TB questions, East Kwaio answers: community-based participatory research in a remote area of Solomon Islands

Abstract

A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2Results: Four interviews and a focus group of 12 key informants were conducted and a mountain hamlet with a history of TB was visited. The results represent the data from the interviews and the focus group. The time delay in presenting to the Hospital from when participants first became unwell ranged between two and three years. In the mountain hamlet, two additional people with probable TB were seen who had not presented to the Hospital during illnesses of five and nine months. Reasons for delays included: seeking care from traditional healers; the challenge of accessing health services due to distance, cost and cultural issues different from the Hospital's worldview; social isolation when in hospital; and being old so not having long to live. Delays in diagnosis of people with TB will increase the risk of transmission to family and through hamlets and villages. This study has led to plans being developed to build a more culturally appropriate TB ward and community treatment program. Conclusions: The study has identified TB questions that need East Kwaio answers. It has shown that a small project can inform the development of important changes to TB services, such as the redevelopment and relocation of the TB ward. To enable TB control, the local health services need to develop an understanding of, and appropriately engage with, traditional beliefs that influence how people interact with Hospital TB treatment and management. This is the case even if the beliefs are based on a worldview different than that of the health service providers. Ongoing operational research is required into TB diagnosis and treatment services and the many factors that contribute to the high TB burden in this remote area.

Time to diagnosis and treatment of pulmonary tuberculosis in indigenous peoples: a systematic review

“…Studies that received ‘poor’ ratings for ethics/bias did not state ethics [ 32 – 34 ] and/or limited their discussions of bias related to methods and data collected. Some studies used convenience or purposive samples [ 3 , 32 , 35 , 36 ] and others required more sampling [ 28 , 34 , 37 – 39 ], which impacted the bias, transferability, and generalizability of results. Remoteness and heterogeneity of Indigenous communities within and across regions is an additional limitation to generalizing results from observational studies.…”

“…2 A forest plot that describes the distribution of estimate types related to time to diagnosis and/or treatment of TB among Indigenous peoples across literature included in the systematic review. a) Acronyms: pulmonary TB (PTB), smear positive pulmonary TB (S + PTB), and pulmonary and extrapulmonary TB (PTB & EPTB), b) Distribution was reconstructed to determine the interquartile range, median, and/or range values [ 30 , 32 , 35 ], c) Interval with no point estimate, represents a range [ 31 , 32 , 36 ], and d) Interquartile ranges were used to describe the spread for median values except in Basa et al and Hussen et al [ 37 , 41 ], which was reported as a range …”

“…Uncertainty of point estimates was either reported or reconstructed from data [ 35 ] within the study (if available) in 8 out of 23 studies (35%). Three studies reported a range without a point estimate [ 31 , 32 , 36 ]. Two studies reported range values (instead of IQR) with a median point estimate [ 37 , 41 ].…”

“…Among studies that reported ranges, the greatest variability was observed in patient and total delay estimates. One study, conducted in the Solomon Islands, reported patient delays of between two and three years [ 36 ]. Seeking care from traditional healers, inaccessibility of healthcare due to remoteness, and cost were some of the factors explaining significantly longer patient delays compared to other studies.…”

“…The estimated total (24–240 days), patient (20 days–2.5 years), and health system (3–34 days) delay for Indigenous peoples were within previously reported ranges that focused on PTB in low, middle, and high-income countries in the general population [ 10 , 11 , 44 , 45 ]. One study estimating patient delay (2–3 years) that fell outside this range was conducted in the Solomon Islands, an extremely remote community with barriers to healthcare access due to distance, cost, and preference for traditional practices [ 36 ]. Over 60% of disaggregated studies described longer patient and/or total delay among Indigenous peoples compared to non-Indigenous persons despite shared socioeconomic challenges faced in medium (15–29 cases per 100,000 population) and high (> 30 cases per 100,000 population) TB incidence countries [ 45 , 46 ].…”