An Exploration of Factors Contributing to Patient Delay in Seeking Tuberculosis Care Services in the Hhohho Region of Eswatini

Tuberculosis (TB) is one of the top twenty leading causes of death globally, it is the second leading cause of mortality from a single infectious cause after COVID-19 but ahead of HIV/AIDS. In 2020, TB was responsible for the ten million disease burden and an estimated 1.5 million deaths world-wide. Africa and South-East Asia account for almost 70% of the global TB burden but HIV/AIDS remains the biggest driver of TB morbidity and mortality in sub-Saharan Africa. This study aimed to explore patients’ attitudes, perceptions and beliefs that promote or hinder TB care-seeking behaviour at Dvokolwako Health Centre, Hhohho region, Eswatini. This was an explorative qualitative study and the primary data was obtained through semi-structured interviews. A sample of fourteen male and female participants above eighteen years of age were selected from the list of patients enrolled into TB care as late presenters in the period from 1 January 2020 to 30 December 2021. All data collected was audio-recorded, transcribed verbatim and analyzed using the thematic content approach. The study findings showed multiple factors contributing to the delayed access to TB health services. Inadequate knowledge, beliefs about TB symptoms, stigma associated with TB and lack of access to TB health services were individual factors that were found to contribute to patient delay in seeking TB care services. Lack of decentralized and community-based health education and promotion and negative health care workers’ attitudes were the health system-related factors that hindered early TB care-seeking. Persistence of symptoms and family encouragement and support were found to be motivators for eventual presentation into TB care services. From the findings of this study, a multi-pronged approach targeting the factors hindering early TB care-seeking and strengthening the motivators of health-seeking behaviour is necessary to mitigate the late presentation into TB care services in this and similar settings.