There are an estimated 32,000 incident cases of multidrug-resistant tuberculosis in children globally each year. Extended hospitalisation is often required to ensure optimal adherence to the complex multidrug-resistant tuberculosis treatment regimen. Hospitalisation usually results in caregiver–child separation which is known to cause psychological difficulties in children. We explored caregivers’ and health workers’ perceptions of the effects of caregiver–child separation during hospitalisation for tuberculosis in the Western Cape. We conducted semi-structured interviews with health workers (n = 7) and caregivers (n = 14) of children who were receiving multidrug-resistant tuberculosis treatment. All interviews were audio-recorded, transcribed, and translated. We used thematic analysis to organise and interpret the data. We identified three themes: (1) multidrug-resistant tuberculosis treatment was a distressing experience for children, caregivers, and health workers; (2) children’s behavioural states during and post-hospitalisation (e.g., crying, aggression, hyperactivity, and withdrawal) were suggestive of their distress; and (3) caregivers and health workers used strategies, such as deception, threat, and the prioritisation of biomedical health over psychological health as a means to manage their own as well as the children’s distress. This article presents novel research on the dynamics involved in caregiver–child separation as a result of multidrug-resistant tuberculosis treatment in South Africa. We highlight that the challenges of caregiver–child separation intersected with predisposing factors related to the social adversity that families affected by childhood tuberculosis experience. Delivery models that facilitate outpatient community-based care should be prioritised and a more structured form of psychological support should be implemented for those who still require hospitalisation.

据估计，全球每年有 32,000 例儿童耐多药结核病病例。通常需要延长住院时间以确保对复杂的耐多药结核病治疗方案的最佳依从性。住院通常会导致照顾者与孩子的分离，众所周知，这会导致儿童的心理困难。我们探讨了护理人员和卫生工作者对西开普省结核病住院期间护理人员与儿童分离的影响的看法。我们对卫生工作者 ( n  = 7) 和护理人员 ( n = 14) 正在接受耐多药结核病治疗的儿童。所有采访都进行了录音、转录和翻译。我们使用主题分析来组织和解释数据。我们确定了三个主题：(1) 耐多药结核病治疗对儿童、护理人员和卫生工作者来说是一种痛苦的经历；（2）儿童住院期间和住院后的行为状态（如哭闹、攻击性、多动和退缩）暗示了他们的痛苦；(3) 护理人员和卫生工作者使用欺骗、威胁等策略，将生物医学健康置于心理健康之上，以此作为管理他们自己和儿童痛苦的手段。本文介绍了南非耐多药结核病治疗导致照顾者与儿童分离的动态变化的新研究。我们强调，照顾者与儿童分离的挑战与受儿童结核病影响的家庭所经历的社会逆境相关的易感因素相交。应优先考虑促进门诊社区护理的交付模式，并应为仍需要住院的人实施更结构化的心理支持形式。