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      Knowledge, Health Seeking Behavior and Perceived Stigma towards Tuberculosis among Tuberculosis Suspects in a Rural Community in Southwest Ethiopia

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          Abstract

          Background

          Perceived stigma and lack of awareness could contribute to the late presentation and low detection rate of tuberculosis (TB). We conducted a study in rural southwest Ethiopia among TB suspects to assess knowledge about and stigma towards TB and their health seeking behavior.

          Methods

          A community based cross sectional survey was conducted from February to March 2009 in the Gilgel Gibe field research area. Any person 15 years and above with cough for at least 2 weeks was considered a TB suspect and included in the study. Data were collected by trained personnel using a pretested structured questionnaire. Logistic regression analysis was done using SPSS 15.0 statistical software.

          Results

          Of the 476 pulmonary TB suspects, 395 (83.0%) had ever heard of TB; “evil eye” (50.4%) was the commonly mentioned cause of TB. Individuals who could read and write were more likely to be aware about TB [(crude OR = 2.98, (95%CI: 1.25, 7.08)] and more likely to know that TB is caused by a microorganism [(adjusted OR = 3.16, (95%CI: 1.77, 5.65)] than non-educated individuals. Males were more likely to know the cause of TB [(adjusted OR = 1.92, (95%CI: 1.22, 3.03)] than females. 51.3% of TB suspects perceived that other people would consider them inferior if they had TB. High stigma towards TB was reported by 199(51.2%). 220 (46.2%) did not seek help for their illness. Individuals who had previous anti-TB treatment were more likely to have appropriate health seeking behavior [(adjusted OR = 3.65, (95%CI: 1.89, 7.06)] than those who had not.

          Conclusion

          There was little knowledge about TB in the Gilgel Gibe field research area. We observed inappropriate health seeking behavior and stigma towards TB. TB control programs in Ethiopia should educate rural communities, particularly females and non-educated individuals, about the cause and the importance of early diagnosis and treatment of TB.

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          Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia

          Meaza Demissie, Bernt Lindtjørn, Yemane Berhane (2002)
          Background Delay in the diagnosis of tuberculosis may worsen the disease, increase the risk of death and enhance tuberculosis transmission in the community. This study aims to determine the length of delay between the onset of symptoms and patients first visit to health care (patient delay), and the length of delay between health care visit and the diagnosis of tuberculosis (health service delay). Methods A cross sectional survey that included all the public health centres was conducted in Addis Ababa from August 1 to December 31 1998. Patients were interviewed on the same day of diagnosis using structured questionnaire. Results 700 pulmonary TB patients were studied. The median patient delay was 60 days and mean 78.2 days. There was no significant difference in socio-demographic factors in those who delayed and came earlier among smear positives. However, there was a significant difference in distance from home to health institute and knowledge about TB treatment among the smear negatives. The health service delay was low (median 6 days; mean 9.5 days) delay was significantly lower in smear positives compared to smear negatives. Longer health service delay (delay more than 15 days) was associated with far distance. Conclusions The time before diagnosis in TB patients was long and appears to be associated with patient inadequate knowledge of TB treatment and distance to the health centre. Further decentralization of TB services, the use of some components of active case finding, and raising public awareness of the disease to increase service utilization are recommended.
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            Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study

            Sushil Baral, Deepak Karki, James N Newell (2007)
            Background Tuberculosis (TB) is a major cause of death. The condition is highly stigmatised, with considerable discrimination towards sufferers. Although there have been several studies assessing the extent of such discrimination, there is little published research explicitly investigating the causes of the stigma and discrimination associated with TB. The objectives of our research were therefore to take the first steps towards determining the causes of discrimination associated with TB. Methods Data collection was performed in Kathmandu, Nepal. Thirty four in-depth interviews were performed with TB patients, family members of patients, and members of the community. Results Causes of self-discrimination identified included fear of transmitting TB, and avoiding gossip and potential discrimination. Causes of discrimination by members of the general public included: fear of a perceived risk of infection; perceived links between TB and other causes of discrimination, particularly poverty and low caste; perceived links between TB and disreputable behaviour; and perceptions that TB was a divine punishment. Furthermore, some patients felt they were discriminated against by health workers Conclusion A comprehensive package of interventions, tailored to the local context, will be needed to address the multiple causes of discrimination identified: basic population-wide health education is unlikely to be effective.
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              Gender and socio-cultural determinants of TB-related stigma in Bangladesh, India, Malawi and Colombia.

              D. Gosoniu, E. Thomas, Christopher Kemp … (2008)
              Tuberculosis (TB) control programmes in Bangladesh, India, Malawi and Colombia. Assess indicators of TB-related stigma and socio-cultural and gender-related features of illness associated with stigma. Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Indicators of self-perceived stigma were analysed individually and in a validated index, which was compared across sites and between men and women at each site. Cultural epidemiological explanatory variables for stigma and interactions with female sex were analysed at each site. Qualitative illness narratives were examined to explain the role and context of explanatory variables. The overall stigma index was highest in India, lowest in Malawi and greater for women in Bangladesh. In India and Malawi, women were more likely to be concerned about impact on marital prospects. Associations with HIV/AIDS were linked to TB stigma in Malawi, where sexual contact as a perceived cause was more associated with stigma for men and less for women. Stigma both influences and indicates the effectiveness of TB control. Cultural epidemiological methods clarify cross-cutting and local features of stigma and gender for TB control.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2010
                Publication date (Electronic): 11 October 2010
                Volume: 5
                Issue: 10
                Electronic Location Identifier: e13339
                Affiliations
                [1 ]Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
                [2 ]Department of Epidemiology, Jimma University, Jimma, Ethiopia
                [3 ]Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
                [4 ]Department of Internal Medicine, Jimma University, Jimma, Ethiopia
                [5 ]Department of Psychiatry, Jimma University, Jimma, Ethiopia
                [6 ]Department of Health Service Management, Jimma University, Jimma, Ethiopia
                [7 ]Armauer Hanssen Research Institute, Addis Ababa, Ethiopia
                [8 ]Department of Comparative Physiology and Biometrics, University of Ghent, Ghent, Belgium
                [9 ]Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
                St. Petersburg Pasteur Institute, Russian Federation
                Author notes

                Conceived and designed the experiments: GA AD. Analyzed the data: GA AD. Contributed reagents/materials/analysis tools: GA AD LA KW JS MT A Abdissa FD CJ MB A Aseffa LD RC. Wrote the paper: GA AD. Coordinated the field work: GA. Designed the study: LA KW JS MT A Abdissa FD CJ MB. Reviewed the article: LA KW JS MT A Abdissa FD CJ MB A Aseffa. Supervised data collection: KW JS MT AAbdissa FD CJ MB. Critically reviewed the article: LD RC.

                Article
                Publisher ID: 10-PONE-RA-17838R2
                DOI: 10.1371/journal.pone.0013339
                PMC ID: 2952624
                PubMed ID: 20948963
                SO-VID: 049f334b-3c10-49c4-910c-985ef8677c09
                Copyright © Abebe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 9 April 2010
                Date accepted : 16 September 2010
                Page count
                Pages: 7
                Categories
                Subject: Research Article
                Subject: Infectious Diseases/Epidemiology and Control of Infectious Diseases
                Subject: Public Health and Epidemiology/Infectious Diseases
                Subject: Public Health and Epidemiology/Social and Behavioral Determinants of Health

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