Abstract:
Tuberculosis, a deadly infectious disease caused mainly by Mycobacterium tuberculosis, is
increasingly becoming one of the leading health concerns globally. Human Immunodeficiency
Virus has exacerbated the situation in developing countries and it has led to the
resurgence of tuberculosis. Of more concern is the emergence of multidrug-resistant (MDR)
and extensively drug resistant (XDR) TB which are much more difficult and costly to treat.
Kenya has mounted a series of interventions with a view to sensitizing people about the
disease. Despite those efforts, there remain hard-to reach regions or communities such as the
Maasai whose coverage in the interventions have been minimal. A special TB treatment
programme, “TB Manyatta” strategy was introduced to maximize treatment outcomes in the
region. The main objective of the study was to establish the community perceptions, sociocultural
beliefs and practices and other factors influencing TB control among Maasai of
Narok District. This was a survey which utilized quantitative and qualitative methods of data
collection. A sample size total of 384 TB patients were recruited for the study as they went
into the TB clinics, after obtaining prior informed consent. Quantitative data was analyzed
using SPSS version 10 program. The level of significance was P<0.05. Qualitative data was
analyzed thematically using NVIVO (version 8). To obtain secondary data, this study also
utilized records that were kept at the district hospital. Bivariate analysis revealed several
factors that had independent statistical significance when related with respondents’
knowledge of TB. These included age of the respondent (P<0.001), marital status (P=0.034),
religion (P=0.032), the level of education acquired (P=0.022), accessibility to TB education
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(P=0.039) and overall patients attitude towards TB (P<0.001). Tuberculosis was perceived
as a highly contagious, incurable and killer disease such that those suffering from it were
reported to be stigmatized and isolated. Socio-cultural practices such as coughing without
covering the mouth (92%), consumption of untreated milk (25%) and crowding in traditional
huts with no or minimal ventilation predispose the Maasai to contracting TB. Regarding
health seeking behavior, first health facility visited was significantly related to knowledge
on TB (P=0.002). Patient delay before medical consultation was conspicuously observed.
Major factors associated with delay before seeking medical consultation included use of
traditional medicines (47.9%), inaccessibility of health facilities (29.2%) and poverty
(21.1%). The Maasai community had a negative attitude towards TB manyatta strategy, as
they considered it forced treatment. As a result records reviewed for year 2008/2009
revealed that treatment defaulting has always been around 13.5%. Knowledge of TB disease
is inadequate and attitude towards TB is predominantly negative. Knowledge gap that exists
should be bridged through continuous public health education that is tailored to suit the
Maasai beliefs and practices. To improve access, health services should be decentralized
nearer to the people.