A qualitative exploration of community knowledge, attitudes, and practices towards tuberculosis in the Karamoja subregion, northeastern Uganda.

Background: The Karamoja subregion is a high TB burden pastoralist community that previously had limited access to public health services. We explored the community's perceptions towards TB to better understand how healthcare services should be structured to meet the needs of the persons with TB and their households.

Methods: From September to October 2022, we conducted 12 focus group discussions (FGDs) and interviewed 95 persons (48 community members and 47 health workers). Research assistants trained in qualitative interviewing carried out the FGDs using an FGD guide that was developed iteratively following collection of quantitative data and initial interviews. We transcribed and analyzed data inductively and presented emerging themes about knowledge on, attitudes towards and practices associated with TB in the region.

Results: Participants were aware that TB was a significant public health problem and accurately described the signs and symptoms of TB. However, knowledge on TB transmission was inaccurate. Respondents thought that in addition to being airborne, TB was a contagious disease transmitted through direct contact or sharing of utensils. This affected attitudes towards patients with TB, contributing to stigmatization and isolation of persons diagnosed with TB in several homesteads. Community members preferred to go to public health facilities for TB diagnosis except where these health facilities were too far in which case they resorted to alternative care providers e.g., traditional healers or private health providers. Community members were aware of and had experienced the benefits of TB preventive therapy.

Conclusion: Knowledge about TB transmission is suboptimal and leads to stigmatization and isolation of infected individuals. Addressing this gap would contribute to reducing stigma and enhance care practices for patients diagnosed with TB. Development and distribution of communication messages with accurate information about TB transmission should be a priority. These messages should also include a strong component on the benefits of TB preventive therapy.