Tuberculosis Causation, Misconceptions and Health Seeking Behavior Among Beneficiaries of Integrated Tuberculosis, Mental Health and Substance Use Disorder Services in Nigeria; A Qualitative Study

Tuberculosis (TB) is a preventable and curable disease. It is an infectious disease caused by a bacterium, Mycobacterium tuberculosis complex. It has been posited that the perception of TB and knowledge associated with the disease shape health seeking behavior. This study was designed to assess the knowledge of the cause of TB/mental health disorders and the health seeking behaviors among beneficiaries of an integrated service delivery of TB, mental health (MH) and substance use disorder (SUD) in Nigeria. This was a community-based cross-sectional study using an exploratory qualitative approach. A pre-tested focus group discussion (FGD) guide was used to collect information from the participants. The study took place in three states in Nigeria: Nasarawa, Enugu and Anambra states. Twelve FGDs were conducted involving a total of one hundred and sixteen participants. Participants in the study were patients that were treated during the integrated service delivery (ISD) for TB/MH/SUD and their relatives. Four FGDs were conducted in each of the three states included in the study. There were separate discussions for the male and female participants as well as for the patients and their relatives. QDA Miner Lit v2.0.6 was used in the thematic analysis of data. Only a few of the participants correctly identified bacteria as the cause of TB and even among these individuals, misconceptions persisted such as the belief that common cold is a precursor for TB. For most of the participants, exposure to cold and drinking of cold water cause TB. Some of the participants also attributed TB to poisoning by one’s enemies. Despite these misconceptions, most of the participants recognized TB as an infectious disease. Based on this observation, most of the participants favored the use of face masks as the sure way to prevent the spread of TB. Most of the participants attributed the cause of mental health disorders to changing life circumstances and substance abuse. The participants attributed substance use disorder to peer pressure, unemployment/economic hardship and loss of a loved one. Regarding care-seeking behaviour, participants reported that community members seek care for TB from traditional healers, and patent medicine vendors before seeking care at formal health facilities. For issues related to mental health, almost all the participants were of the opinion that the people seek help in prophetic churches and with traditional healers. Improving public awareness of TB, mental health and substance use disorder should be prioritized. There is the need to widen the scope of public enlightenment on TB in Nigeria with emphasis on the cause of TB and dismissing the several myths surrounding the disease. Enhancing community understanding of TB could contribute to earlier and more appropriate care-seeking behavior when combined with culturally responsive communication and accessible and trusted health services. The same principle could be applied to mental health.