Exploring the Socio-cultural Dynamics of Treatment Adherence amongst Females living with Pulmonary Tuberculosis in Karachi, Pakistan

Abstract

Background & Objective: Pakistan ranks fifth amongst thirty high-burden TB countries and fourth-highest in prevalence of multi-drug resistant TB. Despite higher TB rates among men, women disproportionately experience unsuccessful treatment outcomes.  The National TB-Control Program despite its contributions has not adequately addressed underlying grassroots factors, particularly those impacting women, that contribute to poor treatment-outcomes. Thus the objective is to explore socio-cultural and grassroots factors influencing treatment non-adherence amongst females living with Pulmonary TB.

Methods: A qualitative Phenomenological design was adopted. Twelve in-depth interviews were conducted at a TB Clinic in Karachi (from February to May 2020) with participants including (i) females living with Pulmonary TB and (ii) healthcare providers engaged in TB service-provision. Interviews were semi-structured and conducted in-person. Data was analyzed inductively using thematic analysis.

Results: Three themes contributing to treatment non-adherence emerged, which are: A) The burden of home-making with sub-themes of a culture of matriarchy, traditional household norms, and intended non-disclosure of TB status; B) The journey of pursing treatment with subthemes of challenges in accessing diagnostic services, barriers in treatment adherence/continuation, unique treatment-related misconceptions; and C) TB myths with subthemes emphasizing local rumors and an inherent lack of trust in public healthcare services.

Conclusion: This study reveals important grassroots, socio-cultural and physical barriers to treatment adherence among women, including gender, social norms and treatment demands. Addressing these requires a holistic approach prioritizing community empowerment with a focus on understanding day-to-day lived experiences of TB and enhancing healthcare provider capacity.