Exploring the Socio-cultural Dynamics of Treatment Adherence amongst Females living with Pulmonary Tuberculosis in Karachi, Pakistan
Bibliographic record
Abstract
Background & Objective: Pakistan ranks fifth amongst thirty high-burden TB countries and fourth-highest in prevalence of multi-drug resistant TB. Despite higher TB rates among men, women disproportionately experience unsuccessful treatment outcomes. The National TB-Control Program despite its contributions has not adequately addressed underlying grassroots factors, particularly those impacting women, that contribute to poor treatment-outcomes. Thus the objective is to explore socio-cultural and grassroots factors influencing treatment non-adherence amongst females living with Pulmonary TB. Methods: A qualitative Phenomenological design was adopted. Twelve in-depth interviews were conducted at a TB Clinic in Karachi (from February to May 2020) with participants including (i) females living with Pulmonary TB and (ii) healthcare providers engaged in TB service-provision. Interviews were semi-structured and conducted in-person. Data was analyzed inductively using thematic analysis. Results: Three themes contributing to treatment non-adherence emerged, which are: A) The burden of home-making with sub-themes of a culture of matriarchy, traditional household norms, and intended non-disclosure of TB status; B) The journey of pursing treatment with subthemes of challenges in accessing diagnostic services, barriers in treatment adherence/continuation, unique treatment-related misconceptions; and C) TB myths with subthemes emphasizing local rumors and an inherent lack of trust in public healthcare services. Conclusion: This study reveals important grassroots, socio-cultural and physical barriers to treatment adherence among women, including gender, social norms and treatment demands. Addressing these requires a holistic approach prioritizing community empowerment with a focus on understanding day-to-day lived experiences of TB and enhancing healthcare provider capacity.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".