Getting the message across: Characterizing a need to bridge public health messaging for tuberculosis across a rural/urban and CHW/traditional healer divide in Madagascar (A review)

The urgent need and extremely limited resources available for public health messaging to prevent and treat tuberculosis (TB) in Madagascar mandates a search for identifying additional low- or no-cost channels able to deliver such information to the widest demographic of urban and rural message recipients alike. However, despite increased interactions between community health workers (CHWs) and indigenous/traditional healers (ITHs) as one such potential channel for cost-effectively amplifying public health messaging, a review of the public messaging literature for TB in Madagascar yielded effectively no studies addressing this potential. A main finding of this study, then, was identification of three key divides (urban/rural, western/traditional, and male/female) that impact interactions between CHWs and ITHs and thus the capacity for message delivery. Recommendations for how to bridge these key divides in order to increase the reach of TB public health information in Madagascar are discussed.