Social stigma and risk determinants associated with tuberculosis transmission to vulnerable residents in India
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20263232Keywords:
Tuberculosis, Social stigma, Risk factors, Drug resistant-TB, Epidemic, TransmissionAbstract
Due to enduring socioeconomic disparities and deep-rooted societal stigma, tuberculosis (TB) remains one of India's most urgent public health concerns. This review article assesses how societal stigma and important risk factors are linked to the onset and spread of TB, especially in vulnerable groups, including slum dwellers, migrants, and people with little access to healthcare. Stigmatization frequently leads to social isolation, non-adherence to treatment, and delayed diagnosis, all of which raise the risk of ongoing transmission within the community settings. Malnutrition, poverty, and co-infection with HIV increase the vulnerability to infection and the course of the disease. A misconception about TB is that it is an ethically motivated disease that discourages people from seeking treatment through healthcare organisations and reinforces discrimination in many Indian communities. Subsequently, failing to report and insufficient treatment remain major obstacles to controlling this disease. The perceived threat of TB infection transmission among susceptible inhabitants in both urban and rural India is highlighted in this article as a result of these intersecting social and epidemiological factors. Thus, it is imperative to develop stigma-reduction initiatives, integrate TB services into primary healthcare, and strengthen community-based awareness campaigns to break the chains of transmission and assert equal access to healthcare. To achieve India's aim of TB elimination, it is vital to address the combined problem of biological and social risk factors. Knowing the social aspects of TB transmission is essential for developing focused treatments that enhance treatment results and promote a more inclusive, stigma-free public health strategy.
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Padhi A, Agarwal A, Bhise M, Chaudhary A, Joshi K, Katoch CDS. Progress and challenges in achieving tuberculosis elimination in India by 2025: A systematic review and meta-analysis. PLoS One. 2024;19(3):e0301060. DOI: https://doi.org/10.1371/journal.pone.0301060
Laycock KM, Enane LA, Steenhoff AP. Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People. Trop Med Infect Dis. 2021;6(3):148. DOI: https://doi.org/10.3390/tropicalmed6030148
Khanna A, Saha R, Ahmad N. National TB elimination programme-What has changed. Indian J Med Microbiol. 2023;42:103. DOI: https://doi.org/10.1016/j.ijmmb.2022.10.008
Purty AJ. Detect-Treat-Prevent-Build: Strategy for TB elimination in India by 2025. Indian J Community Med. 2018;43(1):1-4. DOI: https://doi.org/10.4103/ijcm.IJCM_321_17
Mancuso G, Midiri A, De Gaetano S, Ponzo E, Biondo C. Tackling Drug-Resistant Tuberculosis: New Challenges from the Old Pathogen Mycobacterium tuberculosis. Microorganisms. 2023;11(9):2277. DOI: https://doi.org/10.3390/microorganisms11092277
Zhang T, Zhang J, Wei L. The global, regional, and national burden of tuberculosis in 204 countries and territories, 1990-2019. J Infect Public Health. 2023;16(3):368-75. DOI: https://doi.org/10.1016/j.jiph.2023.01.014
Liebenberg D, Gordhan BG, Kana BD. Drug resistant tuberculosis: Implications for transmission, diagnosis, and disease management. Front Cell Infect Microbiol. 2022;12:943545. DOI: https://doi.org/10.3389/fcimb.2022.943545
Selvaraju S, Velayutham B, Rao R. Prevalence and factors associated with tuberculosis infection in India. J Infect Public Health. 2023;16(12):2058-65. DOI: https://doi.org/10.1016/j.jiph.2023.10.009
Lv H, Wang L, Zhang X. Further analysis of tuberculosis in eight high-burden countries based on the Global Burden of Disease Study 2021 data. Infect Dis Poverty. 2024;13(1):70. DOI: https://doi.org/10.1186/s40249-024-01247-8
Kiazyk S, Ball T. Latent tuberculosis infection: An overview. Canada Commun Dis Rep. 2017;43(3-4):62. DOI: https://doi.org/10.14745/ccdr.v43i34a01
Chijioke-Akaniro OO, Ubochioma E, Omoniyi A. Improving TB case notification and treatment coverage through data use. Public Heal Action. 2022;12(3):128. DOI: https://doi.org/10.5588/pha.22.0001
Litvinjenko S, Wu S, Phd W. Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews. Lancet Infect Dis. 2023;23(12):1395. DOI: https://doi.org/10.1016/S1473-3099(23)00372-9
Thimmanahalli Sobagaiah R, Kumari N, Bharathi Gattam D, Khazi MS. Nationwide surveys of awareness of tuberculosis in India uncover a gender gap in tuberculosis awareness. Commun Med. 2024;4(1):168. DOI: https://doi.org/10.1038/s43856-024-00592-x
Dandona R, Kumar GA, Dora SSP, Akbar M, Singh K, George S, et al. Sex-disaggregated patterns in tuberculosis treatment coverage and outcomes among a nationally representative sample of deaths in India: 2019–2022. Lancet Reg Heal- Southeast Asia. 2024;31:100448. DOI: https://doi.org/10.1016/j.lansea.2024.100448
Swinkels HM, Jilani TN, Tobin EH. Tuberculosis Prevention, Control, and Elimination. StatPearls. 2025.
Lin PL, Flynn JL. Understanding Latent Tuberculosis: A Moving Target. J Immunol. 2010;185(1):15. DOI: https://doi.org/10.4049/jimmunol.0903856
Luies L, Preez I du. The Echo of Pulmonary Tuberculosis: Mechanisms of Clinical Symptoms and Other Disease-Induced Systemic Complications. Clin Microbiol Rev. 2020;33(4):e00036-20. DOI: https://doi.org/10.1128/CMR.00036-20
Dookie N, Ngema SL, Perumal R, Naicker N, Padayatchi N, Naidoo K. The Changing Paradigm of Drug-Resistant Tuberculosis Treatment: Successes, Pitfalls, and Future Perspectives. Clin Microbiol Rev. 2022;35(4):e00180-19. DOI: https://doi.org/10.1128/cmr.00180-19
Chatterjee S, Das P, Stallworthy G, Bhambure G, Munje R, Vassall A. Catastrophic costs for tuberculosis patients in India: Impact of methodological choices. PLOS Glob Public Heal. 2024;4(4):e0003078. DOI: https://doi.org/10.1371/journal.pgph.0003078
Lee JY, Kwon N, Goo G yeon, Cho S il. Inadequate housing and pulmonary tuberculosis: a systematic review. BMC Public Health. 2022;22(1):622. DOI: https://doi.org/10.1186/s12889-022-12879-6
Alegría M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K. Social Determinants of Mental Health: Where We Are and Where We Need to Go. Curr Psychiatry Rep. 2018;20(11):95. DOI: https://doi.org/10.1007/s11920-018-0969-9
Nagarajan K, Muniyandi M, Janagaraj V, Karthick C, Stephen A, Senthil S, et al. Economic Burden of TB Deaths in India (2021): A Retrospective Cross-sectional Study. Open Forum Infect Dis. 2025;12(8)of433. DOI: https://doi.org/10.1093/ofid/ofaf433
Oxlade O, Murray M. Tuberculosis and Poverty: Why Are the Poor at Greater Risk in India? PLoS One. 2012;7(11):e47533. DOI: https://doi.org/10.1371/journal.pone.0047533
Wang EY, Arrazola RA, Mathema B, Ahluwalia IB, Mase SR. The impact of smoking on tuberculosis treatment outcomes: a meta-analysis. Int J Tuberc Lung Dis. 2020;24(2):170. DOI: https://doi.org/10.5588/ijtld.19.0002
Zvolska K, Pankova A, Nohavova I, Rumana H, Helen E, Melanie B, et al. A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries. Tob Induc Dis. 2020;18:67. DOI: https://doi.org/10.18332/tid/125195
Lee J, Chung C, Jung SS, Hye KP, Sung-Soon L, Ki Man L. Do patients attempt and succeed in quitting smoking during tuberculosis treatment? A prospective cohort study. BMC Pulm Med. 2023;23(1):1-8. DOI: https://doi.org/10.1186/s12890-023-02693-0
Jang JG, Chung JH. Diagnosis and treatment of multidrug-resistant tuberculosis. Yeungnam Univ J Med. 2020;37(4):277. DOI: https://doi.org/10.12701/yujm.2020.00626
Schwalb A, Kayumba K, Houben RMGJ, Bothamley GH. Recent Travel and Tuberculosis in Migrants: Data From a Low-Incidence Country. Clin Infect Dis An Off Publ Infect Dis Soc Am. 2023;78(3):742. DOI: https://doi.org/10.1093/cid/ciad672
Aldridge RW, Zenner D, White PJ, Robert WA, Dominik Z, Peter JW, et al. Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland. Lancet (London, England). 2016;388(10059):2510. DOI: https://doi.org/10.1016/S0140-6736(16)31008-X
Franco JVA, Bongaerts B, Metzendorf MI, Agostina R, Yang G, Laura PS, et al. Undernutrition as a risk factor for tuberculosis disease. Cochrane Database Syst Rev. 2024;2024(6):CD015890.
Shifera N, Yosef T. Undernutrition and its predictors among tuberculosis patients in Southwest Ethiopia. Front Nutr. 2024;11:1450669. DOI: https://doi.org/10.3389/fnut.2024.1450669
Navasardyan I, Miwalian R, Petrosyan A, Yeganyan S, Venketaraman V. HIV-TB Coinfection: Current Therapeutic Approaches and Drug Interactions. Viruses. 2024;16(3):321. DOI: https://doi.org/10.3390/v16030321
Sultana ZZ, Hoque FU, Beyene J, Akhlak-Ul-Islam M, Rahman Khan MH, Ahmed S, et al. HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis. BMC Infect Dis. 2021;21(1):51. DOI: https://doi.org/10.1186/s12879-020-05749-2
Kubiak RW, Sarkar S, Horsburgh CR, Gautam R, Mario K, Ayiraveetil R, et al. Interaction of nutritional status and diabetes on active and latent tuberculosis: A cross-sectional analysis. BMC Infect Dis. 2019;19(1):1-9. DOI: https://doi.org/10.1186/s12879-019-4244-4
Talat N, Perry S, Parsonnet J, Dawood G, Hussain R. Vitamin D Deficiency and Tuberculosis Progression. Emerg Infect Dis. 2010;16(5):853. DOI: https://doi.org/10.3201/eid1605.091693
Boadu AA, Yeboah-Manu M, Osei-Wusu S, Yeboah-Manu D. Tuberculosis and diabetes mellitus: The complexity of the comorbid interactions. Int J Infect Dis. 2024;146:107140. DOI: https://doi.org/10.1016/j.ijid.2024.107140
Medrano M, Carrillo-Cruz E, Montero I, Perez-Simon JA. Vitamin D: Effect on Haematopoiesis and Immune System and Clinical Applications. Int J Mol Sci. 2018;19(9):2663. DOI: https://doi.org/10.3390/ijms19092663
Baussano I, Nunn P, Williams B, Pivetta E, Bugiani M, Scano F. Tuberculosis among Health Care Workers. Emerg Infect Dis. 2011;17(3):488. DOI: https://doi.org/10.3201/eid1703.100947
Carwile ME, Babu SP, Cintron C, Madolyn D, Susie JP, Mahalakshmi T, et al. TB stigma in India: A narrative review of types of stigma, gender differences, and potential interventions. PLOS Glob Public Heal. 2025;5(9):e0005109. DOI: https://doi.org/10.1371/journal.pgph.0005109
Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep. 2010;125(4):34-42. DOI: https://doi.org/10.1177/00333549101250S407
Yadav S. Stigma in Tuberculosis: Time to Act on an Important and Largely Unaddressed Issue. Cureus. 2024;16(6):e61964. DOI: https://doi.org/10.7759/cureus.61964
Oaten M, Stevenson RJ, Case TI. Disease avoidance as a functional basis for stigmatization. Philos Trans R Soc B Biol Sci. 2011;366(1583):3433. DOI: https://doi.org/10.1098/rstb.2011.0095
Kılıç A, Zhou X, Moon Z, Yohhei H, Trinh D, Charlotte L, et al. A systematic review exploring the role of tuberculosis stigma on test and treatment uptake for tuberculosis infection. BMC Public Health. 2025;25(1):1-17. DOI: https://doi.org/10.1186/s12889-024-20868-0
Samal J. Women and tuberculosis care in India: a scoping review. Egypt J Bronchol. 2025;19(1):1-11. DOI: https://doi.org/10.1186/s43168-025-00383-5
Kumari Indira KS, Mathew N. TB related stigma and gender disparity among unaffected population in central Kerala, a survey. Indian J Tuberc. 2023;70(2):168-75. DOI: https://doi.org/10.1016/j.ijtb.2022.03.028
Vericat-Ferrer M, Ayala A, Ncogo P, Eyene-Acuresila J, García B, Benito A, et al. Knowledge, Attitudes, and Stigma: The Perceptions of Tuberculosis in Equatorial Guinea. Int J Environ Res Public Health. 2022;19(14):8227. DOI: https://doi.org/10.3390/ijerph19148227
Siva N, Mohanty K, Rath R, Mishra S, Mishra M, Samal K, et al. A systematic scoping review of health-seeking behavior and healthcare utilization in tribal communities of odisha, india: concentration on maternal and child health. BMC Public Heal. 2025;25(1):1-14. DOI: https://doi.org/10.1186/s12889-025-24079-z
Seyedmehdi SM, Jamaati H, Varahram M. Barriers and facilitators of tuberculosis treatment among immigrants: an integrative review. BMC Public Health. 2024;24(1):3514. DOI: https://doi.org/10.1186/s12889-024-21020-8
Figueroa-Munoz JI, Ramon-Pardo P. Tuberculosis control in vulnerable groups. Bull World Health Organ. 2008;86(9):733. DOI: https://doi.org/10.2471/BLT.06.038737
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. DOI: https://doi.org/10.1155/2023/1014666
Narasimhan P, Wood J, Macintyre CR, Mathai D. Risk Factors for Tuberculosis. Pulm Med. 2013;2013:828939. DOI: https://doi.org/10.1155/2013/828939
Krishnan L, Akande T, Shankar AV, Katherine NM, Celine RG, Gupta A, et al. Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies. Tuberc Res Treat. 2014;2014:215059. DOI: https://doi.org/10.1155/2014/215059
Craig GM, Daftary A, Engel N, O’Driscoll S, Ioannaki A. Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries. Int J Infect Dis. 2017;56:90-100. DOI: https://doi.org/10.1016/j.ijid.2016.10.011
Kamble B, Singh S, Jethani S, Chellaiyan DV, Acharya B. Social stigma among tuberculosis patients attending DOTS centers in Delhi. J Fam Med Prim care. 2020;9(8):4223. DOI: https://doi.org/10.4103/jfmpc.jfmpc_709_20
Aitambayeva N, Aringazina A, Nazarova L, Kamila F, Magripa B, Nazerke N, et al. A Systematic Review of Tuberculosis Stigma Reduction Interventions. Healthcare. 2025;13(15):1846. DOI: https://doi.org/10.3390/healthcare13151846
Baral SC, Karki DK, Newell JN. Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study. BMC Public Health. 2007;7:211. DOI: https://doi.org/10.1186/1471-2458-7-211
Roya-Pabon CL, Perez-Velez CM. Tuberculosis exposure, infection and disease in children: a systematic diagnostic approach. Pneumonia. 2016;8(1):1-18. DOI: https://doi.org/10.1186/s41479-016-0023-9
Reuter A, Seddon JA, Marais BJ, Furin J. Preventing tuberculosis in children: A global health emergency. Paediatr Respir Rev. 2020;36:44-51. DOI: https://doi.org/10.1016/j.prrv.2020.02.004
Cioboata R, Balteanu MA, Osman A, Silviu GV, Ovidiu MZ, Denisa MM, et al. Coinfections in Tuberculosis in Low- and Middle-Income Countries: Epidemiology, Clinical Implications, Diagnostic Challenges, and Management Strategies-A Narrative Review. J Clin Med. 2025;14(7):2154. DOI: https://doi.org/10.3390/jcm14072154
Tanyanyiwa FT, Van Wyk RH, Setswe KG. Assessment of the Syndemic Relationship Between Individual, Social, and Structural Determinants of Tuberculosis Among People Living in Johannesburg, South Africa. Int J Environ Res Public Heal. 2025;22(8):1272. DOI: https://doi.org/10.3390/ijerph22081272
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