Acceptability of traditional healers as directly observed treatment providers in tuberculosis control in a tribal area of Andhra Pradesh, India

SETTING: Vizianagaram district of Andhra Pradesh, India, where 9% of the population is tribal.OBJECTIVE: To 1) examine traditional healers' (THs) diagnostic and treatment practices for tuberculosis (TB); 2) understand health-seeking behaviour for TB amongst tribal groups; 3) evaluate the acceptability of THs to public health workers; and 4) assess how THs can collaborate with the TB Programme.METHODS: In-depth interviews with 120 THs, 37 exit interviews and four focus group discussions with TB patients; interviews with eight non-governmental organisations (NGOs) and 38 public health staff.RESULTS: There were 18 THs per 1000 population. Of the 120 THs interviewed, 15 (13%) claimed to be TB specialists. Of the 72 healers aware of TB, 65 (90%) considered prolonged cough an important symptom and 53 (74%) believed that TB could be cured with allopathic drugs. THs felt collaboration was possible by directly observed treatment (DOT) providers (49, 68%), referring symptomatic individuals (54, 75%) and offering treatment for side effects (18, 25%).CONCLUSION: Involvement of THs in the TB Control Programme may improve services as they are a major health service provider in tribal areas and are acceptable as DOT providers to patients, public health providers and NGO workers.