representations of-xdr-tb-in-south-african-newspapers[1]
TRANSCRIPT
1 3Mark Daku , Andrew Gibbs Jody Heymann2 , 1 2 McGill University, Political Science, Montreal, Canada; Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
3 McGill University, Institute for Health and Social Policy, Montreal, Canada
For further information contact: Mark Daku, [email protected] or Andrew Gibbs, [email protected]
Representations of
XDR-TBin South African Newspapers
MethodsUsing the Factiva online newspaper archive, we collected articles which mention XDR-TB (and
variants of this keyword) from 18 South African newspapers between February 2004 to July 2009 [4].
This gave us a sample of 310 articles on XDR-TB. We categorised articles into themes, sub-themes,
and thematic networks according to Attride-Stirling's framework for thematic network analysis using
QDA Miner v3.2.1 [5, 6]. The networks were constructed, explored, and patterns were identified and
interpreted.
ResultsThe thematic network analysis identified two main dimensions:
causes of XDR-TB and treatment approaches/solutions.
Table 1Dominant media-identified causes of XDR-TB
Quote 1:
Sadly, resistance to cheap
and fast-acting “first-line”
treatments has emerged.
Because patients have all too
often failed to complete their
treatments, “multidrug-
resistant” (MDR) tuberculosis
has spread. Business Day,
10 March 2008”
Table 2Dominant media-identified treatment approaches/solutions
Ensuring treatment of patients: XDR-TB needed to be 'solved' by the effective treatment of patients who were living with the illness, by providing them with effective medication.
Adherence to first line medication: Paralleling the focus on patients' failures to adhere to first-line TB medication as a cause of XDR-TB, was the focus on the need to improve adherence to TB medication among patients.
Patient targeted approaches: This sub-theme focused on strategies directed at people living with XDR-TB to improve the chances of their treatment and reduce the likelihood of them infecting others. This however, typically revolved around limiting their human rights, through holding patients in hospitals against their wishes and so forth. (Quote 2)
Improved surveillance for XDR-TB: It was recognised that XDR-TB could only be solved if health practitioners could identify it quickly. The media also stressed the need for practitioners to understand the scale of the disease if it was to be managed effectively. (Quote 3)
This work is made possible by HEARD’s Joint Funding Arrangement (JFA) supported by:
Content and findings of this work do not necessarily reflect the views of the JFA partners.
BackgroundThe design and implementation of health policies are shaped by research,
funding, networks and popular understandings of health issues. In South Africa,
the media is a key source of information for those who develop and implement
these policies [1]. While the media can contribute to elite agenda setting, more
important for our purposes is the impact that the media can have by 'framing'
issues in specific ways. The media does so by selecting “some aspects of a
perceived reality and [making] them more salient in a communicating text, in
such a way as to promote a particular problem definition, causal interpretation,
moral evaluation and/or treatment recommendation” [2]. If elites are influenced
by the media, and the media consistently frames an issue in a particular way, this
is worthy of attention.
In this study, we are interested in understanding how the media frames health
issues by examining the case of Extensively Drug Resistant Tuberculosis (XDR-
TB) in South Africa. Current research emphasises XDR-TB's close relationship
with HIV/AIDS as an opportunistic infection [3]. Given that South Africa has one
of the highest levels of HIV-prevalence globally and has the largest reported
cluster of XDR-TB infections in the world, the effective management of XDR-TB
is a crucial issue for health policy makers in South Africa.
Individual Institutional
Largest sub-theme, focused on how patients with XDR-TB were likely to have acquired it due to poor adherence to TB medication (Quote 1)
Relatively small sub-theme, emphasised nosocomial transmission of XDR-TB in hospital settings
Costs of testing are high, resulting in people being diagnosed late
Quote 2:
To contain the further spread of drug-resistant TB, the
department decided to isolate patients infected with the XDR
strain. [Health Minister] Tshabalala-Msimang said this had not
been an easy decision, but had been taken with the interests of
the public in mind. Mail & Guardian, 28 March 2008
Quote 3:
The World Health Organisation (WHO) yesterday announced
plans to provide a new rapid test for multidrug resistant
tuberculosis (MDR-TB) to developing countries, the first
significant technological advance in fighting TB in more than
50 years. The test can give results within two days, a
dramatic improvement on today's tests, which take up to
three months in some parts of the world. Faster diagnosis
should lead to more effective treatment of patients with
MDR-TB, and help curb the spread of the disease, said
Martie van der Walt, scientist with the Medical Research
Council, which worked with the National Health Laboratory
Services to gather evidence that the test is reliable in routine
clinic conditions. Business Day, 1 July 2008
Individual Institutional Systemic
ConclusionOur analysis identifies a trend in South African media to identify a broad range of causes of XDR-TB,
while emphasising that treatment approaches should be directed at the individual.
It is within this frame that those in charge of designing and implementing XDR-TB programmes come
to understand the issue. Such an emphasis is problematic for two reasons. First, framing patients as
problematic leads to controlling, rather than empowering, approaches to treatment and prevention.
Second, it ignores an increasing body of evidence demonstrating the role of hospital and community
routes of XDR-TB infection and treatment [7-10]. The effect of the media, and its particular framing of
XDR-TB, may lead South African policy makers to make poor choices in regards to the most effective
way to treat and prevent XDR-TB.
Works Cited1. Jacobs, S. and K. Johnson, Media, Social Movements and the State: Competing Images of HIV/AIDS in South Africa. African Studies Quarterly, 2007.
9(4).2. McCombs, M., The Agenda-Setting Function of the Press, in The Press, G. Overholser and K.H. Jamieson, Editors. 2005, Oxford University Press: New
York.3. Gandhi, N., et al., Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South
Africa. The Lancet, 2006. 369(9547): p. 1575-1580.4. Dow Jones. Factiva. 2009; Available from: http://factiva.com/.5. Péladeau, N., QDA Miner version 3.2.1. 2009, Provalis Research: Montreal.6. Attride-Stirling, J., Thematic networks: an analytic tool for qualitative research. Qualitative Research, 2001. 1(3).7. Mitnick, C., et al., Community-Based Therapy for Multidrug-Resistant Tuberculosis in Lima, Peru. N Engl J Med, 2003. 348(2): p. 119-128.8. Basu, S., et al., Prevention of nosocomial transmission of extensively drug-resistant tuberculosis in rural South African district hospitals: an
epidemiological modelling study. The Lancet, 2007. 370(9597): p. 1500-1507.9. Bekker, L. and R. Wood, Community-based management of multidrug-resistant tuberculosis in South Africa [Editorial]. The International Journal of
Tuberculosis and Lung Disease, 2010. 14(4): p. 379-379.10. Heller, T., et al., Community-based treatment for multidrug-resistant tuberculosis in rural KwaZulu-Natal, South Africa. The International Journal of
Tuberculosis and Lung Disease, 2010. 14: p. 420-426.