Current Practice

Key to understanding difficulties in the hospital management of patients with brain infections is an exploration of the attitudes of patients, families and health-care workers, and of the social and structural contexts shaping their behaviour. For example, in some cultures, patients may be thought “possessed by spirits”; and even a blood test can be considered as a loss of self, let alone a more invasive investigation, such as a LP – the critical investigation to examine the cerebrospinal fluid and identify the causative organism.

In addition to structural constraints with overburdened systems, health care workers may also have concerns around procedures to manage brain infections; for example, they may fear performing the LP, or lack the skills to perform it; laboratory staff may be unsure of the diagnostic approaches to use for different samples.

This theme will build on previous and ongoing work on understanding structural and social barriers in pathways to care for brain infections, as well as previous ethnographic work on risk and response to severe illness [12]. It will help us understand current beliefs, knowledge, attitudes and practice, and guide training and subsequent interventions.


12. Desmond NA, Nyirenda D, Dube Q, et al. Recognising and treatment seeking for acute bacterial meningitis in adults and children in resource-poor settings: a qualitative study. PLoS One 2013; 8: e68163.