Local perceptions of tuberculosis in a rural district in Malawi

SETTING: Ntcheu district, Malawi. OBJECTIVE: To determine 1) the number of patients treated by traditional he alers, 2) the type of diseases managed by them, 3) the perceived causes of these disease, and 4) how both patients and healers looked at tuberculosis (TB). DESIGN: In-depth interviews and structured questionnaires with traditional healers, and focus group discussions with TB patients and their guardians. RESULTS: Traditional healers recognized four main causes of disease, relate d to why the patient is sick rather than what the patient is suffering from . Two hundred and seventy-six traditional healers saw approximately 4600 pa tients a week, managing a variety of diseases, mainly of a chronic nature. Twenty-four per cent of patients seen by traditional healers had a cough, i ncluding patients with TB. Traditional healers believe they can cure TB, an d have therefore been briefed on the infectious form of TB (smear-positive cases). The possibility of including traditional healers in early diagnosis has been explored. CONCLUSION: There is a need to address local beliefs in health education an d possibly find ways of involving healers in supervision of treatment.