Skip to main content
Home / Public Health Action, Volume 12, Number 4

Open Access Facilitators and barriers to TB care during the COVID-19 pandemic

Download Article:
BACKGROUND: Knowledge about factors influencing access and adherence to TB care, and on the impact of the COVID-19 pandemic on TB care in resource-restricted settings is scarce. We conducted this study in Atsimo-Andrefana, a rural region in southern Madagascar where TB prevalence, poverty and food insecurity rates are high. We aimed to determine facilitators and barriers to access to and provision of TB care in rural Madagascar during the COVID-19 pandemic.

METHODS: We conducted qualitative focus group discussions (FGDs) and in-depth interviews (IDIs) with patients with TB, community health workers, facility-based health workers, public health officials and non-governmental organisation staff. We analysed interviews using thematic analysis.

RESULTS: We conducted 11 FGDs and 23 IDIs. We identified three main barriers to access and adherence to TB care: 1) stigma, 2) indirect treatment costs, and 3) food insecurity. The facilitator perceived as most influential was high health worker motivation. The effects of the COVID-19 pandemic on TB care varied between stake-holders; some health workers described delays in TB diagnosis and increased workload.

CONCLUSIONS: To improve access and adherence to TB care, both indirect treatment costs and stigma need to be reduced; undernourished patients with TB should receive food support.

Keywords: Sars-CoV-2; respiratory disease; sub-Saharan Africa

Document Type: Research Article

Affiliations: 1: Charité Global Health, Charité - Universitätsmedizin, Berlin, Germany, Doctors for Madagascar, Antananarivo, Madagascar 2: Charité Global Health, Charité - Universitätsmedizin, Berlin, Germany 3: Doctors for Madagascar, Antananarivo, Madagascar 4: Charité Global Health, Charité - Universitätsmedizin, Berlin, Germany, Doctors for Madagascar, Antananarivo, Madagascar, Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin, Berlin, Germany, Berlin Institute of Health, Berlin, Germany 5: Charité Global Health, Charité - Universitätsmedizin, Berlin, Germany, Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany, Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin, Berlin, Germany

Publication date: December 21, 2022

More about this publication?

  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

  • Editorial Board
  • Information for Authors
  • International Journal of Tuberculosis and Lung Disease
  • Public Health Action
  • Ingenta Connect is not responsible for the content or availability of external websites

Share Content

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content