital because of the persistent belief that
TB is caused by witches. This was represented in the
following narrative:
Our culture made people to think that TB is caused by
witchcraft or other malevolent spirits; hence their pref-
erence for traditional healing practices (Hospital Labo-
ratory Tech nician, IDI).
I think that religious believes are also affecting the
rate at which suspected TB patients come to the clinic
because they sometimes believe that TB can be cured
through prayers from Muslim healers (Malam s) (Com-
munity health nurse, IDI).
3.10. Case Detection and Treatment
Case detection and treatment is hampered by the fact
that there is no facility at the sub-district levels for test-
ing suspected patients. Also, drugs are received from the
district level only when a case has been confirmed at the
District hospital. Staff at the sub-district level have la-
mented that most specimen sent to the district hospital
for testing either have no results send to them or takes so
long before the result are sent to them and this was put-
ting probable patients way from reporting at their fa-
cilities. They maintained that, it was making things dif-
ficult for them, especially when they do not know what
to do for the patients without the test result. The follow-
ing narratives captured in detail the difficulty that pe-
riphery facilities go through to diagnose and treat TB.
In fact there are many problems with the way we treat
suspected TB cases here. In the first place the people are
unwilling to come because of stigmatisation but the few
that come to us also have to wait for a long time before
getting into treatment because we have to wait for the
test result from Tumu. You see this young girl (pointing to
the girl); it took more than one year to get her into
treatment because we did not get the laboratory result
from Tumu. ...the patient kept coming to me ...I sent an-
other sample and this time, nothing was heard from
Tumu about it. ...about three month ago I sent a third
sample ...I followed it up on every market day until about
two weeks ago when I received the test result and it was
positive. ...she is now on drug and looking a bit better
now. How can you explain this situation to suspected TB
patients? (A nurse: in charge of a sub-district facility,
3.11. Financial and Social Support
Majority (70.5%) of the survey respondents said they
were being supported by their spouse and other family
members in various ways, especially financial and social
supports (Table 3). The three most important decision
makers during illness in the Sissala East Districts were
parents (54.1%), the sick person himself (27.9%) and
spouse (21.3%).
The results show that people with suspected cough and
other community members as well as traditional healers
were awa re that TB cou ld be treated at biomedical health
facilities. However, people who have coughed for more
than 14 days (suspected TB cases) were not going to the
health facilities for diagnosis and treatment ([6,7,10],
gmj 2008, phm 2009). Various reasons could be assigned
to this behaviour; however from our results three main
Copyright © 2013 SciRes. OPEN ACCE SS
C. K. Ahorlu, F. Bonsu / Journal of Tuberculosis Research 1 (2013) 29-36 35
Table 3. Sources of financial support available to suspected TB
(Sources of Financial Support) Frequency** Percentage
Parents 41 67.2
Self 24 39.3
Spouse 15 24.6
Adult children 14 23.0
Extended family members 12 19.7
Friends 4 6.6
Religious affiliations 1 1.6
*Multiple choices allowed; **Sorted in descending order in column 2.
reasons clearly stood out. The first one was the fear of
stigmatization both by community members and health
care providers. Community members presumed every
suspected TB patient to be suffering from HIV/AIDS, a
condition that is even more stigmatized than TB in the
study area ([16], Weiss 2006) and similar findings were
reported from elsewhere [12,13] It is good for health care
providers to protect themselves against infections but
when this is done in ways that cause some discomfort to
patients then it may serve as a disincentive for seeking
health at health facilities ([13-15], g mj 2008, phm 2009).
Secondly, the lack of effective communication be-
tween the peripheral facilities and the laboratory at the
district hospital, where the results for samples from the
periphery facilities are not communicated on time and in
some cases not communicated at all, could also be af-
fecting the confidence of suspected patients in the health
care facilities since the laboratory results are needed for
the initiation of treatment or otherwise. This may also
affect health care providers at the periphery facilities as
they may not be encourag ed to send more samples to the
district laboratory.
Thirdly, the availability of traditional healers to man-
age suspected TB cases either rightly or wrongly may be
keeping suspected patients away from the health care
facilities because they share a common worldview and
local beliefs with suspected patients, which makes them
more attractive ([6,10], Dodo r 2008).
While the men reported that there was no gender dif-
ferences in the distresses suffered by TB patients; most
of the ladies, especially during FGD sessions, said there
were some gender differences in TB-related distresses in
the community. These differences must therefore be
taken seriously and dealt with when working on TB
stigma reduction in the district. This findings show how
quantitative data alone could not clearly bring out the
features of stigma and other distresses associated with
TB, especially among women in a male dominated envi-
Both health care providers and healers complained of
high treatment dropout among TB patients. This must be
addressed through patients’ education and support system.
The need and importance of completing treatment to
reduce the risk of the emergence of drug resistance must
be emphasized ([6,10], Dodor, 2008, gmj 2008, phm
2009). The dangers and benefits associated with treat-
ment dropout must be drummed home in ant TB-related
health education programme in the study area.
The introduction of community-based DOT for TB
treatment was endorsed by respondents. However, this
must be implemented by training volunteers sufficiently
enough not only to deliver and supervise medication but
also to identify suspected cases and support them to re-
port at designated health care facilities. This may b e use-
ful considering the distance some patients have to cover
to access health services as this will reduce the travel
cost to the patients and family caretakers and thereby
improve treatment adherence [1].
TB patients, apart from the stigma also suffer from
lack of income due to reduce capacity to work. TB also
damage intimate relationships since women with sus-
pected TB were not allowed to have sex with their hus-
bands and this could lead to divorce and neglect which
will further exacerbate the suffering of the patient [6,10].
The understanding of TB as a deadly disease should
serve as an entry point to encourage appropriate health
seeking behaviour for suspected TB patients. To be suc-
cessful, however there is the need to emphasise the point
that TB could become deadly only if it is not treated at
the clinic/hospital appropriately early. Also, the avail-
ability of effective treatment at health facilities must be
promoted. The need to ex pand laboratory facilities to the
periphery facilities could not be overemphasized as this
greatly affects the time of first health seeking for sus-
pected TB and the start of the actual treatment. The
situations where laboratory results take months to be
made available to the periphery facilities cannot be al-
lowed to persist if the current control measures are to
make headway as expected.
Although this study did not verify the claim by tradi-
tional healers that they could cure TB, the control pro-
gramme should find a co llaborative wa y to use healers to
gain access to suspected TB patients. This is because the
people will continue to visit traditional healers as the
local perception of TB naturally favours the use of the
services of traditional healers. There is ther efo re th e n eed
for vigorous health education to inform the people about
the biomedical causes of TB and the availability of ap-
propriate treatment for the disease at health facilities.
However, the education should not aim at changing the
Copyright © 2013 SciRes. OPEN ACC ESS
C. K. Ahorlu, F. Bonsu / Journal of Tuberculosis Research 1 (2013) 29-36
Copyright © 2013 SciRes.
[10] Dodor, E.A. (2008) Health professionals expose TB pa-
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biomedical causes and see TB as treatable infection,
which could be controlled.
[11] Doror, E.A., Kelly, S. and Neal, K. (2009) Health profes-
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district in Ghana. Psychology, Health & Medicine, 14,
301-310. http://dx.doi.org/10.1080/13548500902730127
We are grateful to the Sissala East District Health Ad ministration for
collaborating with us on this study. We sincerely thank the community
assistants and the two research assistants who conducted the interviews
and performed translation during qualitative data collection for their
assistance on the field. Thanks to professor Koram for his support and
Cynthia Ahorlu for data entry and secretarial support. Many thanks to
the chiefs and people of the study area especially the respondents.
Financial support was provided by the Ghana National TB Control
Programme, Ghana Health Service, Accra.
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