To characterize lumbar puncture (LP) acceptability among patients/caregivers and providers in Zambia.

Meningitis mortality is disproportionately high for Zambia’s sociodemographic index. We examined barriers to meningitis care in Lusaka. Poor LP uptake is a barrier, yet little is known about LP acceptability.

Audio-recorded face-to-face and telephone interviews were conducted with patients admitted with meningitis or their caregivers (n=25), doctors (n=8), and nurses (n=8) at University Teaching Hospital (UTH). Patient/caregiver interviews addressed meningitis treatment, understanding of meningitis, and biomedical care. Provider interviews focused on care of meningitis patients and inpatient care challenges. A framework approach was used for analysis.

Patients/caregivers knew that LP collected fluid from the back but could not describe procedure benefits. They viewed LP as a dangerous procedure associated with death, to be avoided at all costs. Caregivers who consented to LP often knew someone who had survived LP. LP consent implied accepting blame for patient mortality, though this was mitigated if death was viewed as “God’s will”. Wives felt they lacked capacity to consent for LP, and deferred to extended family, which delayed care.

Doctors and nurses recognized poor community understanding of LP but cited multiple barriers to bedside counseling, including competing clinical demands, limited patient/caregiver education, and language. Limited counseling did not overcome strongly negative LP views, as caregivers often remained with misconceptions after consent and LP refusal was sometimes followed by immediate hospital discharge. Consent was often obtained late in the patient’s illness and often several days after initiation of empiric antibiotics. Preceding antibiotic therapy was often not considered when interpreting results.

Poor LP uptake reflects patient/caregiver misgivings, perceived blame for potential poor outcomes, and ineffective bedside education.  Complementary efforts addressing patient, provider, and community concerns are needed to improve LP acceptability and utility in Zambia.