Post-2015, why delay to seek healthcare? Perceptions and field experiences from TB healthcare providers in northern Malawi: a qualitative study

Background: Malawi is a low-income country with high Tuberculosis (TB) burden. TB diagnosis delay and untimely initiation of treatment is still a major problem in Malawi which could increase the risk of tuberculosis transmission in the communities. This study investigated factors related to the diagnostic delay of tuberculosis from TB healthcare providers in the northern region of Malawi. Methods: Nine focus group discussions were conducted with 57 participants in total. The participants were healthcare cadres including district TB officers, clinical officers, TB nurses, laboratory technicians and Health Surveillance Assistants (HSAs). NVivo (11.0) software was used for data analysis. Results: The factors related to diagnostic delay were categorized into three themes: client factors, institutional factors and healthcare provider related factors. Client's stigma and fear for HIV test, resource shortage within healthcare institutions and the healthcare workers' poor attitude against potential patients were among the most influential factors behind the TB diagnostic delay. Conclusions: The TB control strategies should aim to reduce HIV stigma, improve resource supply and improve TB healthcare workers' morale in order to achieve timely TB diagnosis.