Gaps in TB-related knowledge and practices: An assessment of health care seeking behavior among adults with HIV and caregivers of paediatric patients with presumptive TB symptoms in Manhiça district, southern Mozambique

Although tuberculosis is a preventable and treatable disease, its management has been challenging for tuberculosis control and prevention programs in low- and middle- income countries such as Mozambique. We assessed the TB knowledge and healthcare-seeking behaviors among adults with HIV and caregivers of paediatric patients with symptoms of TB. The study was conducted between February and October 2023 at Manhiça District Hospital. A total of 60 interviews were conducted with people with HIV and caregivers of paediatric patients showing symptoms of TB. The interviews were transcribed, coded using an excel matrix, and analyzed using a content analysis approach. Half of the participants recognized airborne transmission through coughing as the main mode of TB transmission, while others were unsure or linked TB to sociocultural beliefs. Coughing was identified by most as the main symptom, with some also mentioning chest pain, bleeding, fatigue or weakness, weight loss, fever and night sweats. Many respondents believed that avoiding sharing utensils was the main way of preventing TB. Respecting the respondents' reasons and time taken to seek health care, our findings revealed that most participants had experienced the persistent coughing for more than 3 weeks. Some sought medical care, but did not see any improvement, while others chose to wait for their next scheduled doctor visit, hoping to address their symptoms. Our results showed that delays in seeking care were common among participants with TB symptoms, reflecting limited awareness of the disease. Factors such as waiting for the next scheduled doctor's visit, misinterpreting symptoms, and misconceptions about TB may have contributed to these delays. To address this, raising awareness about TB transmission, symptoms and prevention, dispelling myths through health education, and improving TB symptom follow-up through a coordinated approach across various patient entry points are essential.