Tuberculous meningitis: barriers to adherence in home treatment of children and caretaker perceptions.

Introduction: In-hospital treatment of children with tuberculous meningitis (TBM) is not a feasible option in many resource-poor countries. Home-based treatment has shown to be a viable alternative. Adherence is an important factor determining success of treatment.

Objective: Identify possible barriers to adherence of home-based treatment and caretaker perception of the disease.

Method: A qualitative study consisting of 11 in-depth semi-structured interviews was performed based on principles of the health belief model.

Results: Barriers of adherence identified include poor understanding of the disease and transmission route, difficulty with medication administration and side effects, lack of access to the health-care facility, long waiting times and hidden costs of transportation. Caretakers showed good appreciation of the adverse effects of noncompliance and benefits obtained from taking treatment in the home environment.

Conclusion: Improved doctor-patient communication, information brochures, structural changes to hospital settings, provision of financial and peer support all contribute to optimal TBM home-based treatment.