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Alsoukhni MA, Khader Y, Abaza H, Wilson N, Satyanarayana S. Tuberculosis-related knowledge, behaviors, stigmatizing attitude, and discrimination among refugees, migrants, and the general population in Jordan. SAGE Open Med 2023; 11:20503121231187743. [PMID: 37492648 PMCID: PMC10363878 DOI: 10.1177/20503121231187743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objective A better understanding of tuberculosis-related knowledge, attitude, practices in the community, and other issues can help in implementing evidence-driven activities to control tuberculosis in Jordan. This study aimed to assess tuberculosis-related knowledge, attitude, and behaviors among refugees, migrants, and general population, and assess their stigmatizing and discrimination attitudes toward tuberculosis patients, social behavior toward tuberculosis, and healthcare-seeking behaviors. Methods A cross-sectional study was conducted among Jordanians, Syrian refugees, and migrants living in four governorates including Amman, Zarqa, Mafraq, and Irbid during the study period of June to September 2021. A structured questionnaire was developed to collect data via face-to-face interviews. Descriptive statistics, chi-square test, and general linear model procedure were used to analyze data. Results A total of 2302 (27.7% Jordanians, 25.7% urban refugees, 22.1% camp refugees, and 24.5% migrants) participated in this study. Of the total, 90.1% of participants reported that they have heard of tuberculosis. However, 88.9% of Jordanians, 92.8% of urban refugees, 92% of camp refugees, and 90.5% of migrants had low level of tuberculosis-related knowledge. About 62.0% of urban refugees, 54.8% of Jordanians, 43.0% of camp refugees, and 55.4% of migrants had moderate to high stigmatizing attitude toward tuberculosis patients. About 15.1% of Jordanians, 10.6% of urban refugees, 23.7% of camp refugees, and 16.1% of migrants had moderate to high level of discriminating attitude toward tuberculosis patients. Camp refugees had a significantly higher level of discriminating attitude toward tuberculosis patients than the other groups. Conclusion This study identified significant gaps in tuberculosis-related knowledge among the targeted groups. Moderate to high level of stigmatizing attitude was reported by a considerable proportion of the study participants. This suggests a need for public health education programs to educate people on tuberculosis causes, signs, symptoms, mode of transmission, and address related stigma, especially among the most disadvantaged and affected communities in Jordan.
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Affiliation(s)
- Majd A Alsoukhni
- Center of Excellence for Applied Epidemiology, Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Yousef Khader
- Department of Community Medicine, Public Health, and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Hiba Abaza
- Migration Health Division, International Organization for Migration, Amman, Jordan
| | - Nevin Wilson
- Migration Health Division, International Organization for Migration, Amman, Jordan
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2
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DeSanto D, Velen K, Lessells R, Makgopa S, Gumede D, Fielding K, Grant AD, Charalambous S, Chetty-Makkan CM. A qualitative exploration into the presence of TB stigmatization across three districts in South Africa. BMC Public Health 2023; 23:504. [PMID: 36922792 PMCID: PMC10017062 DOI: 10.1186/s12889-023-15407-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) stigma is a barrier to active case finding and delivery of care in fighting the TB epidemic. As part of a project exploring different models for delivery of TB contact tracing, we conducted a qualitative analysis to explore the presence of TB stigma within communities across South Africa. METHODS We conducted 43 in-depth interviews with 31 people with TB and 12 household contacts as well as five focus group discussions with 40 ward-based team members and 11 community stakeholders across three South African districts. RESULTS TB stigma is driven and facilitated by fear of disease coupled with an understanding of TB/HIV duality and manifests as anticipated and internalized stigma. Individuals are marked with TB stigma verbally through gossip and visually through symptomatic identification or when accessing care in either TB-specific areas in health clinics or though ward-based outreach teams. Individuals' unique understanding of stigma influences how they seek care. CONCLUSION TB stigma contributes to suboptimal case finding and care at the community level in South Africa. Interventions to combat stigma, such as community and individual education campaigns on TB treatment and transmission as well as the training of health care workers on stigma and stigmatization are needed to prevent discrimination and protect patient confidentiality.
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Affiliation(s)
- Daniel DeSanto
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Richard Lessells
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene & Tropical Medicine, TB Centre, London, UK
- KwaZulu-Natal Research Innovation & Sequencing Platform, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Dumile Gumede
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Centre for General Education, Durban University of Technology, Durban, South Africa
| | - Katherine Fielding
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- London School of Hygiene & Tropical Medicine, TB Centre, London, UK
| | - Alison D Grant
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- London School of Hygiene & Tropical Medicine, TB Centre, London, UK
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- The Aurum Institute, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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3
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Atkins S, Heimo L, Carter DJ, Ribas Closa M, Vanleeuw L, Chenciner L, Wambi P, Sidney-Annerstedt K, Egere U, Verkuijl S, Brands A, Masini T, Viney K, Wingfield T, Lönnroth K, Boccia D. The socioeconomic impact of tuberculosis on children and adolescents: a scoping review and conceptual framework. BMC Public Health 2022; 22:2153. [PMID: 36419146 PMCID: PMC9686126 DOI: 10.1186/s12889-022-14579-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) has been repeatedly shown to have socioeconomic impacts in both individual-level and ecological studies; however, much less is known about this effect among children and adolescents and the extent to which being affected by TB during childhood and adolescence can have life-course implications. This paper describes the results of the development of a conceptual framework and scoping review to review the evidence on the short- and long-term socioeconomic impact of tuberculosis on children and adolescents. OBJECTIVES To increase knowledge of the socioeconomic impact of TB on children and adolescents. METHODS We developed a conceptual framework of the socioeconomic impact of TB on children and adolescents, and used scoping review methods to search for evidence supporting or disproving it. We searched four academic databases from 1 January 1990 to 6 April 2021 and conducted targeted searches of grey literature. We extracted data using a standard form and analysed data thematically. RESULTS Thirty-six studies (29 qualitative, five quantitative and two mixed methods studies) were included in the review. Overall, the evidence supported the conceptual framework, suggesting a severe socioeconomic impact of TB on children and adolescents through all the postulated pathways. Effects ranged from impoverishment, stigma, and family separation, to effects on nutrition and missed education opportunities. TB did not seem to exert a different socioeconomic impact when directly or indirectly affecting children/adolescents, suggesting that TB can affect this group even when they are not affected by the disease. No study provided sufficient follow-up to observe the long-term socioeconomic effect of TB in this age group. CONCLUSION The evidence gathered in this review reinforces our understanding of the impact of TB on children and adolescents and highlights the importance of considering effects during the entire life course. Both ad-hoc and sustainable social protection measures and strategies are essential to mitigate the socioeconomic consequences of TB among children and adolescents.
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Affiliation(s)
- S Atkins
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - L Heimo
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - D J Carter
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - M Ribas Closa
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - L Vanleeuw
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - L Chenciner
- Royal Free London NHS Foundation Trust, London, UK
| | - P Wambi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - K Sidney-Annerstedt
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - U Egere
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Verkuijl
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - A Brands
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - T Masini
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - K Viney
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - T Wingfield
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - K Lönnroth
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - D Boccia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Almalki ME, Almuqati FS, Alasmari R, Enani MJ, Bahwirith AA, Alloqmani AA, Alqurashi A, Hassan-Hussein A. A Cross-Sectional Study of Tuberculosis Knowledge, Attitude, and Practice Among the General Population in the Western Region of Saudi Arabia. Cureus 2022; 14:e29987. [PMID: 36381904 PMCID: PMC9642831 DOI: 10.7759/cureus.29987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/16/2023] Open
Abstract
Background Religious gatherings like the Hajj, an Islamic pilgrimage, attract millions of people to one place during the same time frame. Due to crowding, infectious diseases, specifically tuberculosis (TB), are very common during such events. This study investigates the knowledge, attitudes, and practices of the public in the western region of Saudi Arabia related to TB to better understand the situation. Methodology An observational, questionnaire-based, cross-sectional study was conducted over two months between January and March 2022. A survey of 29 questions was used to collect data from the general population. The study included any person who was a resident of Makkah. Individuals under 18 years of age and health workers were excluded. We used OpenEpi, version 3.0, for sample size calculation, which gave a result of 604 participants, and SPSS version 25.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results A total of 604 participants were included in this study; 64.7% of respondents showed poor overall knowledge, and 14.1% had good knowledge of TB. Concerning attitude, 89.9% of the respondents showed poor attitude, and only 2.3% had a good attitude. As for practice, 59.4% of respondents had poor knowledge of proper practices, and only 10.4% knew the right practices regarding TB. Upon further analysis of our results, women exhibited better knowledge of TB than men (0.62, 95% confidence interval (CI), 0.44-0.87). Participants over 50 years old had the lowest knowledge about TB compared with participants aged 18 to 28 years old (7.61, 95% CI, 4.35-13.32). Non-Saudi residents had less knowledge compared with Saudi residents (45.849, 95% CI, 18.475-113.78). Level of education also played a substantial role; university graduates had the most knowledge about TB compared with participants with below university or no formal education (0.052, 95% CI, 0.01-0.40). Conclusions Participants with lower educational backgrounds were the most lacking in knowledge, attitude, and practice regarding TB. This lack of knowledge was more common among non-Saudi men over 50 years old. Information campaigns are needed to help reduce the prevalence of TB.
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Boah M, Kpordoxah MR, Adokiya MN. Self-reported gender differentials in the knowledge of tuberculosis transmission and curative possibility using national representative data in Ghana. PLoS One 2021; 16:e0254499. [PMID: 34252131 PMCID: PMC8274842 DOI: 10.1371/journal.pone.0254499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Health-seeking behaviour, stigma, and discrimination towards people affected by tuberculosis (TB) are influenced by awareness of the disease. Gender differentials in the diagnosis and treatment of TB have been reported in other settings of the world. However, little is known about the gender differences in the knowledge of TB transmission and curative possibility in Ghana. Methods The analysed data were a weighted sample of 9,396 women aged 15–49 years and 4,388 men aged 15–59 years, obtained from the 2014 Ghana Demographic and Health Survey. The dependent variable, correct knowledge regarding TB transmission and cure was derived from questions on the transmission of the disease and the possibility of a cure. A design-based multivariate logistic regression model in Stata 13.0/SE was used to identify the correlates of reporting correct knowledge. Results Overall, the mean knowledge score was 6.1±0.9 (maximum = 7). Of the 13,784 respondents, 45.7% (95% CI: 44.0–47.3) reported correct knowledge regarding TB transmission and cure. Men had significantly higher knowledge than women (50.9% versus 43.2%). Misconceptions, including TB transmitted through sharing utensils (13.3%), food (6.9%), touching a person with TB (4.5%), sexual contact (4.1%), and mosquito bites (0.4%) were noted. About 30% (33% women and 25% men) of the total sample would keep the information secret when a household member is affected with TB. In the adjusted analysis, age, gender, education, region, place of residence, wealth quintile, frequency of reading newspaper/magazine, listening to the radio, and watching television were significantly associated with reporting correct knowledge. Conclusions There was low knowledge regarding TB transmission and cure. Misconceptions regarding the transmission of TB prevailed among the participants. Gender differential in knowledge was observed. Comparatively, females were less likely to be aware of TB and report correct knowledge regarding TB transmission but were more likely to conceal information when a household member was affected by the disease.
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Affiliation(s)
- Michael Boah
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
- * E-mail:
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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6
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Wademan DT, Mainga T, Gondwe M, Ayles H, Shanaube K, Mureithi L, Bond V, Hoddinott G. 'TB is a disease which hides in the body': Qualitative data on conceptualisations of tuberculosis recurrence among patients in Zambia and South Africa. Glob Public Health 2021; 17:1713-1727. [PMID: 34187320 DOI: 10.1080/17441692.2021.1940235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The WHO estimates 58 million people experienced one or more TB disease episodes between 2000 and 2018. These 'former TB patients' are at greater risk of future TB infection and death than TB naïve people. Additionally, former TB patients experience social, psychological, and physiological difficulties after microbiological cure. Drawing on semi-structured interviews collected with 28 people from communities in Zambia (n = 8) and South Africa (n = 2) between October 2018 and March 2019, we describe their perceptions of having two or more TB episodes. Utilising a discursive analytic approach, we interrogated how participants conceptualise their risk of disease recurrence. Despite being surprised by subsequent TB episodes, participants utilised their bodily experiences of TB signs and symptoms alongside their experiential knowledge of health systems processes to procure timely diagnosis and care. Yet, many participants were unable to resume social and economic participation. Experiences of multiple TB episodes and correlating social, economic, and physiological vulnerabilities, challenged participants biomedical understanding of TBs curability. Through notions of dirt and 'staining', participants conceptualise TB as a sinister, malicious presence they are bound to encounter time and again. Health providers should discuss the risk of TB recurrence with patients and promote prevention, early detection, and diagnosis of TB disease.
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Affiliation(s)
- Dillon T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Tila Mainga
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Melleh Gondwe
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Linda Mureithi
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Global Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Noora CL, Bandoh DA, Nuoh RD, Sarfo B, Nyarko KM, Kenu E. Evaluation of timeliness of treatment initiation among smear positive pulmonary tuberculosis patients in Brong Ahafo Region, Ghana, 2015. Ghana Med J 2021; 54:73-82. [PMID: 33536672 PMCID: PMC7837353 DOI: 10.4314/gmj.v54i2s.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background We evaluated timeliness and factors influencing treatment initiation (TI) among smear positive pulmonary tuberculosis (PTB+) patients in Brong Ahafo Region (BAR), Ghana. Design and Setting We conducted a cross-sectional study in health facilities (HF) in six districts in BAR, from November 2014 to May 2015. Newly diagnosed smear positive PTB patients were selected randomly proportionate to size of facility cases. Timeliness of symptoms, diagnosis, TI and factors for delay were assessed using structured questionnaire. Patient delay was defined as presentation to a health care provider after 21 days of the onset of TBrelated symptoms and TI delay as therapy initiated after 30-days of onset of TB-related symptoms. We determined median patient timeliness, HF, and TI timeliness. We identified factors associated with TI delay using logistic regression. Results There were a total of 237 PTB+ patients; median patient timeliness of 30 days (IQR:14, 60). The median health facility timeliness was 8 days (IQR:4, 10); and the median TI timeliness was 36 days (IQR:25, 69). Majority (58.7%) of patients delayed in seeking treatment. TI delay was associated with: unemployment [aOR=7.4, 95%CI(1.9-28.8)], fear of losing job [aOR=3.4, 95%CI(1.3-8.5)], traditional healer as first port of call [aOR=10.6, 95%CI(13.0-66.8)], and initially being treated for HIV [aOR=4.9, 95%CI(1.6-14.8)]. Conclusion There were delays in treatment initiation and patient treatment seeking timeliness. One-third of patients would prefer traditional healers/self-treatment/drug store as an option. A concerted effort by stakeholders is needed to improve behaviour change communication on good health seeking behaviour for persons living with TB to reduce delays in seeking treatment. Funding The study was funded by the authors.
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Affiliation(s)
- Charles L Noora
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Delia A Bandoh
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Robert D Nuoh
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Bismark Sarfo
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Kofi M Nyarko
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
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Idris NA, Zakaria R, Muhamad R, Nik Husain NR, Ishak A, Wan Mohammad WMZ. The Effectiveness of Tuberculosis Education Programme in Kelantan, Malaysia on Knowledge, Attitude, Practice and Stigma Towards Tuberculosis among Adolescents. Malays J Med Sci 2021; 27:102-114. [PMID: 33447138 PMCID: PMC7785272 DOI: 10.21315/mjms2020.27.6.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/02/2020] [Indexed: 10/27/2022] Open
Abstract
Background Tuberculosis (TB) is contagious and the transmission risk is high in congregate settings like school. Incidence of TB among adolescents is significantly high hence an education programme was developed to improve knowledge, attitude, practice and stigma (KAPS) among them. Methods This school-based, non-randomised controlled study was conducted among secondary school students with a total of 236 respondents. The KAPS score were assessed before and 1 month after using self-administered validated KAPS questionnaire on TB. Analysis was done using repeated measures ANOVA. Results The mean percentage score (SD) for baseline knowledge, attitude, practice and stigma score for the respondents were 54.0 (4.48), 65.6 (1.74), 70.0 (1.43) and 66.0 (6.88), respectively. There was a significant difference (P < 0.001) in the knowledge and stigma score for intervention group compared to control group, adjusted for gender, ethnicity and smoking status 4 weeks post-TB educational programme. However, with regards to attitude and practice score, there was no significant difference (P = 0.210 and P = 0.243, respectively). Conclusion TB education programme was effective in improving knowledge and stigma related to TB. This health education programme can be used as one of the strategies for the prevention and control of TB in schools.
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Affiliation(s)
- Nur Aiza Idris
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Rosnani Zakaria
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nik Rosmawati Nik Husain
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Azlina Ishak
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Mohammedhussein M, Hajure M, Shifa JE, Hassen TA. Perceived stigma among patient with pulmonary tuberculosis at public health facilities in southwest Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0243433. [PMID: 33290413 PMCID: PMC7731994 DOI: 10.1371/journal.pone.0243433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Although tuberculosis (TB) related stigma has a significant impact on the diagnosis, patient adherence with treatment, and recovery from the disease, there is limited evidence from Ethiopia regarding perceived stigma among patient with pulmonary tuberculosis (PTB).The purpose of this study was to assess perceived stigma and associated factors among patient with PTB on treatment in southwest Ethiopia. METHODS Institution-based cross-sectional study was conducted from April to May 2019 among 410 patient with PTB. Data were collected by using the perceived tuberculosis stigma scale. Epi data v3.1 and SPSSv23 were used for data entry and analysis. Multivariable logistic regression models were fitted to identify factors associated with perceived stigma. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULT Prevalence of perceived stigma among patient with Pulmonary tuberculosis was 57.1% (95% CI: 52.2, 61.7). Poor social support (AOR = 2.41; 95% CI: 1.06, 5.48), above a month duration of illness (AOR = 2.48; 95% CI: 1.33, 4.64), high perceived stress (AOR = 1.95; 95% CI:1.09, 3.49), current khat use (AOR = 1.88; 95% CI:1.05, 3.37), and presence of depression (AOR = 8.18; 95% CI:4.40, 15.22) were significantly associated with perceived stigma. Patient with HIV co-infection were 5.67 times (AOR = 5.67; 95% CI: 2.32, 13.87) more likely to have Perceived stigma than their counterparts. CONCLUSION TB related stigma was reported by more than half of the study participant. Stigma reduction measures are needed to lower TB related stigma perceived by the patient, the level of distress associated with it, and to promote the psychological wellbeing of patient with TB.
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Affiliation(s)
- Mustefa Mohammedhussein
- Department of Psychiatry, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, Ethiopia
| | - Mohammedamin Hajure
- Department of Psychiatry, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, Ethiopia
| | - Jemal Ebrahim Shifa
- Department of Psychiatry, School of Health Sciences, Mada Walabu University, Shashemene campus, Shashemene, Ethiopia
| | - Tahir Ahmed Hassen
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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10
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Mukerji R, Turan JM. Challenges in accessing and utilising health services for women accessing DOTS TB services in Kolkata, India. Glob Public Health 2020; 15:1718-1729. [PMID: 32290773 DOI: 10.1080/17441692.2020.1751235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Challenges in accessing and utilising TB treatment are a major reason for the existing gaps in tuberculosis (TB) control in India. Twenty qualitative interviews were conducted with women who were attending or had attended a directly observed treatment short course (DOTS) clinic in Kolkata, India. The resulting data were analysed using a thematic approach. Our results indicated that women experienced several challenges categorised as (1) DOTS specific challenges, (2) lack of client friendly services, and (3) resource constraints. DOTS specific challenges included having to come to the clinic for medicines, lack of privacy, providers minimising contact with patients, length of treatment, drug side effects and pill burden. Lack of client friendly services led to mistrust in government services and a preference for private providers, which was compounded by corruption in the medical system. Inability to complete household duties due to inflexible clinic hours, long lines and overcrowded spaces, and mistreatment from providers were further challenges faced by women. Lastly, resource constraints meant women faced financial difficulties with additional treatment costs and suffered from lack of adequate food and nutrition. Our findings lead to several recommendations for addressing these challenges that should help improve women's experiences with DOTS TB treatment.
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Affiliation(s)
- Reshmi Mukerji
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Heath K, Byard RW. Tuberculosis-related stigma contributing to a 'hidden' disease at autopsy. MEDICINE, SCIENCE, AND THE LAW 2019; 59:135-138. [PMID: 31081464 DOI: 10.1177/0025802419849350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 29-year-old African immigrant to Australia was found dead in bed. She had no known medical history, except for recent weight loss and hip/leg pain. Autopsy examination revealed extensive tuberculous consolidation with widespread cavitation of the lungs, with multiple caseating granulomas containing large numbers of acid fast bacilli on histology. Similar granulomas were also present in lymph nodes of the porta hepatis, mediastinum and pulmonary hilum, and within the liver, spleen and mesentery. Mycobacterial polymerase chain reaction analysis confirmed tuberculous infection. Her serum was negative for human immunodeficiency virus infection. Death was due to disseminated tuberculosis. In many parts of Africa, there are negative cultural associations attached to tuberculosis, which often leads to a delay in diagnosis. The case demonstrates the extent of active disease that may be uncovered at autopsy in decedents from societies where tuberculosis is stigmatised and therefore concealed. It also emphasises the risk of infection for forensic workers.
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Affiliation(s)
- Karen Heath
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Australia
| | - Roger W Byard
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Australia
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Chakrabartty A, Basu P, Ali KM, Ghosh D. Tuberculosis related stigma attached to the adherence of Directly Observed Treatment Short Course (DOTS) in West Bengal, India. Indian J Tuberc 2019; 66:259-265. [PMID: 31151494 DOI: 10.1016/j.ijtb.2019.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 03/03/2019] [Accepted: 03/30/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stigma is a major barrier to the successful completion of the Directly Observed Treatment Short Course (DOTS). People put on DOTS have to face repeated exposure to stigma as per the requirement of the treatment. Thus stigma can shape the extent of access and adherence to treatment. But there is very little information available in Indian context explaining the extent of association between the stigma perceived among the patients and adherence to their DOTS therapy. AIM To explore the level of stigma perceived by the persons with TB and its influence on the adherence to DOTS treatment. METHODS A cross sectional epidemiological study was conducted among 145 DOTS defaulters from three randomly selected districts in West Bengal. Respondents were approached at their households. Information was collected using a pretested questionnaire. Adherence to DOTS was grouped as early default (continued DOTS from 0 to 30 days) and late default (continued DOTS > 30). Stigma score was assessed using 11 item questions. Stigma score was grouped as low level (0-23) and high level (24-44). Analysis was done using Chi-square and multivariate logistic regression models to identify factors to influence adherence to DOTS. SPSS 23.0 version statistical software was used for analysis. RESULTS Mean stigma score for the state was 23.0. Total 51 (40.69%) persons were within the low stigma group and 94 persons (59.31%) were within high stigma score group. District wise mean score was 19.8, 22.8 and 24.5 respectively for Birbhum, Jalpaiguri and North 24 Parganas. In North 24 Parganas, the high stigma score group accounted for 85.5% compared to 35.9% in Birbhum. Among the low stigma group, late default was 52.1% compared to 66.7% in high stigma group (p = 0.054). People with lower stigma level were 8.59 times more likely to have late default than the people with higher stigma level (p = 0.001). CONCLUSION Perceived stigma among the patients was identified as an important predictor for the adherence to DOTS therapy. Stigma reduction strategy should be designed to improve adherence to DOTS therapy. Present study recommends in-depth qualitative research to get more insight on the extent and shape of stigma and the way it influences the adherence. Apart from the stigma of the patients, influence of community stigma is a gray area for further research.
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Affiliation(s)
| | - Pampa Basu
- Community Medicine, Medical College, Kolkata, India
| | - Kazi Monjur Ali
- Department of Nutrition, M.U.C. Women's College, Burdwan, 713 104, India
| | - Debidas Ghosh
- Department of Bio Medical Laboratory Science and Management, Vidyasagar Univeristy, Midnapore, 721 102, India
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The relationship between patients’ perception of nurse caring behaviors and tuberculosis stigma among patients with drug-resistant tuberculosis in Swaziland. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2018.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Barua M, Van Driel F, Jansen W. Tuberculosis and the sexual and reproductive lives of women in Bangladesh. PLoS One 2018; 13:e0201134. [PMID: 30024977 PMCID: PMC6053219 DOI: 10.1371/journal.pone.0201134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/09/2018] [Indexed: 01/23/2023] Open
Abstract
When they do not meet norms related to sexuality and reproduction, Bangladeshi women often face abandonment and are thus deprived of an active sexual life, a marital relationship, and motherhood. Little is known about how a stigmatised disease such as tuberculosis (TB) may constrain the reproductive health and sexual lives of women. This article, derived from a larger study on the impact of TB on women’s sexual and reproductive health and rights in Narsingdi district and Dhaka, Bangladesh, aims to fill this gap. Based on interviews with nine married women who have or had TB, four husbands, and two mothers-in-law, this article highlights that the ways in which TB impedes on the sexual and reproductive lives of women depends on the stigma within their family and community, their relationships with their husbands, motherhood, their living arrangements, their economic contribution to the family and/or their disclosure of their TB diagnosis. Women with children and supportive husbands retain a stronger position among their in-laws and are less likely to be isolated or rejected. The patients’ narratives revealed that the instructions of health workers influenced their decisions about intercourse or abstinence. Future studies should examine the instructions patients receive from health workers regarding their living and sleeping arrangements, sexual intercourse, and pregnancy, as well as policy documents on TB treatment and prevention.
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Affiliation(s)
- Mrittika Barua
- Radboud Gender and Diversity Studies, Radboud University, Nijmegen, The Netherlands
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- * E-mail:
| | - Francien Van Driel
- Anthropology and Development Studies, Radboud University, Nijmegen, The Netherlands
| | - Willy Jansen
- Gender Studies, Radboud University, Nijmegen, The Netherlands
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Lantian A, Muller D, Nurra C, Klein O, Berjot S, Pantazi M. Stigmatized beliefs: Conspiracy theories, anticipated negative evaluation of the self, and fear of social exclusion. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2018. [DOI: 10.1002/ejsp.2498] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anthony Lantian
- Département de Psychologie; Laboratoire Parisien de Psychologie Sociale; UPL; Université Paris Nanterre; Nanterre France
| | - Dominique Muller
- Univ. Grenoble Alpes; Univ. Savoie Mont Blanc; LIP/PC2S; 38000 Grenoble France
| | - Cécile Nurra
- Univ. Grenoble Alpes; Univ. Savoie Mont Blanc; LaRAC; 38000 Grenoble France
| | | | | | - Myrto Pantazi
- University of Cambridge; Cambridge UK
- Université Libre de Bruxelles; Brussels Belgium
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Chakrabartty A, Basu P, Ali KM, Sarkar AK, Ghosh D. Tuberculosis related stigma and its effect on the delay for sputum examination under the Revised National Tuberculosis Control Program in India. Indian J Tuberc 2017; 65:145-151. [PMID: 29579429 DOI: 10.1016/j.ijtb.2017.08.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/10/2017] [Accepted: 08/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND One major barrier to achieve goal of tuberculosis (TB) control program globally, is the stigma attached to the disease. Perceived stigma can delay sputum test in time. Delay will lead to spread of infection in the community. There is no scientific information available in India exactly looking into the association between delay in sputum examination and stigma. AIM We conducted a study in rural West Bengal among persons with cough for 2 weeks or more to assess their level of stigma, its influence on delay for sputum test and identify factors those shape the level of stigma. METHODS A community based cross sectional survey was conducted from February to June 2015 in West Bengal, India. We interviewed 135 persons of 15-60 years. Data were collected using a pretested structured questionnaire. Chi-square and logistic regression analysis were done using SPSS 23.0 statistical software. RESULTS Among the 'lower stigma' group (score 4-24), 'delay' (14-25 days) is found among 46.2% respondents and 'much delay' (26-120 days) among 53.8%. Among the 'higher stigma' (score 25-36) group, 'delay' is found among 20.5% respondents and 'much delay' among 79.5%. Persons with lower stigma are 0.17 times likely to delay than persons with higher stigma [adjusted odds ratio (AOR): 0.17 (0.044-0.668), p=0.011)]. Important influencers of stigma are caste [AOR: 5.90 (1.66-20.90), p=0.006], number of family members [AOR: 3.46 (1.08-11.06), p=0.009] and residence in urban or rural [AOR: 3.97 (1.03-15.27), p=0.045]. CONCLUSION Revised National Tuberculosis Control Program in India should de-stigmatize the community giving priorities to lower castes, big families and rural areas.
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Affiliation(s)
- Arupkumar Chakrabartty
- Hony. Secretary, Health Vision & Research, 333A/1, Jessore Road, Kolkata 700 089, India.
| | - Pampa Basu
- Post Graduate Student (MD), Department of Community Medicine, Medical College, Kolkata 700073, India
| | - Kazi Monjur Ali
- Assistant Professor, Department of Nutrition, M.U.C. Women's College, Burdwan, India
| | - Aditi Kishore Sarkar
- Additional Director of Health Services (Admin), H&FW Department, Government of West Bengal, India
| | - Debidas Ghosh
- Professor, Department of Bio-Medical Laboratory Science and Management, Vidyasagar University, Midnapore 721 102, West Bengal, India
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Kerrigan D, West N, Tudor C, Hanrahan CF, Lebina L, Msandiwa R, Mmolawa L, Martinson N, Dowdy D. Improving active case finding for tuberculosis in South Africa: informing innovative implementation approaches in the context of the Kharitode trial through formative research. Health Res Policy Syst 2017; 15:42. [PMID: 28558737 PMCID: PMC5450237 DOI: 10.1186/s12961-017-0206-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/10/2017] [Indexed: 11/12/2022] Open
Abstract
Background Tuberculosis (TB) is the leading infectious killer worldwide, with approximately 1.8 million deaths in 2015. While effective treatment exists, implementation of active case finding (ACF) methods to identify persons with active TB in a timely and cost-effective manner continues to be a major challenge in resource-constrained settings. Limited qualitative work has been conducted to gain an in-depth understanding of implementation barriers. Methods Qualitative research was conducted to inform the development of three ACF strategies for TB to be evaluated as part of the Kharitode cluster-randomised trial being conducted in a rural province of South Africa. This included 25 semi-structured in-depth interviews among 8 TB patients, 7 of their household members and 10 clinic health workers, as well as 4 focus group discussions (2 rural and 2 main town locations) with 6–8 participants each (n = 27). Interviews and focus group discussions explored the context, advantages and limitations, as well as the implications of three ACF methods. Content analysis was utilised to document salient themes regarding their feasibility, acceptability and potential effectiveness. Results Study participants (TB patients and community members) reported difficulty identifying TB symptoms and seeking care in a timely fashion. In turn, all stakeholder groups felt that more proactive case finding strategies would be beneficial. Clinic-based strategies (including screening all patients regardless of visit purpose) were seen as the most acceptable method based on participants’ preference ranking of the ACF strategies. However, given the resource constraints experienced by the public healthcare system in South Africa, many participants doubted whether it would be the most effective strategy. Household outreach and incentive-based strategies were described as promising, but participants reported some concerns (e.g. stigma in case of household-based and ethical concerns in the case of incentives). Participants offered insights into how to optimise each strategy, tailoring implementation to community needs (low TB knowledge) and realities (financial constraints, transport, time off from work). Conclusions Findings suggest different methods of TB ACF are likely to engage different populations, highlighting the utility of a comprehensive approach. Trial registration Clinicaltrials.gov (NCT02808507). Registered June 1, 2016. The participants in this formative study are not trial participants.
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Affiliation(s)
- Deanna Kerrigan
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 257, Baltimore, MD, 21205, United States of America
| | - Nora West
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6532, Baltimore, MD, 21205, United States of America.
| | - Carrie Tudor
- International Council of Nurses, 3 Place Jean Marteau, 1201, Geneva, Switzerland
| | - Colleen F Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6031, Baltimore, MD, 21205, United States of America
| | - Limakatso Lebina
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, 2000, South Africa
| | - Reginah Msandiwa
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, 2000, South Africa
| | - Lesego Mmolawa
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, 2000, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, 2000, South Africa
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6531, Baltimore, MD, 21205, United States of America
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Touso MM, Popolin MP, Crispim JDA, Freitas IMD, Rodrigues LBB, Yamamura M, Pinto IC, Monroe AA, Palha PF, Ferraudo AS, Villa TCS, Arcêncio RA. [Social stigma and the families of patients with tuberculosis: a study based on cluster and multiple correspondence analysis]. CIENCIA & SAUDE COLETIVA 2016; 19:4577-86. [PMID: 25351323 DOI: 10.1590/1413-812320141911.46062013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/20/2013] [Indexed: 11/22/2022] Open
Abstract
The social stigma associated with TB is a challenge facing management of the area of public health care. The aim of this study was to investigate the social stigma in families of patients with TB and identify the profile of those who are affected by the event in relation to socioeconomic and demographic conditions. It is a cross-sectional study that was conducted in 2011 in the city of Ribeirão Preto, state of São Paulo, Brazil, with a sample of 110 individuals. The data were analyzed using the univariate descriptive technique and cluster and multiple correspondence assessment. The stigmatized groups tend to have lower scholarity, incipient access to the media and little understanding about TB, as opposed to those that have higher educational levels, continuous access to the media, consider themselves well informed and show proactive attitudes to deal with the disease. The identification of varied profiles highlights the need to develop health interventions to cater to the singularities of families with respect to the social stigma of the disease.
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Affiliation(s)
- Michelle Mosna Touso
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Marcela Paschoal Popolin
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Juliane de Almeida Crispim
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Isabela Moreira de Freitas
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Ludmila Barbosa Bandeira Rodrigues
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Mellina Yamamura
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Ione Carvalho Pinto
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Aline Aparecida Monroe
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Pedro Fredemir Palha
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | | | - Tereza Cristina Scatena Villa
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Ricardo Alexandre Arcêncio
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
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Amo-Adjei J. Individual, household and community level factors associated with keeping tuberculosis status secret in Ghana. BMC Public Health 2016; 16:1196. [PMID: 27887600 PMCID: PMC5124270 DOI: 10.1186/s12889-016-3842-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022] Open
Abstract
Background In tuberculosis (TB) control, early disclosure is recommended for the purposes of treatment as well as a means of reducing or preventing person-to-person transmission of the bacteria. However, disclosure maybe avoided as a means of escaping stigma, and possible discrimination. This study aimed at providing insights into factors associated with intentions of Ghanaians to keep positive TB diagnosis in their families’ a secret. Methods The paper was based on data from the 2014 Ghana Demographic and Health Survey. Descriptive statistics of proportions with Chi-square test and binary logistic regression were used to identify individual, household and community level factors that predicted the outcome variable (keeping TB secret). Results Women were more inclined (33%) than men (25%) to keep TB in the family a secret. Views about keeping TB secret declined with age for both sexes. For women, higher education had a positive association with whether TB in the family would be kept a secret or not but the same was not observed for men. In a multivariable regression model, the strongest predictor of keeping TB secret was whether the respondent would keep HIV secret, and this was uniform among women (OR = 6.992, p < 0.001) and men (OR = 9.870, p < 0.001). Conclusion Unwillingness towards disclosing TB status in Ghana is associated with varied socioeconomic and demographic characteristics, which may be driven by fears of stigma and discrimination. Addressing TB-related stigma and discrimination can enhance positive attitudes towards TB disclosure. For an infectious disease such as TB, openness towards status disclosure is important for public health.
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Affiliation(s)
- Joshua Amo-Adjei
- African Population and Health Research Center, Nairobi, Kenya. .,Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
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20
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Arcêncio RA, de Almeida Crispim J, Touso MM, Popolin MP, Rodrigues LBB, de Freitas IM, Yamamura M, Neto MS. Preliminary validation of an instrument to assess social support and tuberculosis stigma in patients' families. Public Health Action 2015; 4:195-200. [PMID: 26400810 DOI: 10.5588/pha.13.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 07/22/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Ribeirão Preto, São Paulo, Brazil. OBJECTIVE To develop and validate a preliminary instrument for assessing social support and tuberculosis (TB) stigma in families of TB patients. DESIGN A literature review on social support and TB stigma was used to generate the theoretical domains for the instrument. A focus group was then conducted with TB patients and their families to revise the domains. Reviewers were invited to judge the appropriateness of the items in the instrument. A cross-sectional survey was carried out among 110 family members to assess the factorial structure using principal component analysis and confirmatory factor analysis to assess construct validity. Reliability was assessed in terms of internal consistency using Cronbach's alpha. RESULTS After semantic validation and a pilot study, 23 items were selected for the scale. Examination of the factorial structure of the 16 items that were factorable using principal component analysis led to the extraction of two factors. The 16-item instrument was assessed for construct validity with confirmatory factor analysis, which confirmed a model with four items for each dimension. CONCLUSION The study analysed the psychometric properties of an instrument that is still in its preliminary stages. Other studies on a similar scale in the Brazilian setting are required.
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Affiliation(s)
- R A Arcêncio
- Department of Maternal-Infantile Nursing and Public Health
| | - J de Almeida Crispim
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M M Touso
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M P Popolin
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L B B Rodrigues
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - I M de Freitas
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M Yamamura
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M Santos Neto
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Abstract
Background Any delay in diagnosis and consequently treatment of TB patients not only increases the infectivity of the disease in the community, but may also lead to more advance disease state, which may result in more complications and expose patients to higher risk of death. The aim of this study was to assess delays in diagnosing new TB patients and the factors associated with these delays in Hohoe Municipality of Ghana. Methods A cross sectional study was carried out among 73 new TB Patients, 15 years or older, registered between 1st June, 2013 and 31st May, 2014 in Hohoe Municipality. Questionnaires were administered to patients to evaluate factors related to delay by patients in seeking care, delays at healthcare facilities, and total diagnostic delay. Logistic regression was used to determine the factors associated with patient delay (>30 days), healthcare services delay (>15 days), and total delay (>45 days). Results The median total delay was 104 days (inter-quartile range (IQR):17–191). The median patient delay was 59 days (IQR: 5–123), and the median healthcare services delay was 45 days (IQR: 38–128). Not medically insured (AOR = 6.12; 95 % CI: 1.26–29.88; P < 0.025) and perceived stigma (AOR = 5.30; 95 % CI: 1.33–21.18; P < 0.018) were risk factors associated with prolonged patient delay. Multiple healthcare contact following signs and symptoms (AOR = 10.26; 95 %CI: 2.95–35.72; P < 0.0001) was the only risk factor associated with prolonged healthcare services delay. Conclusion There is a considerable delay in TB case detection mainly due to patients delay in seeking healthcare. The factors associated with patients’ delay include lack of medical insurance, perceived stigma, and making multiple healthcare encounters. Health system strengthening towards decentralizing TB diagnosis and management, raising public awareness about the disease, training of healthcare providers, and collaborating with non-formal healthcare providers may reduce long delays in the management of TB.
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Cremers AL, de Laat MM, Kapata N, Gerrets R, Klipstein-Grobusch K, Grobusch MP. Assessing the consequences of stigma for tuberculosis patients in urban Zambia. PLoS One 2015; 10:e0119861. [PMID: 25806955 PMCID: PMC4373828 DOI: 10.1371/journal.pone.0119861] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/17/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Stigma is one of the many factors hindering tuberculosis (TB) control by negatively affecting hospital delay and treatment compliance. In Zambia, the morbidity and mortality due to TB remains high, despite extended public health attempts to control the epidemic and to diminish stigma. STUDY AIM To enhance understanding of TB-related stigmatizing perceptions and to describe TB patients' experiences of stigma in order to point out recommendations to improve TB policy. METHODS We conducted a mixed method study at Kanyama clinic and surrounding areas, in Lusaka, Zambia; structured interviews with 300 TB patients, multiple in-depth interviews with 30 TB patients and 10 biomedical health workers, 3 focus group discussions with TB patients and treatment supporters, complemented by participant observation and policy analysis of the TB control program. Predictors of stigma were identified by use of multivariate regression analyses; qualitative analysis of the in-depth interviews, focus group discussions and participant observation was used for triangulation of the study findings. RESULTS We focused on the 138/300 patients that described TB-related perceptions and attitudes, of whom 113 (82%) reported stigma. Stigma provoking TB conceptions were associated with human immunodeficiency virus (HIV)-infection, alleged immoral behaviour, (perceived) incurability, and (traditional) myths about TB aetiology. Consequences of stigma prevailed both among children and adults and included low self-esteem, insults, ridicule, discrimination, social exclusion, and isolation leading to a decreased quality of life and social status, non-disclosure, and/or difficulties with treatment compliance and adherence. Women had significantly more stigma-related problems than men. CONCLUSIONS The findings illustrate that many TB patients faced stigma-related issues, often hindering effective TB control and suggesting that current efforts to reduce stigma are not yet optimal. The content and implementation of sensitization programs should be improved and more emphasis needs to be placed on women and children.
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Affiliation(s)
- Anne Lia Cremers
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Myrthe Manon de Laat
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathan Kapata
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- The National TB/Leprosy Control Programme, Lusaka, Zambia
- University of Zambia—University College London (UNZA-UCL) program, Lusaka, Zambia
| | - Rene Gerrets
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Epidemiology, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Peter Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Kibrisli E, Bez Y, Yilmaz A, Aslanhan H, Taylan M, Kaya H, Tanrikulu AC, Abakay O. High social anxiety and poor quality of life in patients with pulmonary tuberculosis. Medicine (Baltimore) 2015; 94:e413. [PMID: 25621689 PMCID: PMC4602632 DOI: 10.1097/md.0000000000000413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pulmonary tuberculosis (PT) has been previously related with various psychosocial adverse consequences including stigmatization and social isolation.Social anxiety is a psychiatric condition that may be associated with social isolation and fear of social exclusion.To date no study has investigated social anxiety and its impact on quality of life (QoL) among patients with PT. Therefore, we aimed to determine the severity of social anxiety in a group of patients with PT.Among patients who were recently discharged from hospital with the diagnosis of PT 94 patients and 99 healthy control subjects who had similar demographical features have been included in the study. A psychiatrist interviewed all participants and a semistructured interview form, which was prepared by the authors, Liebowitz Social Anxiety Scale (LSAS), and Short Form-36 were administered to them.Patients with PT showed higher levels of performance avoidance and social avoidance than healthy control subjects. They reported lower QoL scores across all dimensions. Among patients women showed higher levels of LSAS subscale scores and total score. Fear of social exclusion was predicted by perceived illness severity and emotional role difficulty. On the other hand, perceived illness severity was predicted by fear of exclusion and sedimentation level.PT patients seem to experience higher levels of social anxiety and associated fear of social exclusion that add to their worse QoL during the earlier months of their disease. Among them fear of social exclusion is related with perceived illness severity.
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Affiliation(s)
- Erkan Kibrisli
- From the Department of Family Medicine (EK, AY, HA), School of Medicine, Dicle University, Diyarbakir; Department of Psychiatry (YB), School of Medicine, Marmara University, Istanbul; and Department of Chest Diseases (MT, HK, ACT, OA), School of Medicine, Dicle University, Diyarbakir, Turkey
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Amo-Adjei J, Kumi-Kyereme A, Fosuah Amo H, Awusabo-Asare K. The politics of tuberculosis and HIV service integration in Ghana. Soc Sci Med 2014; 117:42-9. [PMID: 25042543 DOI: 10.1016/j.socscimed.2014.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/14/2014] [Accepted: 07/04/2014] [Indexed: 11/29/2022]
Abstract
The need to integrate TB/HIV control programmes has become critical due to the comorbidity regarding these diseases and the need to optimise the use of resources. In developing countries such as Ghana, where public health interventions depend on donor funds, the integration of the two programmes has become more urgent. This paper explores stakeholders' views on the integration of TB/HIV control programmes in Ghana within the remits of contingency theory. With 31 purposively selected informants from four regions, semi-structured interviews and observations were conducted between March and May 2012, and the data collected were analysed using the inductive approach. The results showed both support for and opposition to integration, as well as some of the avoidable challenges inherent in combining TB/HIV control. While those who supported integration based their arguments on clinical synergies and the need to promote the efficient use of resources, those who opposed integration cited the potential increase in workload, the clinical complications associated with joint management, the potential for a leadership crisis, and the "smaller the better" propositions to support their stance. Although a policy on TB/HIV integration exists, inadequate 'political will' from the top management of both programmes has trickled down to lower levels, which has stifled progress towards the comprehensive management of TB/HIV and particularly leading to weak data collection and management structures and unsatisfactory administration of co-trimoxazole for co-infected patients. It is our view that the leadership of both programmes show an increased commitment to protocols involving the integration of TB/HIV, followed by a commitment to addressing the 'fears' of frontline service providers to encourage confidence in the process of service integration.
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Affiliation(s)
- Joshua Amo-Adjei
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Akwasi Kumi-Kyereme
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Hannah Fosuah Amo
- Department of Business Administration, Valley View University, Oyibi, Accra, Ghana
| | - Kofi Awusabo-Asare
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana
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Mishra SR, Adhikari S, Khanal V. Role of mass media on knowledge generation and countering misconceptions about tuberculosis transmission in Nepal. Asian Pac J Trop Biomed 2014. [DOI: 10.12980/apjtb.4.2014apjtb-2014-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Amoah SK, Sandjo LP, Bazzo ML, Leite SN, Biavatti MW. Herbalists, traditional healers and pharmacists: a view of the tuberculosis in Ghana. REVISTA BRASILEIRA DE FARMACOGNOSIA-BRAZILIAN JOURNAL OF PHARMACOGNOSY 2014. [DOI: 10.1590/0102-695x2014241405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Amo-Adjei J, Kumi-Kyereme A. Myths and misconceptions about tuberculosis transmission in Ghana. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:38. [PMID: 24028419 PMCID: PMC3847526 DOI: 10.1186/1472-698x-13-38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 09/11/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Myths and misconceptions about TB can serve as a barrier to efforts at reducing stigmatisation of people infected and affected by the disease. Understanding such drivers of myths and misconceptions is important for improving information, education and communication (IEC) efforts of national control and preventive interventions. This study therefore assesses the influence of interaction of spatial, socioeconomic and demographic characteristics on myths and misconceptions. METHODS Data was drawn from male (N = 4,546) and female (N = 4,916) files of the 2008 Ghana Demographic and Health Survey. A myth and misconception variable was created from five-related constructs with internal consistency score of r = 0. 8802 for males (inter-item correlation: 0.5951) and for females, r = 0. 0.9312 (inter-item correlation: 0.7303). The Pearson Chi-square was used to test the bivariate relationship between the independent variables and the dependent variable. Logistic regression was subsequently used to explore the factors determining myths and misconceptions of TB transmission. RESULTS Majority of Ghanaians (males: 66.75%; females: 66.13%) did not hold myths and misconceptions about TB transmission. Females resident in the Upper East (aOR = 0.31, CI = 0.17-0.55) and Upper West (aOR = 0.41, CI = 0.24-0.69) and males resident in the Northern (aOR = 0.23, CI = 0.13-0.39) and the Greater Accra (aOR = 0.25, CI = 0.16-0.39) regions were independently associated with no misconceptions about TB transmission. Significant differences were also found in education, ethnicity and age. CONCLUSION That spatial and other socioeconomic difference exists in myths and misconceptions suggest the need for spatial, socioeconomic and demographic segmentations in IEC on TB. This holds potentials for reaching out to those who are in critical need of information and education on the transmission processes of TB.
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Affiliation(s)
- Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
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Abebe G, Deribew A, Apers L, Woldemichael K, Shiffa J, Tesfaye M, Abdissa A, Deribie F, Jira C, Bezabih M, Aseffa A, Duchateau L, Colebunders R. Knowledge, health seeking behavior and perceived stigma towards tuberculosis among tuberculosis suspects in a rural community in southwest Ethiopia. PLoS One 2010; 5:e13339. [PMID: 20948963 PMCID: PMC2952624 DOI: 10.1371/journal.pone.0013339] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 09/16/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Perceived stigma and lack of awareness could contribute to the late presentation and low detection rate of tuberculosis (TB). We conducted a study in rural southwest Ethiopia among TB suspects to assess knowledge about and stigma towards TB and their health seeking behavior. METHODS A community based cross sectional survey was conducted from February to March 2009 in the Gilgel Gibe field research area. Any person 15 years and above with cough for at least 2 weeks was considered a TB suspect and included in the study. Data were collected by trained personnel using a pretested structured questionnaire. Logistic regression analysis was done using SPSS 15.0 statistical software. RESULTS Of the 476 pulmonary TB suspects, 395 (83.0%) had ever heard of TB; "evil eye" (50.4%) was the commonly mentioned cause of TB. Individuals who could read and write were more likely to be aware about TB [(crude OR = 2.98, (95%CI: 1.25, 7.08)] and more likely to know that TB is caused by a microorganism [(adjusted OR = 3.16, (95%CI: 1.77, 5.65)] than non-educated individuals. Males were more likely to know the cause of TB [(adjusted OR = 1.92, (95%CI: 1.22, 3.03)] than females. 51.3% of TB suspects perceived that other people would consider them inferior if they had TB. High stigma towards TB was reported by 199(51.2%). 220 (46.2%) did not seek help for their illness. Individuals who had previous anti-TB treatment were more likely to have appropriate health seeking behavior [(adjusted OR = 3.65, (95%CI: 1.89, 7.06)] than those who had not. CONCLUSION There was little knowledge about TB in the Gilgel Gibe field research area. We observed inappropriate health seeking behavior and stigma towards TB. TB control programs in Ethiopia should educate rural communities, particularly females and non-educated individuals, about the cause and the importance of early diagnosis and treatment of TB.
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Affiliation(s)
- Gemeda Abebe
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
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Deribew A, Hailemichael Y, Tesfaye M, Desalegn D, Wogi A, Daba S. The synergy between TB and HIV co-infection on perceived stigma in Ethiopia. BMC Res Notes 2010; 3:249. [PMID: 20920360 PMCID: PMC2966463 DOI: 10.1186/1756-0500-3-249] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 10/04/2010] [Indexed: 11/23/2022] Open
Abstract
Background The synergy between tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection on perceived stigma is not well studied. The objective of this study was to assess the effect of TB/HIV co-infection on perceived stigma in selected hospitals of Oromiya region, Ethiopia. A cross sectional study was conducted from February to April, 2009 in Adama, Nekemet and Jimma Specialized hospitals. Data were collected by trained HIV counselors. A structured questionnaire which consisted of socio-demographic variables, clinical information, perceived stigma, and depression was used to collect the data Findings A total of 591 participants were included in the study of whom 124 (20.9%) were co-infected with TB/HIV. The stigma items were highly reliable (Cronbach's alpha = 0.93) and had strong inter dimension correlation. Respondents who were co-infected with TB and HIV were more likely to have perceived stigma compared to non-co-infected HIV patients, [OR = 1.4, (95% CI: 1.2, 2.0)]. Non-literate individuals [OR = 1.9, (95% CI: 1.2, 3.0)] and females [OR = 1.6, (95% CI: 1.2, 2.3)] had also more perceived stigma. Conclusions TB/HIV co-infected patients, non-literate individuals and females were more likely to have high perceived stigma. Behavioral Change Communication should focus on these segments of the population to rectify the high perceived stigma.
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Affiliation(s)
- Amare Deribew
- Department of Epidemiology, Jimma University, Jimma, Ethiopia.
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Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep 2010; 125 Suppl 4:34-42. [PMID: 20626191 DOI: 10.1177/00333549101250s407] [Citation(s) in RCA: 242] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The institutional and community norms that lead to the stigmatization of tuberculosis (TB) are thought to hinder TB control. We performed a systematic review of the literature on TB stigma to identify the causes and evaluate the impact of stigma on TB diagnosis and treatment. Several themes emerged: fear of infection is the most common cause of TB stigma; TB stigma has serious socioeconomic consequences, particularly for women; qualitative approaches to measuring TB stigma are more commonly utilized than quantitative surveys; TB stigma is perceived to increase TB diagnostic delay and treatment noncompliance, although attempts to quantify its impact have produced mixed results; and interventions exist that may reduce TB stigma. Future research should continue to characterize TB stigma in different populations; use validated survey instruments to quantify the impact of TB stigma on TB diagnostic delay, treatment compliance, and morbidity and mortality; and develop additional TB stigma-reduction strategies.
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Affiliation(s)
- Andrew Courtwright
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Yawkey 4B, Ste. 4700, Boston, MA 02114, USA.
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Manifestations of tuberculosis stigma within the healthcare system: the case of Sekondi-Takoradi Metropolitan district in Ghana. Health Policy 2010; 98:195-202. [PMID: 20637520 DOI: 10.1016/j.healthpol.2010.06.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 06/11/2010] [Accepted: 06/16/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To explore the manifestations of tuberculosis (TB) stigma within the healthcare system. METHOD Twenty-one individual interviews (16 females and 5 males) and six focus groups (1 with health managers, 1 with staff providing services for TB patients, and 4 with general staff) were conducted among healthcare workers (HCWs) and the generated data analysed using grounded theory principles and procedures. RESULTS TB stigma manifests in three broad and inter-related ways within the healthcare system: behaviour towards TB patients; attitudes towards TB work; and administrative procedures and policies of healthcare mangers. Healthcare workers expressed fear of infection when interacting with TB patients; a fear which intensifies after the confirmation of the diagnosis. For fear of infection, they shuned, avoided, and advocated the segregation of TB patients at home and in the hospitals. They sometimes maltreated the patients, and accused and blamed them for deliberately infecting others. Posting to TB units/wards is viewed as a punishment, with majority indicating refusal to work there or be trained as TB nurse/doctor. They maintained that those working at TB units should be given incentives. Health managers also situated TB units/wards in isolated parts of the hospital, and do not provide adequate tools, equipment, support and supervision for those offering TB services. CONCLUSIONS Fear of infection underlies the stigmatisation of TB by HCWs and worsen by administrative procedures and policies of healthcare managers. To help minimise TB stigma, a national guideline for the prevention of TB in HCWs should be developed as this may help protect them and alleviate their fear of infection. Rewarding and motivating HCWs involved in TB control may also improve their attitudes towards TB and those suffering from the disease. Furthermore, interventions to reduce TB stigma should be put in place, and the effects these may have on TB treatment outcomes investigated.
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Deribew A, Abebe G, Apers L, Jira C, Tesfaye M, Shifa J, Abdisa A, Woldemichael K, Deribie F, Bezabih M, Aseffa A, Colebunders R. Prejudice and misconceptions about tuberculosis and HIV in rural and urban communities in Ethiopia: a challenge for the TB/HIV control program. BMC Public Health 2010; 10:400. [PMID: 20604951 PMCID: PMC2909168 DOI: 10.1186/1471-2458-10-400] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 07/06/2010] [Indexed: 12/02/2022] Open
Abstract
Background In Ethiopia, where HIV and tuberculosis (TB) are very common, little is known about the prejudice and misconceptions of rural communities towards People living with HIV/AIDS (PLHA) and TB. Methods We conducted a cross sectional study in Gilgel Gibe Field Research area (GGFRA) in southwest Ethiopia to assess the prejudice and misconceptions of rural and urban communities towards PLHA and TB. The study population consisted of 862 randomly selected adults in GGFRA. Data were collected by trained personnel using a pretested structured questionnaire. To triangulate the findings, 8 focus group discussions among women and men were done. Results Of the 862 selected study participants, 750(87%) accepted to be interviewed. The mean age of the respondents was 31.2 (SD ± 11.0). Of the total interviewed individuals, 58% of them were females. More than half of the respondents did not know the possibility of transmission of HIV from a mother to a child or by breast feeding. For fear of contagion of HIV, most people do not want to eat, drink, and share utensils or clothes with a person living with HIV/AIDS. A higher proportion of females [OR = 1.5, (95% CI: 1.0, 2.2)], non-literate individuals [OR = 2.3, (95%CI: 1.4, 3.6)], rural residents [OR = 3.8, (95%CI: 2.2, 6.6)], and individuals who had poor knowledge of HIV/AIDS [OR = 2.8, (95%CI: 1.8, 2.2)] were more likely to have high prejudice towards PLHA than respectively males, literates, urban residents and individuals with good knowledge. Exposure to cold air was implicated as a major cause of TB. Literates had a much better knowledge about the cause and methods of transmission and prevention of TB than non-literates. More than half of the individuals (56%) had high prejudice towards a patient with TB. A larger proportion of females [OR = 1.3, (95% CI: 1.0, 1.9)] and non-literate individuals [OR = 1.4, (95% CI: 1.1, 2.0)] had high prejudice towards patients with TB than males and literate individuals. Conclusion TB/HIV control programs in collaboration with other partners should invest more in social mobilization and education of the communities to rectify the widespread prejudice and misconceptions.
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Affiliation(s)
- Amare Deribew
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
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