Barriers and facilitators to timely diagnosis of childhood tuberculosis in Karachi, Pakistan

Sara Ahmad, BDS, MBA, MMSc '24 (expected)

sara ahmadPrior to joining the Master of Medical Sciences in Global Health Delivery program, Sara Ahmad worked as a Childhood TB National Program Manager at the Indus Hospital and Health Network, Pakistan. Before this role, she worked on TB Reach 3 and 4 projects and the DR-TB Contact Screening and Infection Treatment, a collaboration with Harvard Medical School. She was also the manager of the NGO Schools Program and Dental Health Program at Naya Jeevan, a micro-health insurance firm providing health coverage for the urban poor in Pakistan. Sara received her dental degree from Altamash Institute of Dental Medicine and an MBA in Health and Hospital Management from the Institute of Business Management.

All study participants gave permission for their photos to be taken and shared. Caregivers gave consent for children to be photographed and for their photos to be shared. 

Anahi Strader interview 2023

Student Perspectives

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Photo on the left is of Indus Hospital, photo on the top right is of the TB clinic patient waiting area, and the photo on the bottom right is of the sputum collection area as well as the audiometry room

The photo on the left is of Indus Hospital, and the photo on the top right is of the tuberculosis (TB) clinic patient waiting area, and the photo on the bottom right is of the sputum collection area as well as the audiometry room.
The Indus Hospital is the main site of my research. The TB clinic waiting area is well-ventilated and open-air  (since TB is transmitted through air) and also the place where I met patients for her data collection, and the third photo shows the space designated for TB patients who need to expectorate sputum– a significant part of a patient’s journey.

This TB clinic has been a part of my journey as a public health professional for the past ten years. It brings back many memories, albeit for the first time as a student/researcher and not an employee. It was exciting for me to interact with patients and their caregivers one-on-one, as I have previously has always been on the implementation side of TB intervention programs and not the clinical side.

Three pictures. Left is 3 men on a small boat, looking over at the water. Top right is 2 men in dark grey uniforms standing in a clinic. Bottom right is 4 men in a grey office.

The photo on the left is of treatment support workers Owais and Siraj on their way to an island to provide treatment support to a family diagnosed with Drug-Resistant TB. On the top right is a photo of Amir and Farooq (they help manage the patient flow in the four TB clinics), and pictured below is the support team made up of treatment support workers, a counselor, and a supervisor. 


All three photos show a few employees who work very diligently every day to ensure TB patient's and their family's comfort and well-being. The two treatment support workers also helped me recruit participants for my study, as they have an established rapport with the families. They have gone above and beyond to serve this community and give a true meaning to the term “accompaniment”. 


The last few weeks of September were slightly challenging - most of the people I interviewed have come in late to Indus Hospital mainly because of financial constraints. It is difficult to see people’s lives affected so deeply by poverty and limited resources – observing the sheer helplessness of not being able to bring your child to the hospital just because there is no extra money in the monthly budget – is quite jarring and frustrating (to say the least). 

Sara talking to a woman in a doctors office
Sara talking to one of the study participants, while her daughter (a 15-year-old TB patient) looked on

Talking to healthcare providers as well as patients’ caregivers has really helped me assess the barriers and facilitators from all aspects. Some interviews with healthcare providers have actually been very eye-opening. I was glad my mentor suggested including both kinds of participants to get a more holistic view of the problems faced by patients in seeking TB diagnosis and treatment.

Photos of Sara interviewing in situ

These are photos of interviews being conducted in different locations. I noticed that the most supportive families were quicker to get to Indus Hospital to get their children diagnosed and started on TB treatment. Distance from the facility, as well as resources to reach it, were equally important factors in facilitating the families to seek TB care. 

Multiple pictures of Sara interviewing various patients at the clinic

These are photos of a few patients whose caregivers were my study participants.


"Putting together this postcard has been a bittersweet experience. Seeing some of the patients’ photos brings tears to my eyes – the sheer hopelessness that most of them felt because of being tired of this debilitating disease as well as the constant back and forth between health facilities, had taken a major toll on them as well as their caregivers. Many broke down during their interviews, leaving me overwhelmed with sadness until much after they had left. And yet, they begin each day with a new surge of hope, and choose to believe they will do whatever they can to overcome this obstacle. It has been an emotional ride for me – to say the least. " ~ Sara 

Read more about the Master of Medical Sciences in Global Health Delivery program here.