INT J TUBERC LUNG DIS 15(7):938–942 © 2011 The Union doi:10.5588/ijtld.10.0211 Tuberculosis knowledge, attitudes and health-seeking behaviour in rural Uganda E. Buregyeya,* † A. Kulane, ‡ R. Colebunders, †§ A. Wajja, ¶ J. Kiguli,* H. Mayanja, ¶ P. Musoke, ¶ G. Pariyo,* E. M. H. Mitchell # * Makerere University School of Public Health, Kampala, Uganda; † Institute of Tropical Medicine, Antwerp, Belgium; ‡ International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; § University of Antwerp, Antwerp, Belgium; ¶ Makerere University School of Medicine, Kampala, Uganda; # KNCV Tuberculosis Foundation, The Hague, The Netherlands Correspondence to: Esther Buregyeya, Makerere University School of Public Health, PO Box 7072, Kampala, Uganda. Tel: (+256) 752 420 555. Fax: (+256) 414 533 531. e-mail: eburegyeya@musph.ac.ug; buregyeyaesther@hotmail.com Article submitted 1 April 2010. Final version accepted 13 January 2011. OBJECTIVES: To assess tuberculosis (TB) knowledge, at- titudes and health-seeking behaviour to inform the design of communication and social mobilisation interventions. SETTING: Iganga/Mayuge Demographic Surveillance Site, Uganda. DESIGN: Between June and July 2008, 18 focus group discussions and 12 key informant interviews were con- ducted, including parents of infants and adolescents and key informant interviews with community leaders, tradi- tional healers and patients with TB. RESULTS: People viewed TB as contagious, but not nec- essarily an airborne pathogen. Popular TB aetiologies in- cluded sharing utensils, heavy labour, smoking, bewitch- ment and hereditary transmission. TB patients were perceived to seek care late or to avoid care. Combining care from traditional healers and the biomedical system was common. Poverty, drug stock-outs, fear of human immunodefciency virus (HIV) testing and length of TB treatment negatively affect health-seeking behaviour. Stigma and avoidance of persons with TB often refects an assumption of HIV co-infection. CONCLUSION: The community’s concerns about pill burden, quality of care, fnancial barriers, TB aetiology, stigma and preference for pluralistic care need to be ad- dressed to improve early detection. Health education messages should emphasise the curability of TB, the fea- sibility of treatment and the engagement of traditional healers as partners in identifying cases and facilitating adherence to treatment. KEY WORDS: tuberculosis; qualitative; health-seeking behaviour; stigma; Uganda TUBERCULOSIS (TB) is a leading cause of death in the developing world, especially in sub-Saharan Af- rica, despite the introduction of the DOTS strategy. 1,2 The DOTS strategy, recommended by the World Health Organization (WHO) for the prevention and control of TB, relies on passive case fnding by spu- tum smear microscopy. 3 Suspects are therefore ex- pected to be able to recognise TB symptoms and have positive attitudes towards TB being managed by for- mal health services. Various studies have found delays in TB case detection associated with poor perception of the health services, 4,5 fear of stigmatisation, 6 lack of knowledge about TB and traditional beliefs. 7 Studies performed in high-burden countries have reported many misconceptions about the causes of TB, such as inter-generational TB transmitted through blood relationships, 8 TB caused by overexertion, 9 cold weather, 10 and breaking cultural rules that require sex- ual abstinence after the death of a family member. 11 To our knowledge, no qualitative study of the knowledge and perceptions about TB has previously been performed in Uganda. Our study explored the knowledge and perceptions about TB in the com- munities and their health-seeking behaviour in prep- aration for community-based TB sensitisation in two districts. METHODS The present study was carried out in June and July 2008 in the Iganga/Mayuge Demographic Surveil- lance Site (DSS), located 120 km east of Kampala, Uganda. This predominantly agricultural (90% rural) DSS, a region that has been well researched, 12–19 has a population of approximately 67 000; the main eth- nic group is Basoga. Focus group discussions (FGDs) and key informant interviews (KIs) were conducted among both male and female parents/caretakers of children and adolescents, school heads, opinion leaders and TB patients. Eighteen FGDs were conducted, including six FGDs of young mothers/fathers/caretakers (aged <36 years) SUMMARY