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Craciun OM, Torres MDR, Llanes AB, Romay-Barja M. Tuberculosis Knowledge, Attitudes, and Practice in Middle- and Low-Income Countries: A Systematic Review. J Trop Med 2023; 2023:1014666. [PMID: 37398546 PMCID: PMC10314818 DOI: 10.1155/2023/1014666] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
Tuberculosis (TB) is the leading cause of death from an infectious agent in the world. Most tuberculosis cases are concentrated in low- and middle-income countries. The aim of this study is to better understand tuberculosis-related knowledge about TB disease, prevention, treatment and sources of information, attitudes towards TB patients and their stigmatization and prevention, diagnosis and treatment practices in the general population of middle- and low-income countries, with a high tuberculosis burden, and provide evidence for policy development and decision-making. A systematic review of 30 studies was performed. Studies reporting on knowledge, attitudes, and practices surveys were selected for systematic review through database searching. Population knowledge about TB signs and symptoms, prevention practices, and treatment means was found inadequate. Stigmatization is frequent, and the reactions to possible diagnoses are negative. Access to health services is limited due to difficulties in transportation, distance, and economic cost. Deficiencies in knowledge and TB health-seeking practices were present regardless of the living area, gender, or country; however, it seems that there is a frequent association between less knowledge about TB and a lower socioeconomic and educational level. This study revealed gaps in knowledge, attitude, and practices in focused in middle- and low-income countries. Policymakers could take into account the evidence provided by the KAP surveys and adapt their strategies based on the identified gaps, promoting innovative approaches and empowering the communities as key stakeholders. It is necessary to develop education programs on symptoms, preventive practices, and treatment for TB, to reduce transmission and stigmatization. It becomes also necessary to provide communities with innovative healthcare solutions to reduce their barriers to access to diagnosis and treatment.
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Affiliation(s)
| | - Malen del Rosario Torres
- National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- Andrés Isola Hospital, Puerto Madryn, Chubut, Argentina
| | - Agustín Benito Llanes
- National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María Romay-Barja
- National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Yuan Y, Jin J, Bi X, Geng H, Li S, Zhou C. Gender-Specific Association Between Perceived Stigma Toward Tuberculosis and Acceptance of Preventive Treatment Among College Students With Latent Tuberculosis Infection: Cross-Sectional Analysis. JMIR Public Health Surveill 2023; 9:e43972. [PMID: 37314847 DOI: 10.2196/43972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND With the increasing enrollment scale of colleges, the number of students on campus has risen sharply in China. The number of students with tuberculosis (TB) and rifampicin-resistant TB in colleges has increased significantly. Preventive treatment of latent tuberculosis infection (LTBI) is an important means for TB prevention and control in colleges. At present, the acceptance of LTBI treatment among college students remains unclear. In addition, evidence shows stigma may be one of the key factors affecting acceptance of LTBI treatment. To date, there is little direct evidence on the gender-specific association between perceived stigma toward TB and acceptance of LTBI treatment among college students. OBJECTIVE This study aimed to describe the acceptance of LTBI treatment among college students in an eastern province of China to explore the association between perceived stigma toward TB and acceptance of LTBI treatment and to examine the moderating effect of gender on the association. METHODS Data were derived from the project on the evaluation of LTBI treatment and its effectiveness among college students in Shandong, China. In total, 1547 college students were included in the analysis. We considered covariates at the individual and family levels. Multilevel mixed-effects logistic regression was used to examine the moderating role of gender and also explore the association between perceived stigma toward TB and acceptance of LTBI treatment. RESULTS The acceptance rate of LTBI treatment among the diagnosed college students was 46.7% (n=723). The proportion of female students (n=361, 51.5%) accepting LTBI treatment was higher than that of male students (n=362, 42.8%; P=.001). There was an interaction between perceived stigma toward TB and gender (OR 0.93, 95% CI 0.87-1.00; P=.06). Among college students with LTBI, perceived stigma toward TB was positively associated with acceptance of preventive treatment (OR 1.03, 95% CI 1.00-1.08, P=.05). Perceived stigma toward TB was positively associated with accepting LTBI treatment only among male students (OR 1.07, 95% CI 1.02-1.12; P=.005). CONCLUSIONS The acceptance rate of preventive treatment among college students with LTBI was low. Contrary to our expectations, perceived stigma toward TB was positively associated with acceptance of preventive treatment. Gender moderated this association; high perceived stigma toward TB was associated with acceptance of preventive treatment only in male gender. Gender-specific strategies are effective in improving the acceptability of LTBI treatment in colleges.
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Affiliation(s)
- Yemin Yuan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jin Jin
- Department of Prevention and Control, Shandong Public Health Clinical Center, Jinan, China
| | - Xiuli Bi
- Department of Prevention and Control, Shandong Public Health Clinical Center, Jinan, China
| | - Hong Geng
- Department of Prevention and Control, Shandong Public Health Clinical Center, Jinan, China
| | - Shixue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
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3
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OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:710-716. [DOI: 10.1093/trstmh/trac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/16/2021] [Accepted: 03/20/2022] [Indexed: 11/14/2022] Open
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Bergman A, Farley JE, Agarwalla V, Relf M. Reframing Intersectional Stigma for a South African Context Integrating Tuberculosis, HIV and Poverty Stigmas. J Assoc Nurses AIDS Care 2022; 33:22-32. [PMID: 34939985 DOI: 10.1097/jnc.0000000000000296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Intersectionality is closely intertwined with Black feminism within the context of the United States. As a result, intersectionality is often overlooked in non-Western contexts where racial homogeneity may reduce some of the impact of race on marginalization. This article will look at intersectional stigma from the South African context using the tuberculosis/HIV (TB/HIV) treatment environment in South Africa to exemplify intersectionality's versatility as an analytic method outside of the United States. We will use colonial history and contemporary research to reframe intersectionality considering a new set of stigmatized identities, including HIV stigma, TB stigma, and poverty stigma, to create a situation-specific framework adapted from a model by Bulent Turan and colleagues.
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Affiliation(s)
- Alanna Bergman
- Alanna Bergman, MSN, AGNP-BC, AAHIVS, is a PhD Student, Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA. Jason E. Farley, PhD, MPH, ANP-BC, AACRN, FAAN, FAANP, is a Professor at Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA. Vidisha Agarwalla, MA, is a Social Design Associate, Johns Hopkins University in the PROMOTE Center, Baltimore, Maryland, USA. Michael Relf, PhD, RN, AACRN, ACNS-BC, CNE, ANEF, FAAN, is the Associate Dean, Global and Community Health Affairs, Duke University, School of Nursing, Durham, North Carolina, USA
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Junaid SA, Kanma-Okafor OJ, Olufunlayo TF, Odugbemi BA, Ozoh OB. Tuberculosis stigma: Assessing tuberculosis knowledge, attitude and preventive practices in surulere, Lagos, Nigeria. Ann Afr Med 2021; 20:184-192. [PMID: 34558447 PMCID: PMC8477276 DOI: 10.4103/aam.aam_40_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Tuberculosis (TB), though preventable and curable, remains a global health problem, ranked one of the top causes of death worldwide, despite the World Health Organization's strategies. This may be due to the stigma surrounding the disease. Aim This study assesses TB stigma in light of knowledge, attitudes, and preventive practices among individuals in an urban community. Settings and Design This was a descriptive, cross-sectional study among 317 residents of Surulere, Lagos, Nigeria, selected by multi-stage sampling. Subjects and Methods Data were collected using a pretested, semi-structured, interviewer-administered questionnaire and analyzed using Epi InfoTM version 7.2.2.6 2018 (Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA). Statistical Analysis Used Descriptive variables were summarized as frequencies, and the Chi-square test was used to test the associations. The level of significance was predetermined at P ≤0.05. Results Most participants were between the age group of 21 and 40 years. Approximately 9 out of every 10 respondents (91.8%) were aware of TB. Overall, only 2.4% of respondents had good knowledge of TB, more than half (59.1%) had positive attitudes toward TB, about one-third (37.1%) had good preventive practices and 22.7% of respondents expressed TB stigma, 63.6% would show no compassion or desire to help people with TB while 64.3% would rather people with TB were never employed. However, good knowledge translated into less stigma (P <0.001). Conclusions Most participants were aware of TB, although knowledge, attitude, and practice levels were poor. Knowledge was found to reduce TB stigma, reinforcing the need for improved community literacy regrading TB. This has the potential to influence health-seeking behavior and promote better TB prevention, detection, and treatment outcomes.
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Affiliation(s)
- Salamah Abimbola Junaid
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
| | - Oluchi Joan Kanma-Okafor
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
| | - Tolulope Florence Olufunlayo
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
| | - Babatunde A Odugbemi
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Obianuju Beatrice Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
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Simbwa BN, Katamba A, Katana EB, Laker EAO, Nabatanzi S, Sendaula E, Opio D, Ictho J, Lochoro P, Karamagi CA, Kalyango JN, Worodria W. The burden of drug resistant tuberculosis in a predominantly nomadic population in Uganda: a mixed methods study. BMC Infect Dis 2021; 21:950. [PMID: 34521382 PMCID: PMC8442422 DOI: 10.1186/s12879-021-06675-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
Background Emergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population in Karamoja, Uganda with a high-TB burden (3500 new cases annually) and sought to determine the prevalence, patterns, factors associated with DR-TB. Methods We used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case control study with conditional logistic regression and robust standard errors respectively were used to the determine prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth interviews and key informant interviews. Results The overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64,197 (0.1%) among the new and 37/2693 (1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI 1.552–110.135) and drug stock-outs aOR 0.027 (95%CI 0.002–0.364). The nomadic lifestyle, substance use, congested homesteads and poor health worker attitudes were a great challenge to effective treatment of TB. Conclusion Despite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education may help to stem the burden of TB disease in this nomadic population.
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Affiliation(s)
- Brenda Nakafeero Simbwa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Achilles Katamba
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth B Katana
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Sandra Nabatanzi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel Sendaula
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Denis Opio
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Charles A Karamagi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Pediatrics, Makerere University, Kampala, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Division of Pulmonology, Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda
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Msoka EF, Orina F, Sanga ES, Miheso B, Mwanyonga S, Meme H, Kiula K, Liyoyo A, Mwebaza I, Aturinde A, Joloba M, Mmbaga B, Amukoye E, Ntinginya NE, Gillespie SH, Sabiiti W. Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study. BMJ Open 2021; 11:e050911. [PMID: 34253677 PMCID: PMC8276309 DOI: 10.1136/bmjopen-2021-050911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Early diagnosis and timely treatment are key elements of a successful healthcare system. We assessed the role of socioeconomic and cultural norms in accelerating or decelerating uptake and utilisation of health technologies into policy and practice. SETTING Secondary and tertiary level healthcare facilities (HCFs) in three East African countries. Level of HCF was selected based on the WHO recommendation for implantation of tuberculosis (TB) molecular diagnostics. PARTICIPANTS Using implementation of TB diagnostics as a model, we purposively selected participants (TB patients, carers, survivors, healthcare practitioners, community members, opinion leaders and policy-makers) based on their role as stakeholders. In-depth interviews, key informant interviews and focus group discussions were held to collect the data between 2016 and 2018. The data were transcribed, translated, coded and analysed by thematic-content analysis. RESULTS A total of 712 individuals participated in the study. Socioeconomic and cultural factors such as poverty, stigma and inadequate knowledge about causes of disease and available remedies, cultural beliefs were associated with low access and utilisation of diagnostic and treatment tools for TB. Poverty made people hesitate to seek formal healthcare resulting in delayed diagnosis and resorting to self-medication and cheap herbal alternatives. Fear of stigma made people hide their sickness and avoid reporting for follow-up treatment visits. Inadequate knowledge and beliefs were fertile ground for aggravated stigma and believing that diseases like TB are caused by spirits and thus cured by spiritual rituals or religious prayers. Cultural norms were also the basis of gender-based imbalance in accessing care, 'I could not go to hospital without my husband's permission', TB survivor. CONCLUSION Our findings show that socioeconomic and cultural factors are substantial 'roadblocks' to accelerating the uptake and utilisation of diagnostic and treatment tools. Resolving these barriers should be given equal attention as is to health system barriers.
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Affiliation(s)
- Elizabeth F Msoka
- Kimanjaro Clinical Research Institute - Kilimanjaro Christian Medical University College, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Fred Orina
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Erica Samson Sanga
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, United Republic of Tanzania
| | - Barbara Miheso
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Simeon Mwanyonga
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, United Republic of Tanzania
| | - Helen Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kiula Kiula
- Kimanjaro Clinical Research Institute - Kilimanjaro Christian Medical University College, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
- Department of Rural-Urban Development, The University of Dodoma, Dodoma, United Republic of Tanzania
| | - Alphonce Liyoyo
- Kimanjaro Clinical Research Institute - Kilimanjaro Christian Medical University College, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Ivan Mwebaza
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Augustus Aturinde
- Department of Physical Geography and Ecosystem Science, Lund University, Lund, Sweden
- Department of Physical Geography and Ecosystem Science, Kyambogo University, Kampala, Uganda
| | - Moses Joloba
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Blandina Mmbaga
- Kimanjaro Clinical Research Institute - Kilimanjaro Christian Medical University College, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Evans Amukoye
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nyanda Elias Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, United Republic of Tanzania
| | - Stephen H Gillespie
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Wilber Sabiiti
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, Fife, UK
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Getnet F, Demissie M, Worku A, Gobena T, Tschopp R, Farah AM, Seyoum B. Challenges in delivery of tuberculosis Services in Ethiopian Pastoralist Settings: clues for reforming service models and organizational structures. BMC Health Serv Res 2021; 21:627. [PMID: 34193133 PMCID: PMC8246683 DOI: 10.1186/s12913-021-06662-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The End-TB strategy aims to see a world free of tuberculosis (TB) by the coming decade through detecting and treating all cases irrespective of socioeconomic inequalities. However, case detections and treatment outcomes have not been as they should be in Somali pastoral settings of Ethiopia. Hence, this study aimed to explore the challenges that hinder the delivery and utilization of TB services in pastoral areas. Methods A qualitative study was conducted between December 2017 and October 2018 among pastoralist patients with delay of ≥2 months in seeking healthcare, healthcare providers and programme managers. Data were collected from different sources using 41 in-depth interviews, observations of facilities and a review meeting of providers from 50 health facilities. The data were transcribed, coded and analyzed to identify pre-defined and emerging sub-themes. ATLAS.ti version 7.0 was used for coding data, categorizing codes, and visualizing networks. Results Poor knowledge of TB and its services, limited accessibility (unreachability, unavailability and unacceptability), pastoralism, and initial healthcare-seeking at informal drug vendors that provide improper medications were the key barriers hindering the uptake of TB medical services. Inadequate infrastructure, shortage of trained and enthused providers, interruptions of drugs and laboratory supplies, scarce equipment, programme management gaps, lack of tailored approach, low private engagement, and cross-border movement were the major challenges affecting the provision of TB services for pastoral communities. The root factors were limited potential healthcare coverage, lack of zonal and district TB units, mobility and drought, strategy and funding gaps, and poor development infrastructure. Conclusion In pastoral settings of Ethiopia, the major challenges of TB services are limited access, illicit medication practices, inadequate resources, structural deficits, and lack of tailored approaches. Hence, for the pastoral TB control to be successful, mobile screening and treatment modalities and engaging rural drug vendors will be instrumental in enhancing case findings and treatment compliance; whereas, service expansion and management decentralization will be essential to create responsive structures for overcoming challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06662-3.
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Affiliation(s)
- Fentabil Getnet
- School of Public Health, Jigjiga University, Jigjiga, Ethiopia. .,School of Public Health, Haramaya University, Dire Dawa, Ethiopia.
| | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- School of Public Health, Haramaya University, Dire Dawa, Ethiopia
| | - Rea Tschopp
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Pampalia N, Waluyo A, Yona S. Knowledge, stigma and health-seeking behavior of patients co-infected with HIV and tuberculosis in Jakarta. ENFERMERIA CLINICA 2021. [PMID: 33849184 DOI: 10.1016/j.enfcli.2020.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose was to identify knowledge and TB stigma, as well as its relationship with health-seeking behavior in HIV and TB co-infection patients. A cross-sectional study was conducted with 115 HIV and TB co-infection patients who visited the VCT Polyclinic in five hospitals in Jakarta. This study was using instruments: Brief HIV-Knowledge Questionnaire (HIV-KQ-18), Knowledge TB survey Questionnaire, Berger HIV stigma Scale, Tuberculosis-Related Stigma Scale. This study showed that respondents had good knowledge of TB (69.6%) and had a low stigma of TB (55.7%), and had a health-seeking behavior that did not delay consultation (55.7%). There was a significant relationship between TB knowledge (p-value: 0.042) and TB stigma (p-value: 0.026) with health-seeking behavior. The results of this study can be used as guidelines to improve education and counseling about TB knowledge and TB stigma in HIV and TB co-infection patients.
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Affiliation(s)
- Novi Pampalia
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia; Mohammad Hoesin Cental General Hospital, South Sumatera, Indonesia
| | - Agung Waluyo
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia.
| | - Sri Yona
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia
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Mehta SN, Murrill M, Suryavanshi N, Bhosale R, Naik S, Patil N, Gupta A, Mathad J, Shivakoti R, Alexander M. TB-related knowledge and stigma among pregnant women in low-resource settings. Int J Tuberc Lung Dis 2021; 25:148-150. [PMID: 33656428 DOI: 10.5588/ijtld.20.0241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S N Mehta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Murrill
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Suryavanshi
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Bhosale
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - S Naik
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - N Patil
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - J Mathad
- Weill Cornell Medical College, New York, NY
| | - R Shivakoti
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - M Alexander
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
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Prihanti GS, Julianto NR, Sasmita AH, Nurfahmi A, Setyautami A, Rosyida D, Muslimawaty T, Fatmawati N. The Effectiveness of Cough Etiquette Counseling among People with Presumptive and Confirmed Tuberculosis. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i12021.26-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Tuberculosis (TB) is one of the most severe global health problems. The World Health Organization recommends the application of and compliance with infection control measures, one of which is cough etiquette to prevent transmission of pathogenic droplets. Purpose: The aim of the current research was to determine the effectiveness of cough etiquette counseling on changes in the knowledge, behavior, and awareness of patients with confirmed and suspected TB at Public Health Center (PHC) of C in K city. Methods: This research was designed as a pre-experimental study and was conducted in July 2018. The target population of the research comprised TB patients who were being treated in PHC of C in K city. The inclusion criteria were patients at PHC of C in K city with confirmed TB recorded between January and June 2018 and those with suspected TB reported between May and June 2018. This research was analyze based on univariable and bivariable analysis using T-testing and Wilcoxon testing. Results: There were significant differences in knowledge changes before and after cough etiquette counseling (mean difference = 3.72; p < 0.00). There was a significant difference in behavior before and after counseling (mean difference = 1.12; p = 0.04). There was also a significant difference in awareness before and after counseling (mean difference = 5.89; p < 0.00). Conclusion: Changes in knowledge, behavior, and awareness were observed in confirmed and suspected TB patients after cough etiquette counseling.
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12
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Kazaura M, Kamazima SR. Knowledge, attitudes and practices on tuberculosis infection prevention and associated factors among rural and urban adults in northeast Tanzania: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000104. [PMID: 36962113 PMCID: PMC10022383 DOI: 10.1371/journal.pgph.0000104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
Almost 10 million of the global population was infected with tuberculosis (TB) in 2017. Tanzania is among countries with high incidence of TB. Although control measures of TB are multi factorial, it is important to understand the individual's knowledge, attitudes and practices (KAP) in order to control TB infection. We conducted a cross-sectional study in northeast Tanzania; recruited and interviewed 1519 adults from two districts, one rural and another urban. We scored each participant using several questions for each construct of KAP. A study participant scoring at least 60% of the possible maximum scores was considered as having a good knowledge, positive attitude or good practices. And herein, a participant having positive TB attitude would mean they acknowledge TB exist, recognizes its impact on health and would seek or advise TB-infected individuals to seek the correct remedies. We applied multiple linear regression analysis to assess independent individual-level factors related to TB on KAP scores in the rural and urban populations. Overall, less than half (44%) of the study participants had good overall knowledge about TB infection and significantly more urban than rural adult population had good overall knowledge (p<0.001). Almost one in ten, (11%) of all study participants had positive attitudes towards TB infection. More urban study participants, (16%) had positive attitudes than their rural counterparts, 6%). Almost nine in ten (89%) of all study participants had good practices towards TB prevention and control; significantly more adults in urban, (97%) than the rural populations (56%) (p<0.01). Predictors of KAP scores were individual's education and main source of income. Adults in rural and urban northeast Tanzania have poor knowledge, attitudes and practices for TB infection and prevention. Strategies focusing on health education are important for control of TB, especially among rural communities.
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Affiliation(s)
- Method Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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A Comparative Study of Knowledge, Attitude, and Determinants of Tuberculosis-Associated Stigma in Rural and Urban Communities of Lagos State, Nigeria. Tuberc Res Treat 2020; 2020:1964759. [PMID: 33343936 PMCID: PMC7728486 DOI: 10.1155/2020/1964759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/15/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis (TB) is an important public health concern in Nigeria. TB-associated stigma could lead to delayed diagnosis and care, treatment default, and multidrug resistance. Understanding of TB-associated stigma is therefore important for TB control. The study is aimed at determining and comparing the knowledge, attitude, and determinants of TB-associated stigma. Methodology. This was a comparative cross-sectional study among adults in urban and rural areas of Lagos State, Nigeria. Respondents were selected through a multistage sampling technique and interviewed using a semistructured questionnaire, which contained the Explanatory Model Interviewed Catalogue (EMIC) stigma scale. IBM SPSS Statistics Software package version 20 was used for analysis. Results A total of 790 respondents were interviewed. High proportions of respondents in rural and urban areas were aware of TB (97.5% and 99.2%, respectively). Respondents in the urban areas had overall better knowledge of TB compared to the rural areas (59.4% vs. 23%; p < 0.001), while respondents in the rural areas had a better attitude to TB (60.5% vs. 49.9%; p = 0.002). The majority of respondents in rural and urban areas had TB-associated stigma (93% and 95.7%, respectively). The mean stigma score was higher in the urban compared to rural areas (17.43 ± 6.012 and 16.54 ± 6.324, respectively, p = 0.046). Marital status and ethnicity were the predictors of TB-associated stigma in the rural communities (AOR-0.257; CI-0.086-0.761; p = 0.014 and AOR–3.09; CI-1.087-8.812; p = 0.034, respectively), while average monthly income and age of respondents were the predictors of TB-associated stigma in urban areas (AOR–0.274; CI–0.009-0.807; p = 0.019 and AOR-0.212; CI–0.057-0.788; p = 0.021, respectively). Conclusion TB-associated stigma is prevalent in both rural and urban areas in this study. There is therefore a need to disseminate health appropriate information through the involvement of the community. Also, innovative stigma reduction activities are urgently needed.
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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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Wild H, Mendonsa E, Trautwein M, Edwards J, Jowell A, GebreGiorgis Kidanu A, Tschopp R, Barry M. Health interventions among mobile pastoralists: a systematic review to guide health service design. Trop Med Int Health 2020; 25:1332-1352. [PMID: 32881232 DOI: 10.1111/tmi.13481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap. METHODS We conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records. RESULTS Our search yielded 4884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11). CONCLUSION Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and 'temporary fixed' services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.
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Affiliation(s)
- Hannah Wild
- Stanford University School of Medicine, Stanford, CA, USA.,Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Micah Trautwein
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | - Ashley Jowell
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Rea Tschopp
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Michele Barry
- Stanford University School of Medicine, Stanford, CA, USA.,The Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
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Gelaye KA, Debalkie G, Ayele TA, Wami SD, Sisay MM, Fetene D, Wolde HF, Akalu TY. The role of mass media exposure on tuberculosis knowledge and attitude among migrant and seasonal farmworkers in Northwest Ethiopia. BMC Infect Dis 2020; 20:579. [PMID: 32758160 PMCID: PMC7405343 DOI: 10.1186/s12879-020-05316-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background Globally, tuberculosis (TB) is the 10th leading cause of death. Despite no country achieved its target, the world health organization (WHO) proposed a 90–90-90 approach to fastening the end TB strategy. Improvement and progression of TB control need good knowledge and a favorable attitude towards the disease. However, interventions designed don’t take migrants and seasonal farmworkers into account. Therefore, this study aimed at estimating the level of knowledge and attitude on Tuberculosis among migrant and seasonal farmworkers in northwest Ethiopia. Methods Community-based cross-sectional study was conducted in the West Gondar zone from October to November 2018. A two-stage cluster sampling was used to select 949 migrant and seasonal farmworkers. Both bivariate and multivariable logistic regression analyses were performed. A p-value of < 0.05 was used to declare statistical significance. The goodness of fit was checked using Hosmer and Lemeshow test. Results In this study, (41.8%), (95% CI: 38.73, 45.01) and (50.5%), (95% CI: 47.29, 53.65) of migrants and seasonal farmworkers had good knowledge and a favorable attitude, respectively. The odds of good knowledge among mass media exposed migrants were AOR = 1.42, 95% CI: (1.02, 2.01). Moreover, urban residence and having good knowledge increase the odds of favorable attitude by 1.66, (AOR = 1.7; 95% CI: 1.05, 2.62) and 4.3 (AOR = 4.3, 95%CI: 3.26, 5.75), respectively. Conclusion In this study, the overall knowledge and attitude of migrant and seasonal farmworkers on TB were low. Family size and mass media exposure significantly affect knowledge of the migrants on TB. On the other hand, the attitude was affected by urban residence, health information, and having good knowledge. Health promotion interventions, focused on TB cause, mode of transmission, prevention, and treatment are important to migrant and seasonal farmworkers to improve the knowledge and attitude of migrants and seasonal farmworkers.
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Affiliation(s)
- Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Getu Debalkie
- Department of Health Education and Behavioral Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Sintayehu Daba Wami
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Destaw Fetene
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
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Health services uptake among nomadic pastoralist populations in Africa: A systematic review of the literature. PLoS Negl Trop Dis 2020; 14:e0008474. [PMID: 32716938 PMCID: PMC7447058 DOI: 10.1371/journal.pntd.0008474] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 08/25/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022] Open
Abstract
The estimated 50 million nomadic pastoralists in Africa are among the most "hard-to-reach" populations for health-service delivery. While data are limited, some studies have identified these communities as potential disease reservoirs relevant to neglected tropical disease programs, particularly those slated for elimination and eradication. Although previous literature has emphasized the role of these populations' mobility, the full range of factors influencing health service utilization has not been examined systematically. We systematically reviewed empirical literature on health services uptake among African nomadic pastoralists from seven online journal databases. Papers meeting inclusion criteria were reviewed using STROBE- and PRISMA-derived guidelines. Study characteristics were summarized quantitatively, and 10 key themes were identified through inductive qualitative coding. One-hundred two papers published between 1974-2019 presenting data from 16 African countries met our inclusion criteria. Among the indicators of study-reporting quality, limitations (37%) and data analysis were most frequently omitted (18%). We identified supply- and demand-side influences on health services uptake that related to geographic access (79%); service quality (90%); disease-specific knowledge and awareness of health services (59%); patient costs (35%); contextual tailoring of interventions (75%); social structure and gender (50%); subjects' beliefs, behaviors, and attitudes (43%); political will (14%); social, political, and armed conflict (30%); and community agency (10%). A range of context-specific factors beyond distance to facilities or population mobility affects health service uptake. Approaches tailored to the nomadic pastoralist lifeway, e.g., that integrated human and veterinary health service delivery (a.k.a., "One Health") and initiatives that engaged communities in program design to address social structures were especially promising. Better causal theorization, transdisciplinary and participatory research methods, clearer operational definitions and improved measurement of nomadic pastoralism, and key factors influencing uptake, will improve our understanding of how to increase accessibility, acceptability, quality and equity of health services to nomadic pastoralist populations.
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Mohammedhussein M, Alenko A, Tessema W, Mamaru A. Prevalence and Associated Factors of Depression and Anxiety Among Patients with Pulmonary Tuberculosis Attending Treatment at Public Health Facilities in Southwest Ethiopia. Neuropsychiatr Dis Treat 2020; 16:1095-1104. [PMID: 32636628 PMCID: PMC7326627 DOI: 10.2147/ndt.s249431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/10/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Depression and anxiety are the most commonly occurring psychiatric comorbidities among patients with pulmonary tuberculosis (PTB). Co-occurring anxiety and depression in PTB patients result in poor adherence to anti-tuberculosis medication. This in turn results in lower success rate of treatment and an upsurge in morbidity and mortality. Despite this problem existing globally, little has been explored in southwest Ethiopia. OBJECTIVE The aim of this study was to assess the prevalence and associated factors of depression and anxiety among patients with pulmonary tuberculosis receiving treatment at public health facilities in southwest Ethiopia. MATERIALS AND METHODS A facility-based cross-sectional study was conducted from April to May 2019. Data were collected from 410 PTB patients using hospital anxiety and depression scale (HADS). Epi data version 3.1 and SPSS version 23 were used to enter and analyze data respectively. Multiple logistic regressions were fitted to identify the strength of association between outcome and explanatory variables. P <0.05 was considered statistically significant. RESULTS Prevalence of depression and anxiety among PTB patients were 229 (55.9 %) and 224 (54.6%), respectively. High perceived stress [AOR=3.61 (1.99, 6.53)], perceived stigma [AOR=10.13 (5.52, 18.63)], being in an intensive phase of treatment [AOR= 3.33 (1.83, 6.07)], and low body mass index [AOR=2.07 (1.13, 3.80)] were significantly associated with depression. Being female [AOR=2.42 (1.39, 4.22)], perceived stigma [AOR=3.58 (1.99, 6.42)], high perceived stress [AOR=4.40 (2.52, 7.69)], and family history of mental illness [AOR=2.66 (1.19, 5.94)] had significant association with anxiety. CONCLUSION More than half of the study participants were found to have probable depression and anxiety. This indicates the need to pay attention to the mental health condition of patients with PTB, particularly to those with identified risk factors.
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Affiliation(s)
- Mustefa Mohammedhussein
- Department of Psychiatry, Faculty of Public Health and Medical Science, Mettu University, Mettu, Ethiopia
| | - Arefayne Alenko
- Department of Psychiatry, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Worknesh Tessema
- Department of Psychiatry, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Almaz Mamaru
- Department of Psychiatry, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
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The impact of pastoralist mobility on tuberculosis control in Ethiopia: a systematic review and meta-synthesis. Infect Dis Poverty 2019; 8:73. [PMID: 31474228 PMCID: PMC6717972 DOI: 10.1186/s40249-019-0583-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Directly observed treatment, short-course (DOTS) is the current mainstay to control tuberculosis (TB) worldwide. Context-specific adaptations of DOTS have impending implications in the fight against TB. In Ethiopia, there is a national TB control programme with the goal to eliminate TB, but uneven distribution across lifestyle gradients remains a challenge. Notably, the mobile pastoralist communities in the country are disproportionately left uncovered. The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia. MAIN TEXT We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and systematically reviewed articles in seven electronic databases: Excerptra Medical Database, African Journal Online, PubMed, Google Scholar, Centre for Agriculture and Bioscience International Direct, Cochrane Library and Web of Science. The databases were searched from inception to December 31, 2018, with no language restriction. We screened 692 items of which 19 met our inclusion criteria. Using a meta-ethnographic method, we identified six themes: (i) pastoralism in Ethiopia; (ii) pastoralists' livelihood profile; (iii) pastoralists' service utilisation; (iv) pastoralists' knowledge and awareness on TB control services; (v) challenges of TB control in pastoral settings; and (vi) equity disparities affecting pastoralists. Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country. CONCLUSIONS This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle. Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision. Targeting these two parameters holds promise to enhance effectiveness of an intervention.
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A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
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Sima BT, Belachew T, Abebe F. Health care providers' knowledge, attitude and perceived stigma regarding tuberculosis in a pastoralist community in Ethiopia: a cross-sectional study. BMC Health Serv Res 2019; 19:19. [PMID: 30621678 PMCID: PMC6325851 DOI: 10.1186/s12913-018-3815-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) remains the prime killer disease among infectious diseases. TB control depends on early case detection and treatment in a directly observed treatment short course (DOTS) programme. The success of DOTS depends on the ability of the health care system to identify and properly manage TB cases. The present study aims to assess healthcare provider (HCP) knowledge, attitude and perceived stigma regarding TB and perception about traditional healers. Methods A descriptive cross sectional study was conducted among 108 HCPs using a semi-structured, self-administered questionnaire from September 2014 to January 2015. The study district has a high TB burden area with one district hospital, 4 health centres, and 18 health posts. All health facilities and HCPs available during the study period in the district were included in the study. Statistical software for social science (SPSS) version 22 and STATA version 14 were used to enter and analyse data, respectively. Results The majority (64%) of the HCPs had poor overall knowledge regarding TB, and 67.6 and 57.6% had poor knowledge regarding TB diagnosis and nature of the disease, respectively. Moreover, most 66.7 and 55.6% of the HCPs had an unfavourable attitude towards TB and TB control systems, respectively. Slightly under half (49.1%) of the HCPs had a favourable attitude towards TB patients, and the majority (88.9%) had low perceived stigma. The majority (87.0%) of the HCPs indicated the importance of community involvement in TB control activity. Moreover, most (60.2%) of the HCPs showed willingness to collaborate with traditional healers (THs) on TB control activity. Conclusions Healthcare workers’ knowledge gap and unfavourable attitude towards TB control systems reported in this study may cause poor TB care delivery. HCPs’ perception of the importance of community involvement in TB control and willingness to collaborate with THs on TB management could be an opportunity to strengthen the World Health Organization’s (WHO’s) component of End TB strategy through community engagement. Training and workshops could be used to address the knowledge gap and the unfavourable attitude regarding TB among HCPs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3815-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bezawit Temesgen Sima
- Department of Health Education and Behavioral Science, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia. .,Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway.
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health Science, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Fekadu Abebe
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway
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Choi Y, Jeong GH. Army Soldiers' Knowledge of, Attitude Towards, and Preventive Behavior Towards Tuberculosis in Korea. Osong Public Health Res Perspect 2018; 9:269-277. [PMID: 30402383 PMCID: PMC6202020 DOI: 10.24171/j.phrp.2018.9.5.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this study was to gather information about Korean Army soldiers’ attitude towards tuberculosis to enable the development of an informed educational program and potential intervention plans. Methods There were 500 male soldiers serving in the Korean Army who responded to questionnaires regarding knowledge of, attitudes towards, and preventive behavior towards tuberculosis. The questionnaires were collected between September 10 until October 1, 2014. Participants’ characteristic that influenced differences in knowledge, attitudes, and preventive behavior towards tuberculosis were compared by t test. Variables that influenced preventive behavior were identified by multiple regression analysis. Results The mean scores assessing knowledge of, attitude, and preventive behavior towards tuberculosis were 11.64 (± 4.03) out of 20 points, 3.21 (± 0.38) out of 4 points, and 2.88 (± 0.42) out of 4 points, respectively. Non-smokers were more knowledgeable about tuberculosis than smokers. Participants who had family or friends with tuberculosis had better knowledge and a more productive attitude to tuberculosis. Participants who were educated or obtained information about tuberculosis, received better scores in all areas of knowledge, attitude and preventive behavior compared to other participants. Non-smoking, family or friends who have had tuberculosis, obtaining information about tuberculosis, and positive attitudes towards treatment and preventive education had an explanatory power of 24.6% with regard to preventive behavior against tuberculosis. Conclusion More relatable, systemized education should be provided regularly to improve soldiers’ knowledge of, attitudes towards, and prevention against tuberculosis in the Republic of Korea Army.
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Affiliation(s)
- Yun Choi
- Division of Tuberculosis Epidemic Investigation, Korean Centers for Diseases Prevention and Control, Cheongju, Korea.,Graduate School of Ewha University, Seoul, Korea
| | - Geum Hee Jeong
- Division of Nursing & Research Institute of Nursing Science, Hallym University, Chuncheon, Korea
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Mbuthia GW, Olungah CO, Ondicho TG. Knowledge and perceptions of tuberculosis among patients in a pastoralist community in Kenya: a qualitative study. Pan Afr Med J 2018; 30:287. [PMID: 30637071 PMCID: PMC6317384 DOI: 10.11604/pamj.2018.30.287.14836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/19/2018] [Indexed: 01/03/2023] Open
Abstract
Introduction Tuberculosis awareness is crucial to the success of control and prevention of tuberculosis. However, the knowledge and perceptions of tuberculosis patients in rural Kenya is not well documented. The study sought to explore the knowledge and perceptions of TB patients in West Pokot County Kenya. Methods This was a qualitative descriptive study conducted between January-March 2016. A total of 61 pulmonary tuberculosis patients took part in the study which comprised 6 focus group discussion and 15 in-depth interviews. Thematic analysis was used to analyse the data. Results Participants perceived TB as a serious contagious disease that is hard to diagnose and treat. They attributed tuberculosis to smoking, drinking alcohol, dust, cold air, witchcraft, trauma to the chest, contact with livestock and genetic factors. They believed that TB was transmitted through casual contact with TB patients and sharing of utensils. Conclusion The study showed a lot of misperceptions among tuberculosis patients. The tuberculosis program should heighten patient education to improve patient knowledge and put more effort to dispel misinformation about the cause and mode of transmission of the disease.
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Affiliation(s)
| | | | - Tom Gesora Ondicho
- Institute of Anthropology Gender and African Studies, University of Nairobi, Kenya
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Social distance toward people with schizophrenia is associated with favorable understanding and negative stereotype. Psychiatry Res 2018; 261:264-268. [PMID: 29329046 DOI: 10.1016/j.psychres.2017.12.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 12/14/2022]
Abstract
Previous studies have suggested the consequence of mental health-related public stigma: the problem of knowledge may develop into problem of attitude and behaviour. However, this has not been directly explored in a longitudinal study. As the secondary analysis from our previous randomized controlled trial (RCT) for 219 participants who completed the survey at the 12-month follow-up, we aimed to investigate whether the knowledge and attitude components of stigma toward people with schizophrenia affect each other. At baseline and at 12 months, three types of stigma scales were measured: favorable understanding, negative stereotype, and social distance toward people with schizophrenia. A structured equation model was fitted to the trajectory of stigma scales taking into account the effect of the other stigma components and the interventions. The results showed that greater social distance toward people with schizophrenia at baseline was associated with less favorable understanding and more negative stereotype at the 12-month follow-up. This was not in line with the existing consequences from the previous studies; however, in line with the recent RCTs showing that social contact is the most effective intervention to reduce stigma. Future observational studies with a larger sample size are needed to clarify this relationship further.
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