Perceptions and beliefs about cough and tuberculosis and implications for TB control in rural Rwanda.

SETTING: Two southern provinces of Rwanda, Butare and Gikongoro. OBJECTIVES: To identify beliefs and popular perceptions on cough and tuberculosis (TB) in rural Rwanda and determine how they shape health-seeking behaviour. METHODS: Eight focus group discussions, 21 key informant interviews and 12 illness narratives were conducted between May and June 2004. STUDY POPULATION: TB patients, community members, traditional healers and health workers. RESULTS: There is wide use of herbal treatment for chronic cough in Rwanda. Patients seek conventional care when alternative treatment options fail or when severe symptoms such as shortness of breath, bloody sputum and weight loss appear. There are several local illnesses associated with chronic cough, with different alternative treatments. TB symptoms are often mistaken for the acquired immune-deficiency syndrome (AIDS). Identified causes for cough-related illnesses can be classified as biomedical (germs, internal body dysfunction and worms), environmental (seasonal changes and dust), cultural (inheritance), socio-economic (hard work, malnutrition and tobacco), and supernatural (witchcraft). Three health-seeking end points emerge for chronic cough: home care, health facility and the traditional healer. Healers in some areas, however, believe TB due to witchcraft can only be treated traditionally. CONCLUSION: This study unveils beliefs and treatment options for chronic cough in Rwanda, with important implications for TB control that should be addressed.