Can District-Level tuberculosis case-finding in Malawi be improved? a qualitative study of healthcare worker perceptions in Dedza District

Objectives: This study aimed to identify, from healthcare as major workers’ (HCWs’) perspectives, barriers to tuberculosis (TB) case-finding that can be targeted to aid rapid TB diagnosis within Dedza district.

Design: In-depth interviews were conducted with staffroutinely involved in the diagnosis and treatment of TB patients. Those identified worked at the district hospital or community healthcare centres. Results: There was a consensus amongst HCWs that barriers to TB case-finding in the district health system include logistical problems. HCWs identified the tendency of patients with TB to seek traditional and private healthcare services, the association of TB with HIV/AIDS. difficulties in traveling to healthcare facilities and poverty patient-related barriers to diagnosis.

Conclusion: This study identified perceptions of both health system and patient-related barriers to TB case-finding. Health-system related barriers hightight the need to further integrate TB case-finding into routine district service provision, particularly at peripheral health units. The Malawi National TB Programme and District Health Management Team must share responsibility for overcoming such barriers. There are also broader implications for providing healthcare in general and preventing the exclusion of certain members of the population from health services.