We are pleased to announce that the research team at DMI, in collaboration with researchers at the Mozambique Ministry of Health’s National Tuberculosis Control Programme (NTP), have published the following paper in the PLOS ONE journal:

“Sociocultural understanding of Tuberculosis and implications for care-seeking among adults in the province of Zambezia, Mozambique: qualitative research”

This article is based on formative research conducted for DMI’s TB Reach project in Mozambique. An estimated 1.3 million people die of tuberculosis (TB) around the world every year (WHO, 2023). According to the latest WHO Global Tuberculosis report from 2023, Mozambique has an especially high incidence rate of the disease, with 361 cases out of every 100,000 people. Meanwhile, detection of the disease remains low. To address this, we conducted a radio campaign to improve TB case-detection in Zambezia province, with intensified broadcasting in high-burden districts. To inform the messaging used in this intervention, research was conducted to identify which social and behavioural factors influence TB testing in Zambezia. Researchers interviewed TB programme staff, community providers of TB services and community members, to identify barriers to testing.

Findings showed that knowledge about TB and its causes was low, while certain sociocultural and gender-related myths were acting as barriers to correctly identifying symptoms. Common TB symptoms such as a persistent cough and weight loss were believed to be caused by witchcraft or transgressions of sexual or social norms. Due to these factors, it was common for participants to first seek advice from traditional healers rather than accessing care from a health facility. This barrier to healthcare, coupled with misinformation on TB and its causes, were identified as contributors to low rates of TB testing. The research also found stigma associated with HIV and TB was an additional obstacle to accessing care.

The findings of this research were important in informing the messaging for DMI’s TB Reach campaign, which ran for 6 months from September 2020 to March 2021, and reached an estimated 2.5 million people in Mozambique. From this formative research, DMI was able to tailor messaging to include information on identifying TB symptoms, to encourage listeners to seek testing and treatment at a local health centre, while tackling the identified barriers to behaviour change. It also highlighted the importance of integrating gender-specific factors that negatively affect TB case detection amongst women and men, such as lack of decision-making power to access health services for women. Click here for an example of a radio spot from this campaign.

This project was funded by the Stop TB Partnership and was implemented with support from the Mozambique Ministry of Health’s National Tuberculosis Programme and local NGO, Ajuda de Desenvolvimento de Povo para o Povo (ADPP).

Click here to read the research paper in full.