Open Access Research article

Care seeking and attitudes towards treatment compliance by newly enrolled tuberculosis patients in the district treatment programme in rural western Kenya: a qualitative study

John G Ayisi12*, Anna H van't Hoog34, Janet A Agaya3, Walter Mchembere3, Peter O Nyamthimba3, Odylia Muhenje5 and Barbara J Marston6

Author Affiliations

1 Centre for Global Health Research, Kenya Medical Research Institute, Kisumu-Maseno Rd, Kisian, P.O. Box 1578, Kisumu - 40100, Kenya

2 Directorate of Research Management and Development, Ministry of Higher Education, Science and Technology, Utalii House, Uhuru Highway, P.O. Box 30568, Nairobi - 00100, Kenya

3 Kenya Medical Research Institute, KEMRI/CDC Research and Collaboration programme, Kisumu-Maseno Rd, Kisian, P.O. Box 1578, Kisumu - 40100, Kenya

4 Department of Clinical Epidemiology (KEBB) J1B.207-1, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands

5 Global AIDS Programme, US Centres for Disease Control and Prevention, P.O. Box 54840, Nairobi - 00200, Kenya

6 Global AIDS Programme, Center for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, USA

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BMC Public Health 2011, 11:515  doi:10.1186/1471-2458-11-515

Published: 29 June 2011



The two issues mostly affecting the success of tuberculosis (TB) control programmes are delay in presentation and non-adherence to treatment. It is important to understand the factors that contribute to these issues, particularly in resource limited settings, where rates of tuberculosis are high. The objective of this study is to assess health-seeking behaviour and health care experiences among persons with pulmonary tuberculosis, and identify the reasons patients might not complete their treatment.


We performed qualitative one-on-one in-depth interviews with pulmonary tuberculosis patients in nine health facilities in rural western Kenya. Thirty-one patients, 18 women and 13 men, participated in the study. All reside in an area of western Kenya with a Health and Demographic Surveillance System (HDSS). They had attended treatment for up to 4 weeks on scheduled TB clinic days in September and October 2005.

The nine sites all provide diagnostic and treatment services. Eight of the facilities were public (3 hospitals and 5 health centres) and one was a mission health centre.


Most patients initially self-treated with herbal remedies or drugs purchased from kiosks or pharmacies before seeking professional care. The reported time from initial symptoms to TB diagnosis ranged from 3 weeks to 9 years. Misinterpretation of early symptoms and financial constraints were the most common reasons reported for the delay.

We also explored potential reasons that patients might discontinue their treatment before completing it. Reasons included being unaware of the duration of TB treatment, stopping treatment once symptoms subsided, and lack of family support.


This qualitative study highlighted important challenges to TB control in rural western Kenya, and provided useful information that was further validated in a quantitative study in the same area.

health-seeking; tuberculosis; diagnosis; delay; qualitative