Exploring caregivers’ and health workers’ perceptions on the effects of caregiver-child separation during long-term hospitalisation for MDR-TB in the Western Cape: a qualitative study

Meyerson, Kyla Amy (2019-12)

Thesis (MA)--Stellenbosch University, 2019.

Thesis

ENGLISH ABSTRACT: There are an estimated 32 000 incident cases of multidrug-resistant tuberculosis (MDR-TB) in children globally each year. Between 2011 and 2013, 323 children were diagnosed with TB at the Western Cape regional TB referral hospital and of these children, 4.7% had MDR-TB. MDR-TB treatment requires extended hospitalisation which currently entails caregiver-child separation. Caregiver-child separation has been shown to cause behavioural and emotional problems in children. I explored caregivers’ and health workers’ perceptions of the effects of caregiver-child separation during long-term hospitalisation for MDR-TB treatment. I conducted 19 semi-structured, in-depth interviews with caregivers and health workers of children (aged zero to five years) who were receiving hospital-based treatment for MDR-TB. All interviews were audio-recorded, transcribed and translated verbatim. I used Braun and Clarke’s guidelines for thematic analysis to organise and interpret the data. I identified three major themes: (i) MDR-TB treatment was a distressing experience; (ii) children’s behavioural and emotional states included excessive crying, aggression, hyperactivity, and withdrawal; (iii) caregivers’ and health workers’ used behavioural and emotional management strategies such as deception, threat, and prioritisation of biomedical health over psychological health. This study highlights the challenges that children, caregivers and health workers experienced in the context of caregiver-child separation during MDR-TB treatment. These problems are mostly likely the result of a complex interplay between factors such as caregiver-child separation, long-term hospitalisation, social adversity together with other predisposing factors. Future research should test the effectiveness of an intervention to reduce the negative effects of caregiver-child separation during MDR-TB treatment on children, caregivers and health workers in the Western Cape. Keywords: paediatric MDR-TB, caregiver-child separation, long-term hospitalisation, attachment

AFRIKAANSE OPSOMMING: Daar is na beraming 32 000 nuwe gevalle van veelvoudige middelweerstandige-TB (MDR-TB) onder kinders wêreldwyd elke jaar. Tussen 2011 en 2013 was daar 323 kinders met TB gediagnoseer by die Wes-Kaapse TB verwysing hospitaal, waarvan 4.7% MDR-TB gehad het. Behandeling vir MDR-TB vereis verlengde hospitalisasie wat tans versorger-kind skeiding behels. Versorger-kind skeiding het al getoon om gedrags en emosionele probleme in kinders te veroorsaak. Ek het versorgers en gesondheidswerkers se sieninge oor die effekte van versorger-kind skeiding verken gedurende langtermyn hospitalisasie vir behandeling van MDR-TB. Ek het 19 semi-gestruktureerde, in-diepte onderhoude gevoer met die versorgers en gesondheidswerkers van kinders (zero tot vyf jaar oud) wat behandeling in die hospitaal ontvang het vir MDR-TB. Al die onderhoude was met ‘n oudioband opgeneem, getranskribeer and verbatim vertaal. Ek het Braun en Clarke se riglyne vir tematiese analise gebruik om die data te organiseer en te interpreteer. Ek het drie hooftemas geïdentifiseer: (i) MDR-TB behandeling was ‘n traumatiese ervaring; (ii) kinders se gedrag and emosionele toestande gedurende MDR-TB behandeling het oormatige huilery, aggressie, hiperaktiwiteit, en onttrekking ingesluit; (iii) versorgers en gesondheidswerkers se gedrag en emosionele bestuurstrategië het misleiding, dreiging, en die prioritisering van bio-mediese gesondheid oor sielkundige gesondheid ingesluit. Hierdie studie beklemtoon die uitdagings wat kinders, versorgers en gesondheidswerkers ervaar in die konteks van versorger-kind skeiding, gedurende MDR-TB behandeling. Hierdie probleme is waarskynlik die gevolg van komplekse interaksie tussen faktore soos kind-versorger skeiding, lang termyn hospitalisasie, sosiale teenstrydigheid tesame met ander pridisponerende faktore. Toekomstige navorsing moet verder verken of ‘n intervensie wat versorger-kind verhoudings priotiseer gedurende MDR-TB behandeling die ontwikkeling van gedrag en emosionele probleme kan voorkom in kinders en of dit versorgers en gesondheidswerkers se gebruik van beperkende versorg strategië kan verhoed. Sleutelwoorde: pediatriese MDR-TB, versorger-kind skeiding, langtermyn hospitalisasie, gehegtheid

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/107320
This item appears in the following collections: