Stakeholder perspectives and experiences of persistent cough management in Wakiso District, Uganda

Introduction: Persistent (chronic) cough causes a significant disease burden leading to preventable deaths and catastrophic expenditures. The burden is significantly higher in low-income countries including Uganda where health systems are limited. Evidence on how persistent cough is managed within primary care in these low resource countries is lacking. This study explored stakeholder perspectives and experiences on the persistent cough management in Wakiso District, Uganda. Methods: This was a qualitative cross-sectional study of 8 Focus group discussions among community members including community health workers; and ten key informant interviews (KIIs) in both rural and urban communities. The KIIs were selected from Ministry of Health, district health office, public and private facilities (clinics, pharmacies, drug shops). Sampling was purposive and thematic approach was employed in data analysis using ATLAS.ti. Results: Results from the study are under 4 main themes: increasing persistent cough and related perceptions; self - management of persistent cough; patient empowerment and multidisciplinary approach to persistent cough; training needs and other recommendations to improve persistent cough management. Persistent cough was normalized and increasing with community members practicing a lot of self-medication including self-prescribed antibiotics and herbal medicine in the form of self- management. Patient empowerment and a multidisciplinary approach to persistent cough was limited. Further, knowledge gaps (among health professionals and community members) and social economic constraints at community level were reported with a negative influence on persistent cough management within primary care. Discussion: Unregulated use of antibiotics and herbal medicine in persistent cough management should be addressed. Community and patient empowerment, adequate capacity among health workers as well as a multidisciplinary approach to persistent cough management was lacking and should be prioritized. This study contributes to the needed locally relevant information for best practices and interventions for management of persistent cough within primary care in low-income settings.