Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon

Cremers, Anne Lia; Janssen, Saskia; Huson, Michaëla A. M.; Bikene, G.; Bélard, Sabine; Gerrets, René; Grobusch, M. P.

doi:10.5588/pha.13.0038

Cited by 27 publications

(21 citation statements)

References 18 publications

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“…Reasons for late presentation in Gabon were suggested to be stigma, costs, and cultural in terms of patients commonly seeking medical help in herbal medicines, at pharmacies, or with traditional healers. 15,18 Late presentation and delay in diagnosis of pulmonary TB (PTB) translates into increased transmission in the community, which remains a widespread problem and a major challenge for effective TB control. 19 In this study, late presentation was also a risk factor positively correlated with being lost to follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…2 On the other hand, patient-centered reasons are prevalent as well; such as economic barriers and lack in health education and different perceptions of disease and TB, leading to competing health-care seeking behavior toward traditional healers. 18 Although health-care system deficiencies may be easier to address, improving patient's awareness and understanding of TB and its successful management will be more challenging.…”

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confidence: 99%

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Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study

Bélard

Remppis

Bootsma

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Despite overall global progress in tuberculosis (TB) control, TB remains one of the deadliest communicable diseases. This study prospectively assessed TB epidemiology in Lambaréné, Gabon, a Central African country ranking 10th in terms of TB incidence rate in the 2014 World Health Organization TB report. In Lambaréné, between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up; 66% had bacteriologically confirmed TB and 95% had pulmonary TB. The human immunodeficiency virus (HIV) coinfection rate was 42% in adults and 16% in children. Mycobacterium tuberculosis and Mycobacterium africanum were identified in 82% and 16% of 108 culture-confirmed TB cases, respectively. Isoniazid (INH) and streptomycin yielded the highest resistance rates (13% and 12%, respectively). The multidrug resistant TB (MDR-TB) rate was 4/91 (4%) and 4/13 (31%) in new and retreatment TB cases, respectively. Treatment success was achieved in 53% of patients. In TB/HIV coinfected patients, mortality rate was 25%. In this setting, TB epidemiology is characterized by a high rate of TB/HIV coinfection and low treatment success rates. MDR-TB is a major public health concern; the need to step-up in-country diagnostic capacity for culture and drug susceptibility testing as well as access to second-line TB drugs urgently requires action.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study

Bélard

Remppis

Bootsma

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…Scholarship surrounding the clinical recognition of and interventions for frailty often fails to factor in older adults' perceptions of the term (Manthorpe & Iliffe., ). This is important in the light of the fact that perceptions of health can have significant effect on health‐seeking behaviour (Cremers et al, ; Wanyenze et al, ) and progression of illness (Petrie, Jago, & Devcich, ), with negative health perception being an established risk factor for frailty (Pegorari & Tavares, ). A systematic review by Warmoth, Lang, et al, found negative perceptions towards ageing in older adults were associated with poorer health outcomes across multiple health domains including health/well‐being and quality of life; disability and functioning; physical performance; cognitive performance; medical conditions and outcomes; healthy behaviours; and mortality.…”

Section: Introductionmentioning

confidence: 99%

Resilience, not frailty: A qualitative study of the perceptions of older adults towards “frailty”

Pan

Bloomfield

Boyd

2019

Int J Older People Nursing

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Background Despite increasing importance placed upon the identification of frailty among the older population, scholarship is limited around the perception of older adults towards the term. This qualitative study aimed to investigate the perceptions of older adults in a New Zealand setting towards the term “frail”. Methods Twelve participants identified as frail based on unrelated comprehensive geriatric assessment were approached and interviewed in their own homes. Interviews were transcribed ad verbatim and analysed by general inductive approach. Results There was a diverse conceptualisation of frailty among the participants, across physical, cognitive and social dimensions, which differed from professional definitions of frailty. Participants maintained a neutral stance towards the concept of frailty and, however, reject its application to themselves. They also highlight the importance of independence and resilience in the staving off of frailty and the maintenance of quality of life. Conclusion This study suggests health professionals should shift focus on clinical encounters with the older patient, away from the deficits of frailty and towards independence, resilience and autonomy. Implications for practice Frail older adults often reject the term frailty when used about themselves, therefore using this term in communication with older adults may have negative consequences.

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“…In 2012, I conducted five months of ethnographic fieldwork in and around Lambaréné, Gabon (Cremers et al 2013), with assistance from Grace Bikene, a local researcher. Aiming to explore how TB patients navigated a medically plural landscape, I approached thirty patients who were undertaking TB treatment either at the Albert Schweitzer Hospital (ASH), the regional government hospital, or at the government's ambulatory health care centre for human immunodeficiency virus (HIV) and TB (GAHC).…”

Section: Methods and Settingmentioning

confidence: 99%

“…According to the World Health Organization (2019), two-thirds of TB patients who do not take biomedical treatment will die. The Gabonese National Tuberculosis Programme (NTP) provided treatment for free, but hospitals faced repeated drug stock-outs (Cremers et al 2013;Belard et al 2015), which sometimes persisted for several months. At the time of this study, there were no diagnostic facilities to diagnose resistance to first-line drugs.…”

Section: Medical Pluralism and Tuberculosis In Gabonmentioning

confidence: 99%

Medical pluralism, boundary making, and tuberculosis in Lambaréné, Gabon

Cremers¹

2019

MAT

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Scholars of medical pluralism are interested in how healers position themselves and their healing practices within a therapeutic landscape, and how patients navigate an array of therapeutic traditions. Based on fieldwork in Lambaréné, Gabon, this article examines the discursive practices of tuberculosis patients and healers, finding that therapeutic traditions were kept separate. Examining a national programme that fosters traditional medicine, I show how the Gabonese government engages in practices of boundary making by reinforcing traditional healers’ position within the Gabonese therapeutic landscape. This research confirms popular paradigms of boundary making within the medical pluralism debate, wherein boundaries are produced and crossed to contrast, strengthen, purify, and divide the therapeutic landscape. Additionally, formal state-sponsored discursive practices refer to a merging of traditional medicine and biomedical medicine. This stands in contrast with patients’ and healers’ discursive practices, and their wariness of fluid or adaptive boundary-making processes. To explain this, I introduce the concept of ‘conventional boundary making’ and then analyse it in the context of tuberculosis and in relation to theories of state power, Gabonese therapeutic identity politics, and structural violence.

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Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon

Cited by 27 publications

References 18 publications

Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study

Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study

Resilience, not frailty: A qualitative study of the perceptions of older adults towards “frailty”

Medical pluralism, boundary making, and tuberculosis in Lambaréné, Gabon

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