Knowledge, beliefs, and perceptions of tuberculosis among community members in Ntcheu district, Malawi

Peter Nyasulu,1,2 Simon Sikwese,2,3 Tobias Chirwa,2 Chandra Makanjee,4 Madalitso Mmanga,5 Joseph Omoniyi Babalola,6 James Mpunga,7 Hastings T Banda,8 Adamson S Muula,9,10 Alister C Munthali11 1Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 2School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 3Pakachere Institute of Health and Development Communication, Blantyre, Malawi; 4Department of Medical Radiation Sciences, University of Canberra, Canberra, WA, Australia; 5District TB Office, Department of Environmental Health, District Health Office, Ntcheu, Malawi; 6Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 7National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, 8Research for Equity and Community Health (REACH) Trust, Lilongwe, 9Department of Community Health, College of Medicine, University of Malawi, Blantyre, 10African Centre of Excellence in Public Health and Herbal Medicine, College of Medicine, University of Malawi, Blantyre, 11Centre for Social Research, University of Malawi, Zomba, Malawi Introduction: The global burden of tuberculosis (TB) remains significantly high, with overreliance on biomedical interventions and inadequate exploration of the socioeconomic and cultural context of the infected population. A desired reduction in disease burden can be enhanced through a broader theoretical understanding of people’s health beliefs and concerns about TB. In this qualitative study, we explore the knowledge, beliefs, and perceptions of community members and people diagnosed with TB toward TB in Ntcheu district, Malawi. Methods: Using a qualitative phenomenological study design, data were obtained from eight focus-group discussions and 16 individual in-depth interviews. The community’s experiences and perceptions of TB were captured without using any preconceived framework. Adult participants who had had or never had a diagnosis of TB were purposively selected by sex and age and enrolled for the study. Discussions and individual interviews lasting about 60 minutes each were audiotaped, transcribed, and translated into English and analyzed using MaxQDA 10 software for qualitative analysis. Results: Most participants believed that TB was curable and would go for diagnosis if they had symptoms suggestive of the disease. However, based on their beliefs, individuals expressed some apprehension about the spread of TB and the social implications of being diagnosed with the disease. This perception affected participants’ responses about seeking diagnosis and treatment. Conclusion: A supportive and collective approach consisting of a combination of mass media, interactive communication campaigns, emphasizing TB symptoms, transmission, and stigma could be useful in addressing barriers to early diagnosis and care-seeking behavior. Keywords: tuberculosis, knowledge, perception of TB, beliefs, Ntcheu, Malaw