Journal of Public Health Acceptability of masking and patient separation to control nosocomial Tuberculosis in Uganda: a qualitative study --Manuscript Draft-- Manuscript Number: JOPH-D-11-00121R2 Full Title: Acceptability of masking and patient separation to control nosocomial Tuberculosis in Uganda: a qualitative study Article Type: Original Article Corresponding Author: Esther Buregyeya, M.D Makerere University School of Public Health Kampala, UGANDA Corresponding Author Secondary Information: Corresponding Author's Institution: Makerere University School of Public Health Corresponding Author's Secondary Institution: First Author: Esther Buregyeya, M.D First Author Secondary Information: Order of Authors: Esther Buregyeya, M.D Ellen M.H Mitchell, P.h.D Elizeus Rutebemberwa, P.h.D Robert Colebunders, P.h.D Bart Criel, P.h.D Juliet Kiguli, P.h.D Fred Nuwaha, P.h.D Order of Authors Secondary Information: Abstract: OBJECTIVES: This study explored the acceptability of cough etiquette, wearing masks and separation by tuberculosis (TB) suspects and TB patients in 2 districts in Uganda. DESIGN: The study was conducted in Mukono and Wakiso districts in central Uganda. Eighteen in-depth interviews with patients and eight Focus Group Discussions with health workers were conducted. Patients were asked for their opinions on cough etiquette, patient separation and wearing of masks. RESULTS: Patients and health workers felt that physical separation was ideal, yet separation and masking were regarded as embarrassing to patients, emphasizing their potential infectiousness. Patients reported greater willingness to cover their mouth with a handkerchief than to wear a mask. Good counseling and health education were suggested to improve patients' adoption of separation and masking. However patients expressed concerns about equity and coercive, and stigmatizing approaches. Universal precautions were more acceptable than targeted ones, with the exception of separating TB patients. Lack of community awareness about airborne transmission of TB was identified as a barrier to accept and adopt of TB infection control measures. CONCLUSION: Scaling up effective TB infection control norms and behaviors requires a patient-centered, rights-based, and evidence-based approach. Socially acceptable measures like covering the mouth and nose with a handkerchief should be promoted. We recommend that further studies are needed to explore how community advocacy impacts on acceptability of masking. Furthermore, the efficacy of covering the mouth using a handkerchief or piece of cloth compared to wearing a mask in TB prevention needs to be evaluated. Powered by Editorial Manager® and Preprint Manager® from Aries Systems Corporation