Burden of stigma among tuberculosis patients: a cross-sectional study
Keywords:Burden, Stigma, Tuberculosis
Background: Tuberculosis (TB) is a significant public health problem in populous countries like India. Despite having effective treatment, social stigma still exists and it manifest as social exclusion (enacted stigma) or perception of it (felt stigma). The main causes of stigma are fear of TB and the terrible effects the disease will have on affected people and their family’s health, finances, personal lives, and social standing. Delay in diagnosis and treatment are brought on by stigma, resulting in adverse treatment outcomes and thus prevent TB from being eliminated. The objectives of the study were to (a) estimate the burden of stigma experienced by tuberculosis patients; and (b) identify the factors associated with stigma.
Methods: A cross-sectional analytical observational study was carried out among 100 TB patients above 18 years of age in the months of September - November 2022. Multistage random sampling was used to select the study participants from different peripheral health institutes. Data was collected using predesigned, pretested proforma from explanatory model interview catalogue developed by WHO. Data was collected after obtaining informed consent and analysed by using SPSS 21.
Results: Majority of patients (59%) perceived stigma. Many (73%) revealed that they desire to keep others from knowing about their condition, felt that others would think less of patient’s family (66%) and avoided them (69%) due to disease.
Conclusions: Patients with TB still experience greater stigma at home, among friends, and at work. Sensitization of family and awareness among the public is essential to combat stigma.
WHO. Global tuberculosis report, 2019. Available at: https://www.who.int/publications/i/item/975714. Accessed on 09 March 2023.
Central TB Division. India TB Report, 2022. Available at: https://tbcindia.gov.in/index1.php?lang=1&lev&sublinkid=5612&lid=3658. Accessed on 09 March 2023.
WHO. The end TB strategy, 2015. Available at: https://www.who.int/publications/i/item/WHOHTM-TB-2015.19. Accessed on 09 March 2023.
Ali M. Treating tuberculosis as a social disease. Lancet. 2014;383(9936):2195.
Rubel AJ, Garro LC. Social and cultural factors in the successful control of tuberculosis. Public Health Reports. 1992;107(6):626.
Lin X, Chongsuvivatwong V, Lin L, Geater A, Lijuan R. Dose-response relationship between treatment delay of smear-positive tuberculosis patients and intra-household transmission: a cross-sectional study. Trans R Soc Trop Med Hyg. 2008;102(8):797-804.
WHO. Global tuberculosis report, 2019. Available at: https://www.who.int/publications/i/item. Accessed on 09 March 2023.
TBINFO. From TB survivors to TB Champions, 2022. Available at: http://tbinfo.org/sites/default/files/2021_0. Accessed on 09 March 2023
Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep. 2010;125(4):34-42.
Kamble BD, Singh SK, Jethani S, Chellaiyan VGD, Acharya BP. Social stigma among tuberculosis patients attending DOTS centers in Delhi. J Family Med Prim Care. 2020;9(8):4223-8.
Atre SR, Kudale AM, Morankar SN, Rangan SG, Weiss MG. Cultural concepts of tuberculosis and gender among the general population without tuberculosis in rural Maharashtra, India. Trop Med Int Health. 2004;9(11):1228-38.
Sunil, Singh A, Singh LK, Goyal P, Mondal A. Study of social stigma among tuberculosis patients from northern India. Indian J Public Health Res Dev. 2019;10(8):434-8.
Aryal S, Badhu A, Pandey S, Bhandari A, Khatiwoda P, Khatiwada P, Giri A. Stigma related to tuberculosis among patients attending DOTS clinics of Dharan municipality. Kathmandu Univ Med J (KUMJ). 2012;10(37):48-52.
Gosoniu GD, Ganapathy S, Kemp J, Auer C, Somma D, Karim F, et al. Gender and socio-cultural determinants of delay to diagnosis of TB in Bangladesh, India and Malawi. Int J Tuberc Lung Dis. 2008;12(7):848-55.
Datiko DG, Jerene D, Suarez P. Stigma matters in ending tuberculosis: Nationwide survey of stigma in Ethiopia. BMC Public Health. 2020;20(1):190.