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'That's when I struggle' … Exploring challenges faced by care givers of children with tuberculosis in Botswana
C H Stillson1, H Okatch2, R Frasso3
1University of Pennsylvania, Philadelphia, USA; Center for Public Health Initiatives and Master of Public Health Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Caregivers of children undergoing tuberculosis treatment in Botswana face significant challenges, including diagnostic delays and medication access. Addressing these issues can improve the national TB program for better child and caregiver support.
Area of Science:
- Public Health
- Pediatric Tuberculosis
- Health Services Research
Background:
- Botswana's National TB Programme (NTP) aims to provide comprehensive tuberculosis care.
- Challenges faced by caregivers of children undergoing TB treatment can impact treatment adherence and outcomes.
- A child- and caregiver-centered approach is crucial for effective TB management in pediatric populations.
Purpose of the Study:
- To explore the challenges encountered by caregivers of children receiving tuberculosis treatment in Gaborone, Botswana.
- To identify key areas for improving Botswana's National TB Programme (NTP) strategy to be more child-friendly.
- To inform programmatic adjustments for enhanced pediatric TB care.
Main Methods:
- Qualitative study design utilizing in-depth interviews.
- Conducted 28 interviews with caregivers of children undergoing anti-tuberculosis treatment.
- Focus on understanding caregiver experiences within public health clinics.
Main Results:
- Caregivers reported significant challenges including diagnostic delays, difficulties with daily clinic attendance, and medication administration.
- Treatment interruptions due to medication stock-outs and inadequate patient education were also identified.
- Caregivers prioritized these five areas for improving the management of pediatric tuberculosis.
Conclusions:
- Despite adherence to WHO guidelines, caregivers face substantial obstacles in pediatric TB treatment in Botswana.
- Systematic and programmatic adjustments can effectively address these challenges to improve treatment outcomes.
- Findings will guide the revision of Botswana's NTP guidelines towards a more child- and caregiver-centered strategy.
Setting:
Government-funded public health clinics in and around Gaborone, Botswana.
Objective:
To explore the challenges faced by care givers of children on treatment for tuberculosis (TB) to inform a more child-friendly approach to Botswana's National TB Programme (NTP) strategy.
Design:
Qualitative study using 28 in-depth interviews with care givers of children receiving anti-tuberculosis treatment.
Results:
Care givers identified five main challenges: long delays in their child's diagnosis, difficulty attending clinic for daily treatment, difficulty administering TB medications, stock-outs of TB medications leading to treatment interruptions, and inadequate TB education. Care givers prioritized these same five areas to improve the overall management of their child's TB.
Conclusion:
Our findings suggest that despite accessing care through an NTP that adheres to World Health Organization guidelines, care givers for children on treatment in Botswana continue to encounter significant challenges. While each of these represents a potential threat to successful treatment, they can be addressed with relatively small systematic and programmatic adjustments. These results will inform the next version of the Botswana NTP guidelines towards a more child- and care giver-centered approach.
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