Perception of tuberculosis in the Democratic Republic of Congo: wali ya nkumu in the Mai Ndombe district

Prevalence and Spatial Autocorrelation of Tuberculosis in Indigenous People in Brazil, 2002-2022

Tuberculosis (TB) among indigenous populations in Brazil poses a multifaceted public health challenge influenced by geographical, social, institutional, economic, and cultural factors. This study scrutinized the prevalence and spatial distribution of TB among Brazilian indigenous communities from 2002 to 2022. Employing a cross-sectional and descriptive approach, we analyzed data from the Notifiable Diseases Information System (SINAN) and conducted spatial autocorrelation tests to identify clusters and outliers. The findings uncovered substantial disparities in TB prevalence between the North and Central-West regions, in contrast to the South and Southeast, mirroring social, economic, and cultural inequalities in Brazil. It is concluded that public health strategies should not only consider the epidemiological aspects of TB but also encompass social and environmental determinants, notably the impact of climate change. Holistic and context-sensitive approaches are imperative for addressing TB within indigenous communities, underscoring the need for adaptive and culturally sensitive interventions in the public health landscape.

Tuberculosis related barriers and facilitators among immigrants in Atlantic Canada: A qualitative study

Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis and affects approximately one-quarter of the world's population. Immigrant populations in Canada are disproportionately affected by TB. Canada's immigration medical examinations include screening for active TB but not latent TB infection (LTBI). In LTBI, the bacterium remains dormant within the host but can reactivate and cause disease. Once active, TB can be transmitted to close contacts sharing confined spaces leading to the possibility of outbreaks in the broader community. This study aimed to 1) assess the current TB knowledge, perceived risk, and risk behaviors of immigrants in Atlantic Canada as well as 2) identify barriers and facilitators to testing and treatment of TB among this population. Three focus group discussions were conducted with a total of 14 non-Canadian born residents of New Brunswick aged 19 years and older. Data were analyzed using inductive thematic analysis. Four themes were identified from the data relating to barriers to testing and treatment of LTBI: 1) Need for education, 2) stigma, 3) fear of testing, treatment, and healthcare system, and 4) complacency. Results included reasons individuals would not receive TB testing, treatment, or seek help, as well as facilitators to testing and treatment. These findings may inform the implemention of an LTBI screening program in Atlantic Canada and more broadly across the country.

The perception of healthcare workers of People with Disabilities presenting for care at peri-urban health facilities in Ghana

Healthcare provider attitudes and perceptions of disability may influence the delivery of comprehensive quality care to patients with disabilities. The study was conducted to ascertain healthcare providers' perspectives on access to healthcare by disabled people in a peri-urban district of Ghana. We employed a qualitative approach and selected participants using the purposive sampling technique. Qualitative data were collected from 28 healthcare providers through face-to-face interviews using an interview guide. Data let thematic an alysis was employed to tease out the findings through categorisation and the main themes have been presented as findings with specific quotations to support them. We found that people with disabilities who visited healthcare facilities were perceived as individuals who are stressed up, selfish and inconsiderate, violent, having low self-esteem and also difficult to communicate with. This could affect the interactions between healthcare providers and people with disabilities who visit the facility and subsequently the quality of service provided. It is recommended that the Ministry of Education, Ministry of Health and the Ghana Health Service work closely with the various educational institutions to train healthcare professionals to improve their knowledge on disability issues to improve service delivery.

Role of acceptability barriers in delayed diagnosis of Tuberculosis: Literature review from high burden countries

PURPOSE

Direct transmission of mutated tuberculosis (TB) strains is among major contributors to the worldwide epidemic of Drug-Resistant Tuberculosis. Expanding access to TB-services and decreasing diagnostic delays are acknowledged as potential solutions. We aimed to summarize evidence about links between health care acceptability barriers and TB diagnostic delays. Scoping and systematic review approaches were combined to determine the depth/breadth of the literature, identify gaps, and synthesize findings.

METHODS

Electronic data-bases, key journals, other relevant electronic sources, and references of relevant articles were selected as potential sources through a preliminary search and expertś advice. Titles and abstracts of 4046 initial records and 1796 references were screened against preliminarily developed and post-hoc inclusion/exclusion criteria. Author, year of publication, study location, study aims, overview of methods, study population, intervention type, outcomes measures and results of each included paper were extracted. Methodological quality of studies was assessed. Narrative synthesis of the study results was conducted through the thematic analysis approach.

RESULTS

Patients' negative expectations, doubts about quality of services/medications and burden of stigma, as well as providers' discriminative attitudes towards patients' characteristics (age, gender, ethnicity) were reported as major barriers. Scarcity and unequal distribution of the literature and lack of attention to all potential acceptability barriers were found as major gaps in the current research.

CONCLUSION

Overall, study findings indicate the significance of acceptability barriers' role in TB diagnostic delays. Emerging character of the field is demonstrated. Recommendations about further research directions are outlined.

Data on the descriptive overview and the quality assessment details of 12 qualitative research papers

This data article presents the supplementary material for the review paper "Role of acceptability barriers in delayed diagnosis of Tuberculosis: Literature review from high burden countries" (Barnabishvili et al., in press) [1]. General overview of 12 qualitative papers, including the details about authors, years of publication, data source locations, study objectives, overview of methods, study population characteristics, as well as the details of intervention and the outcome parameters of the papers are summarized in the first two tables included to the article. Quality assessment process of the methodological strength of 12 papers and the results of the critical appraisal are further described and summarized in the second part of the article.

Dynamics of a Mathematical Model for Tuberculosis with Variability in Susceptibility and Disease Progressions Due to Difference in Awareness Level

This work extends a mathematical model for the transmission dynamics of tuberculosis that examined the impact of certain factors on tuberculosis case detection (Okuonghae and Omosigho, 2011). The extended model now classifies the latently infected individuals by their level of tuberculosis awareness (as was done for the susceptible sub-population) and further expands the number of key factors that can positively affect the tuberculosis case detection rate. The effect of these identified factors on the associated reproduction number of the model is considered. It is shown that the system can undergo the phenomenon of backward bifurcation when the associated reproduction number of the model is less than unity; in a special case, the effect of exogenous re-infection on the backward bifurcation phenomenon is significantly dictated by the level of awareness of the latently infected individuals. Qualitative and quantitative analysis of the model showed the effect of key identified factors on the dynamics of tuberculosis while suggesting a serious concentration on tuberculosis awareness programmes, active case finding strategies and use of active cough identification for identifying likely TB cases and sustaining awareness campaigns over a long period of time.

Assessing the consequences of stigma for tuberculosis patients in urban Zambia

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.

American Muslim perceptions of healing: key agents in healing, and their roles

American Muslims represent a growing and diverse community. Efforts at promoting cultural competence, enhancing cross-cultural communication skills, and improving community health must account for the religio-cultural frame through which American Muslims view healing. Using a community-based participatory research model, we conducted 13 focus groups at area mosques in southeast Michigan to explore American Muslim views on healing and to identify the primary agents, and their roles, within the healing process. Participants shared a God-centric view of healing. Healing was accessed through direct means such as supplication and recitation of the Qur'an, or indirectly through human agents including imams, health care practitioners, family, friends, and community. Human agents served integral roles, influencing spiritual, psychological, and physical health. Additional research into how religiosity, health care systems, and community factors influence health-care-seeking behaviors is warranted.

A qualitative review: the stigma of tuberculosis

BACKGROUND

Tuberculosis is a major health problem internationally and brings with it a range of physical, economic and social consequences. There is a stigma associated with having tuberculosis because the disease is commonly viewed as a 'dirty disease'. This stigma can have a negative impact on an individual and may delay the person seeking treatment.

AIMS

The aim of this review was to explore the stigma and impact of having tuberculosis or having a family member with tuberculosis.

DESIGN

Literature review.

METHOD

A comprehensive search of the electronic databases was undertaken. Inclusion criteria for the review were studies that investigated people with tuberculosis or their families, focused on the stigma or impact of tuberculosis and reported descriptions of the experience. Data were synthesised using a thematic analysis.

RESULTS

The literature search identified thirty studies. Three themes emerged from the synthesis: shame, isolation and fear. The shame related to tuberculosis being viewed as a bad disease, a dirty disease. Isolation involved both the withdrawal from social contact and the shunning of contact by other people. Fear was a consequence of the many difficulties that accompany tuberculosis. These factors operated at three levels, on the individual level, the family level and the societal level.

CONCLUSION

The stigma that accompanies tuberculosis can have a negative impact on the individual and family and may result in their withdrawal from society because of shame and fear. The review highlights the need for education to provide practical strategies for individuals and families and to educate communities where tuberculosis is endemic. Relevance to clinical practice.  The review highlights the widespread ignorance of tuberculosis and need for education of the individual, family and community. This education should provide practical strategies to help people cope with tuberculosis. It also suggests that ensuring confidentiality should be an important component of management strategies.

Tuberculosis and stigmatization: pathways and interventions

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.

Manifestations of tuberculosis stigma within the healthcare system: the case of Sekondi-Takoradi Metropolitan district in Ghana

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.

Routes to government TB treatment: private providers, family support, and the process of TB treatment seeking among Ugandan women

Tuberculosis (TB) remains a major source of morbidity and mortality in Uganda. This cross-sectional study explores Ugandan women's TB treatment-seeking processes to determine the routes to effective government TB treatment among a sample of urban, semirural, and rural women. This research focuses on women in particular as Ugandan women with tuberculosis must negotiate their treatment paths in a context where women tend to be politically and economically marginalized, with limited control of household resources and senior family members' health care decisions. The results examine the structural, social, and economic forces similarly guiding treatment seeking across the three research sites and then the specific differences among the settings. The findings suggest that the modest number of nongovernmental health care providers' diagnoses and referrals, particularly for urban and semirural participants, represents a critical barrier to biomedical TB treatment. Private providers' diagnosis delays also carry financial and physical costs, which undermine the resources available for subsequent TB treatment and participants' social and economic well-being. This study indicates that conceptualizations of the political economy of treatment seeking need to more fully acknowledge the dynamic nature of the microlevel political economic context of treatment seeking, including the domino social, economic, and health effects of structurally problematic health care systems.

'We are afraid of them': attitudes and behaviours of community members towards tuberculosis in Ghana and implications for TB control efforts

One major set back to the success of TB control globally is the stigma attached to the disease in most societies. This article explores community's understanding of, and attitudes and behaviours towards TB and examines the implications for disease control efforts. Individual in-depth interviews and focus groups were held with community members and the generated data analysed using Grounded Theory techniques and procedures. At the core of feelings towards TB in the community is the fear of infection leading to imposition of socio-physical distance and participatory restrictions on those suffering from the disease. Because of fear of infection, most of the community members were of the view that TB patients should not be part of the society and said they will not marry a TB patient or encourage any family member to enter such a relationship. They also pointed out that TB patients should not sell in the community and would not be allowed to represent them at any public function because they can infect others. Whenever it becomes unavoidable for the community members to interact with someone with TB, they indicated that they would cover their mouth with a handkerchief, turn their head or sit in the opposite direction of the wind from the TB patient to avoid inhaling the air. When a TB patient joins the community members at any function, he/she is expected to abide by certain 'codes of conduct'. The stigmatising attitudes and behaviours of the community members towards the disease and its sufferers may lead individuals with very obvious signs and symptoms of TB to attribute it to other non-stigmatising conditions or hide the diagnosis from others as well as default from treatment.

Perception and management of tuberculosis symptoms in Addis Ababa, Ethiopia

Management of early tuberculosis (TB) symptoms and adherence to medical treatment are main challenges in controlling TB. The aim of this study is to explore how symptoms of TB are perceived and managed, from the onset of symptoms and during the course of treatment, in Addis Ababa, Ethiopia. We conducted a qualitative interview study, including 50 in-depth interviews and 2 focus groups, with TB patients, their relatives, and health personnel. We found that a patient's perceptions and self-treatment of early symptoms could cause diagnostic delay. Stigma associated with TB and public health services made many patients approach private clinics, causing further delay. Both private and public clinics often labeled and managed symptoms according to lay explanatory models. Lack of adequate knowledge about TB's etiology and cure caused patients to continue relating to symptoms by reference to their own understanding. This affected patients' ability to manage TB and its treatment.

Measuring stigma associated with tuberculosis and HIV/AIDS in southern Thailand: exploratory and confirmatory factor analyses of two new scales

OBJECTIVE

To develop scales to measure tuberculosis and HIV/AIDS stigma in a developing world context.

METHODS

Cross-sectional study of tuberculosis patients in southern Thailand, who were asked to rate their agreement with items measuring TB and HIV/AIDS stigma. Developing the scales involved exploratory and confirmatory factor analyses, internal consistency, construct validity, test-retest reliability and standardized summary scores.

RESULTS

Factor analyses identified two sub-scales associated with both tuberculosis and HIV/AIDS stigma: community and patient perspectives. Goodness-of-fit was good (TLI = 94, LFI = 0.88 and RMSEA = 0.11), internal consistency was excellent (Cronbach's alphas 0.82-0.91), test-retest reliability was moderate, and construct validity showed an inverse correlation with social support.

CONCLUSION

Our scales have good psychometric properties that measure stigma associated with tuberculosis and HIV/AIDS and allow assessment of stigma from community and patient perspectives. Their use will help document the burden of stigma, guide the development of interventions and evaluate stigma reduction programmes in areas with a high HIV/AIDS and tuberculosis burden.

"Focus groups can be fun": the use of activity-oriented questions in focus group discussions

Interest in focus group discussions has grown recently, and so has the recognition of them as a valuable method for qualitative data collection. Despite increasing popularity, they are not an easy option, and moderators must find appropriate ways to approach participants to achieve good-quality data. A path to reach this aim is the inclusion in the focus group agenda of some "exercises" (or activity-oriented questions) that are enjoyable and productive supplements to questions. Exercises provide a different way of gathering information and are beneficial, for instance, for more reflective participants. They can help focus the group's attention on the core study topic and also make subsequent comparative analysis more straightforward. They can also be helpful with young people and to discuss sensitive topics. The author describes and provides suggestions for use and examples of several exercises, illustrating their application in a research project investigating the cultural meaning of youth suicide in university students in Italy, India, and Australia.

Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-synthesis

AIM

This paper reports the findings from a qualitative meta-synthesis concerning people with, or at risk of, tuberculosis, service providers and policymakers and their experiences and perceptions of tuberculosis and treatment.

BACKGROUND

Directly observed therapy is part of a package of interventions to improve tuberculosis treatment and adherence. A Cochrane systematic review of trials showed an absence of evidence for or against directly observed therapy compared with people treating themselves.

METHOD

Qualitative systematic review methods were used to search, screen, appraise and extract data thematic analysis was used to synthesize data from 1990 to 2002, and an update of literature to December 2005. Two questions were addressed: 'What does qualitative research tell us about the facilitators and barriers to accessing and complying with tuberculosis treatment?' and 'What does qualitative research tell us about the diverse results and effect sizes of the randomized controlled trials included in the Cochrane review?' Findings help explain the diverse trial results in a Cochrane systematic review of directly observed therapy and tuberculosis and consider implications for research, policy and practice.

FINDINGS

Five themes emerged from the 1990 to 2002 synthesis: socio-economic circumstances, material resources and individual agency; explanatory models and knowledge systems in relation to tuberculosis and its treatment; the experience of stigma and public discourses around tuberculosis; sanctions, incentives and support, and the social organization and social relationships of care. Two additional themes emerged from the 2005 update.

CONCLUSION

The qualitative meta-synthesis improved the relevance and scope of the Cochrane review of trials. The findings make a major contribution to the development of theory concerning global WHO-branded disease control and the practicality of local delivery to people.