Open Access Highly Accessed Research article

Assessing the impact of multidrug-resistant tuberculosis in children: an exploratory qualitative study

Caroline Franck125*, James A Seddon23, Anneke C Hesseling2, H Simon Schaaf2, Donald Skinner4 and Lucy Reynolds1

Author Affiliations

1 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

2 Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

3 Department of Paediatric Infectious Diseases, Imperial College London, London, UK

4 Unit for Research on Health & Society, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

5 Current Address: Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste-Catherine Road, Suite H-453, Montreal, H3T 1E2, QC, Canada

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BMC Infectious Diseases 2014, 14:426  doi:10.1186/1471-2334-14-426

Published: 1 August 2014

Abstract

Background

While the prevalence of multidrug-resistant (MDR) tuberculosis (TB) is high among children in the Western Cape of South Africa, the psychosocial implications of treatment for children with MDR-TB remain poorly understood. We sought to explore how MDR-TB and its treatment impact children on an individual, familial, and social level.

Methods

Semi-structured interviews were conducted with 20 children and caregivers purposively sampled from a prospective clinical cohort of children. The sample was stratified by age at the start of treatment (children >10 years, and 5-10 years). Caregiver proxy interviews were conducted with younger children, supplemented with child interviews; older children were interviewed directly, supplemented with caregiver proxy interviews. Data were analysed using grounded theory.

Results

Findings revealed pill volume and adverse effects produced significant physical, psychological and academic disturbances in children. Adverse effects related to the medication were important obstacles to treatment adherence. While there appear to be no long-lasting effects in younger children, a few older children showed evidence of persisting internalised stigma. Caregivers suffered important treatment-related financial and psychological costs. Community support, notably through the continued involvement of children in strong social networks, promoted resilience among children and their families.

Conclusions

We found that the current treatment regimen for childhood MDR-TB has significant psychological, academic, and financial impacts on children and their families. There is a need for psychosocial support of children and caregivers to mitigate the negative effects of community stigma, and to manage the stressors associated with chronic illness.

Keywords:
South Africa; Childhood MDR-TB; Psychosocial impact; Qualitative research