Stop TB Partnership

Target TB funded research discovers barriers faced by women seeking TB healthcare.

1st April 2015 - UK based NGO Target Tuberculosis (TB) has received results from a research project carried out by Moses K. Kumwenda in Malawi, entitled ‘Barriers women face when seeking formal TB healthcare in a resource constrained setting, Balaka District, Malawi’.

TB is a major public health problem in Malawi, and the current national strategy relies on passive TB case finding or self-presentation of a patient to a facility. Target TB, UK has been working with Sue Ryder Foundation in Malawi (SRFIM) and Balaka District Health Office on an innovative project which integrates TB symptom screening with routine antenatal and under-5 clinics. During the first year of implementation we found that less than 50% of women with presumptive TB failed to return to submit a second sputum sample for diagnosis. The research aimed to investigate the barriers that women face when seeking a TB diagnosis and the reasons why women fail to submit the second sample. Data were collected using focus group discussions with health care workers (HCWs) and health facility attendees of both genders. Interviews were also carried out with women who failed to bring the second sputum sample.

The research found barriers faced by women at the health system, HCW, socio-economic, and cultural levels. Health system barriers included overcrowding in public health facilities, inadequate staff numbers, lacks of resources and equipment, lengthy process of diagnosis, and poor service organisation. HCW barriers included unprofessional conduct, poor listening skills, and nepotistic and corrupt tendencies. Socio-economic barriers included distance and transport costs, relationship factors, stigma, and a lack of social support. Cultural barriers included traditional and religious beliefs and practices. These barriers do not work in isolation but interact to impede women seeking formal TB healthcare. The reasons given for failing to submit the second sample included high transport costs of repeat visits, poor relationship dynamics with a partner, fear of treatment and HIV diagnosis, and the failure to produce a sputum sample.

In order to address these barriers, suggested solutions included strengthening patient support systems, carrying out sample collection at the village level, engaging the community through sensitization and engagement, controlling local vending of drugs, greater support from HCWs, and the potential for same-day sputum sample submission. An additional research study is being carried out in Balaka District into the potential for same-day microscopy. The research aims to find out whether the same-day approach is equally effective as the standard approach, by testing presumptive TB patients both on the same day, and following the usual routine diagnostic procedure. The findings of this research should be available in August 2015.

To read the full findings of the research go to