Table 2:
Representative quotes, by theme
| Theme | Quote | Respondent |
|---|---|---|
| Health systems challenges | ||
| 1 | …for example, if they come at the end of the month, families have to wait 15 or so days for the … committee to meet. It meets the second and 4th Tuesday of each month. So that’s 15 days, plus the dosing sheet, so 22-25 days until they can start treatment. | Doctor |
| 2 | …the letter didn’t come…he felt hot so I took him to the ER with a friend, and they asked me what's wrong? I said he has a fever of 39°C, and they said since when? I told her well, my son has TB and that's when they started calling me out. 'You're so irresponsible’ they said, in front of everyone who was there…‘There are other kids who could be at risk now because of you, he needs a mask. Go get a mask!’…my friend told me I never should have told them he has TB. I left, and we went to the pharmacy for some cough syrup. | Mother of 2-year-old boy, 50-day delay |
| 3 | I came on a Friday…but they said I had to come on Saturday, they said I had to come with my papers so I did, then they said no, it has to be on Monday to start treatment…I went on Monday immediately so he could get in, and then they told me the doctors rotate, there isn’t one at this health center all the time and he’s not in the office on Mondays, to come back on Tuesday…so Tuesday my son got seen by the doctor and started treatment. | Mother of 14-year-old boy, 13-day delay |
| 4 | I think it depends a lot on the doctors because there’s not always a doctor at the health center, and when we get to the health post they say come tomorrow, come tomorrow, it depends on the health center and also on the mom because sometimes there are moms who say I don’t have time, but the health center wants them to be there right then, you know? I think those are two things that conflict with each other. | Study staff member |
| 5 | … it’s a little more difficult for the MDR cases that need second-line drugs, so we talk to the nurse to see if we can borrow some from another patient. Or, we request them from the pharmacy, or from another health center if they have stock… | Doctor |
| 6 | For drug-sensitive cases, they start treatment the same day. But, for the MDR cases we have to wait at least two weeks, because not everyone has the right medications on hand, and we have to send them out to be prepared in the right doses [weight-based dosing in milligrams per kilogram]. | Doctor |
| Burden on families | ||
| 7 | …[treatment] was delayed because I was working, I had to work because otherwise there was no money. I didn’t know if I should stop working or not, I was between a rock and a hard place, like what do I do? ‘If I stop working, what are these kids going to eat’…that’s how it was. And I had to pay the rent on this place, you know? | Mother of 9-year-old girl, >8 months delay |
| 8 | We had a case where a little girl got diagnosed with TB and the only guardian she had was her dad. Her mom had died of tuberculosis. We would schedule visits with the dad, call him and call him to get him to come to the health center, we’d even coordinate with the nurse in charge at the health post. However, he wouldn’t come, he’d say he had to work. That was his major difficulty, there wasn’t anyone else who could bring the little girl so she could start treatment. | Study staff member |
| Perceptions of disease severity | ||
| 9 | In one health center we had three kids diagnosed with TB, all siblings. Once the Dad found out they were diagnosed, he didn’t want them starting treatment. He said he’d take them somewhere else, that they were fine. As far as I know, a month and a half, nearly two months had gone by and the Dad just didn’t want any of it. People went to try to convince him, but he wouldn't budge; he said his kids seemed stable, he didn’t agree with the doctor’s recommendations. | Study staff member |
| 10 | …it’s just that they don’t trust, or they don’t care and like I said the kid isn’t as symptomatic as the adult so that’s another reason they don’t believe it. | Doctor |
| 11 | Until something bad happens to the child, they [parents] aren’t worried about it, they don’t believe it even when you tell them the child has [TB] contacts…[they believe it] even less if the child doesn’t have symptoms. | Doctor |