“Honestly, this problem has affected me a lot”: A qualitative exploration of the socioeconomic impacts of chronic respiratory disease among people and their communities in Sudan and Tanzania

Abstract

BackgroundOver 500 million people live with chronic respiratory diseases globally and approximately 4 million of these, mostly from the low- and middle-income countries including sub-Saharan Africa, die prematurely every year. Despite high CRD morbidity and mortality, little is known about the socioeconomic impact of CRDs in sub-Saharan Africa. We aimed to gain an in-depth understanding of the socioeconomic impact of CRDs among people with CRD to inform management of CRDs in Sudan and Tanzania. MethodWe conducted in-depth interviews with people with known or suspected CRD and focus group discussions with members of the community in Gezira state, Sudan and Dodoma region, Tanzania, to share their understanding and experience with CRD. The data was analyzed using thematic framework analysis. ResultsPeople with CRD in both contexts reported a significantly diminished capacity to do hard physical work, resulting in both direct and indirect economic impacts for them and their families. Direct costs were incurred while seeking healthcare, including expenditures on transportation to the health facility and procurement of diagnostic tests and treatments, whilst loss of working hours and jobs resulted in substantial indirect costs. Enacted and internalized stigma leading to withdrawal and social exclusion was described by participants and resulted in part from association of chronic cough with tuberculosis and HIV/AIDS. In Sudan, asthma was described as having a negative impact on marital prospects for young women and non-disclosure related to stigma was a particular issue for young people. Impaired community participation and restrictions on social activity led to psychological stress for both people with CRD and their families. ConclusionChronic respiratory diseases have substantial social and economic impacts among people with CRD and their families in Sudan and Tanzania. Stigma is particularly strong and appears to be driven in part by association of chronic cough with infectiousness. Context-appropriate measures to address economic impacts and chronic cough stigma are urgently needed as part of interventions to address chronic respiratory diseases in these sub-Saharan African contexts.

Burden of respiratory problems in low-income and middle-income countries

“…A qualitative study exploring the experiences of people living with CRDs in Sudan and Tanzania [25 ▪ ] found significantly diminished capacity for hard physical work, resulting in direct and indirect costs for them and their families. Direct costs related to provision of care, including transportation to/from health facilities and payments for diagnostic tests and treatments.…”