Ngaka ya setswana, ngaka ya sekgoa or both? Health seeking behaviour in Batswana with pulmonary tuberculosis

The health seeking behaviour of tuberculosis (TB) patients, and their belie fs and attitudes with regard to the disease, was studied in 212 Batswana wi th smear-positive pulmonary TB during 1993/94. There is an apparent resembl ance between traditional ideas of disease being caused by pollution (breaki ng of taboos) and modern theories of spread via germs. TB may be regarded a s a 'European disease' or as a 'Tswana disease' and this has implications f or health behaviour. Patients who regard TB as a 'Tswana disease' may use m odern medicine for symptom relief but traditional medicine to treat what th ey consider the cause of the disease. All patients were eventually diagnose d and initiated specific antituberculous treatment in a modern health facil ity. The median number of health facility visits was two, and the median de lay period was 12 weeks. 95% of patients visited a modern health facility a s their first step of action. Before start of specific treatment one or mor e alternative treatments was tried by 52% of patients during the delay peri od. After starting modern treatment, 47% of patients visited, or planned to visit, a traditional healer or a faith healer. Traditional explanations of disease seemed less prevalent in 1993/94 than in a study conducted among T B patients in Botswana ten years earlier, but few patients had a thorough u nderstanding of TB from a biomedical point of view. More knowledge about pa tients' health seeking behaviour and perceptions would be useful for health workers. The findings of this study could offer suggestions for improvemen t in the area of health education. (C) 1998 Elsevier Science Ltd. All right s reserved.