Research Article | | Peer-Reviewed

Magnitude and Consequences of TB-Related Stigma Experienced by People with Tuberculosis in Tanzania

Received: 11 August 2023     Accepted: 28 August 2023     Published: 11 December 2023
Views:       Downloads:
Abstract

Background: TB-related stigma is a barrier to ending TB. Because of stigma, patients with TB can be delayed in seeking treatment, receiving a diagnosis, initiating and completing treatment, and consequently increasing the transmission of the disease within a community. Information regarding the magnitude and consequences of TB-related stigma in Tanzania are generally missing in our setting. The study aimed to generate such information to inform the planning and implementation of TB-related stigma reduction strategies. Methods: Between September 2021 and February 2022, a cross-sectional survey was conducted to collect data on TB-related stigma among people with or who had TB (PWTB) in five regions of Tanzania. The survey utilized adapted structured questionnaires developed by the Stop TB Partnership. Data collection was carried out through face-to-face interviews. Data were analyzed using SPSS version 26, and the results were presented in tables. Results: The study recruited a total of 418 PWTB, with 276 (66%) being male and 86 (18.4%) having TB-HIV co-infection. Among the participants, 86 PWTB (20.6%) reported experiencing stigma due to their TB status. The most common settings where PWTB encountered stigma were within their families (50%), communities (36%), and workplaces (10%). Delays in seeking care (16.7%), obtaining an accurate diagnosis (15%), and initiating treatment (27%) were identified as the most common consequences associated with TB-related stigma. Participants' region, age, education level, and type of TB were factors significantly associated with experiencing TB-related stigma. Conclusion: This study revealed a moderate level of TB-related stigma experienced by TB patients, primarily originating from family members, neighbors, and co-workers. Furthermore, the findings emphasized the impact of TB-related stigma on the delay in seeking medical care for TB diagnosis and treatment. Therefore, this study highlights the need for the prompt inclusion of TB stigma reduction strategies in the TB prevention and control program in Tanzania.

Published in European Journal of Preventive Medicine (Volume 11, Issue 6)
DOI 10.11648/j.ejpm.20231106.11
Page(s) 82-89
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Tuberculosis, Stigma, Magnitude, Consequences, Tanzania

References
[1] Organization WH, von Delft A. Global tuberculosis report 2022 [Internet]. Geneva; 2022. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022
[2] Barter DM, Agboola SO, Murray MB, Bärnighausen T. Tuberculosis and poverty: The contribution of patient costs in sub-Saharan Africa - A systematic review. BMC Public Health. 2012; 12 (1).
[3] Science Africa. Stigma, Discrimination Hindering Progress inTB [Internet]. 2022 [cited 2022 Jul 24]. p. 1. Available from: https://scienceafrica.co.ke/2022/02/22/stigma-discrimination-hindering-progress-in-tb/
[4] Rood EJJ, Mergenthaler C, Bakker MI, Redwood L, Mitchell EMH. Using 15 DHS surveys to study epidemiological correlates of TB courtesy stigma and health-seeking behaviour. Int J Tuberc Lung Dis. 2017; 21 (July): S60–8.
[5] Godfrey-Faussett P, Kaunda H, Kamanga J, Van Beers S, Van Cleeff M, Kumwenda-Phiri R, et al. Why do patients with a cough delay seeking care at Lusaka urban health centres? A health systems research approach. Int J Tuberc Lung Dis. 2002; 6 (9): 796–805.
[6] Faccini M, Cantoni S, Ciconali G, Filipponi MT, Mainardi G, Marino AF, et al. Tuberculosis-related stigma leading to an incomplete contact investigation in a low-incidence country. Epidemiol Infect. 2015; 143 (13): 2841–8.
[7] Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmink J. Patient adherence to tuberculosis treatment: A systematic review of qualitative research. PLoS Med. 2007; 4 (7): 1230–45.
[8] Skinner D, Claassens M. It’s complicated: Why do tuberculosis patients not initiate or stay adherent to treatment? A qualitative study from South Africa. BMC Infect Dis [Internet]. 2016; 16 (1): 1–9. Available from: http://dx.doi.org/10.1186/s12879-016-2054-5
[9] Daftary A, Mitchell EMH, Reid MJA, Fekadu E, Goosby E. To end TB, first-ever high-level meeting on tuberculosis must address stigma. Am J Trop Med Hyg. 2018; 99 (5): 1114–6.
[10] Link BG, Phelan JC. Onceptualizing tigma. 2001; 27 (Lewis 1998): 363–85.
[11] Courtwright A. Tuberculosis and Stigmatization: Pathways and Interventions. Pract Artic. 2010; 125 (4): 34–42.
[12] Nunes ED. Goffman: contribuições para a Sociologia da Saúde. Physis Rev Saúde Coletiva. 2009; 19 (1): 173–87.
[13] STOP TB Partnership. TB STIGMA ASSESSMENT GUIDANCE. The Hague; 2018. 1–54 p.
[14] Mukerji R, Turan JM. Exploring manifestations of tb-related stigma experienced by women in Kolkata, India. Ann Glob Heal. 2018; 84 (4): 727–35.
[15] Atsu E, Kelly SJ. Manifestations of tuberculosis stigma within the healthcare system: The case of Sekondi-Takoradi Metropolitan district in Ghana. Health Policy (New York) [Internet]. 2010; 98 (2–3): 195–202. Available from: http://dx.doi.org/10.1016/j.healthpol.2010.06.017
[16] Dodor EA. An exploration of the causes, manifestations and consequences of tuberculosis stigma in an urban district in Ghana Emmanuel Atsu Dodor (BSc. MB ChB. MPH) [Internet]. University of Nottingham; 2009. Available from: https://eprints.nottingham.ac.uk/10846/1/Dr_EA_Dodor-_Submitted_Version_of_PhD_Thesis.pdf
[17] Hatherall B, Newell JN, Emmel N, Baral SC, Khan MA. “Who Will Marry a Diseased Girl?” Marriage, Gender, and Tuberculosis Stigma in Asia. Qual Health Res. 2019; 29 (8): 1109–19.
[18] Cremers AL, De Laat MM, Kapata N, Gerrets R, Klipstein-Grobusch K, Grobusch MP. Assessing the consequences of stigma for tuberculosis patients in urban Zambia. PLoS One. 2015; 10 (3): 2–17.
[19] Center for Disease Control and Prevention. National TB Program Objectives & Performance Targets for 2025. CDC. 2022. p. 1.
[20] 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 Glob Public Heal [Internet]. 2021; 1 (12): e0000104. Available from: http://dx.doi.org/10.1371/journal.pgph.0000104
[21] Miller C, Huston J, Samu L, Mfinanga S, Hopewell P, Fair E. “It makes the patient’s spirit weaker”: Tuberculosis stigma and gender interaction in Dar es Salaam, Tanzania. Int J Tuberc Lung Dis. 2017; 21 (December 2016): S42–8.
[22] Mitchell (Eds.) Ellen M. H., van den Hof S. TB Stigma Measurement Guidance. 2018; 380. Available from: https://www.tbdiah.org/resource_tag/Stigma/
[23] Yaw Adusi-Poku, Badu Sarkodie, Comfort Asamoah-Adu, Rita Frimpong-Mansoh, Aliyu Mohammed JA-L. Assessing the Stigma of Tuberculosis in Ghana: Consequences to Accessing and Provision of Services. Jurnal Penelitian Pendidikan Guru Sekolah Dasar. 2020.
[24] Tetiana Kiriazova, Yuliia Serda, Iryna Pykalo, Orena Semorkina, Ilona Yereneva, Olga Klymenko VD. Tb Stigma Assessment in Ukraine. Ukraine; 2021.
[25] Baskaran L, Vasudevan K, Anandaraj. Prevalence of Stigma Among TB Patients and Its Associated Factors-A Community Based Cross-Sectional Study in Puducherry, India. Natl J Community Med. 2023; 14 (6): 379–85.
[26] Mahbub T, Mathur T, Isaakidis P, Daftary A. “One-by-One, TB Took Everything Away From Me”: A Photovoice Exploration of Stigma in Women with Drug-Resistant Tuberculosis in Mumbai. Affil - J Women Soc Work. 2023;
[27] Addo J, Pearce D, Metcalf M, Lundquist C, Thomas G, Barros-Aguirre D, et al. Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment. BMC Public Health [Internet]. 2022; 22 (1): 1–16. Available from: https://doi.org/10.1186/s12889-022-14115-7
[28] Yang W-T, Gounder CR, Akande T, De Neve J-W, McIntire KN, Chandrasekhar A, et al. Barriers and Delays in Tuberculosis Diagnosis and Treatment Services: Does Gender Matter? Tuberc Res Treat. 2014; 2014: 1–15.
[29] Kurspahić-Mujčić A, Hasanović A, Sivić S. Tuberculosis related stigma and delay in seeking care after the onset of symptoms associated with tuberculosis. Med Glas (Zenica) [Internet]. 2013; 10 (2): 272–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23892844
[30] Murray EJ, Bond VA, Marais BJ, Godfrey-Faussett P, Ayles HM, Beyers N. High levels of vulnerability and anticipated stigma reduce the impetus for tuberculosis diagnosis in Cape Town, South Africa. Health Policy Plan. 2013; 28 (4): 410–8.
[31] Cremers AL, Laat MM De, Kapata N, Gerrets R. Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Zambia. 2015; (April).
[32] Podewils LJ, Gler MTS, Quelapio MI, Chen MP. Patterns of Treatment Interruption among Patients with Multidrug-Resistant TB (MDR TB) and Association with Interim and Final Treatment Outcomes. PLoS One. 2013; 8 (7): 1–8.
[33] Virenfeldt J, Rudolf F, Camara C, Furtado A, Gomes V, Aaby P, et al. Treatment delay affects clinical severity of tuberculosis: A longitudinal cohort study. BMJ Open. 2014; 4 (6): 1–8.
[34] Daniel TM. Toman’s Tuberculosis. Case Detection, Treatment, and Monitoring. Questions and Answers. Second Edition. Am J Trop Med Hyg. 2005; 73 (1): 229–229.
[35] Jianzhao H, Van Den Hof S, Lin X, Yubang Q, Jinglong H, Van Der Werf MJ. Risk factors for non-cure among new sputum smear positive tuberculosis patients treated in tuberculosis dispensaries in Yunnan, China. BMC Health Serv Res. 2011; 11.
[36] Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. 2008; 8: 1–9.
[37] Mendelson T, Turner AK, Tandon SD. Social Class As Moderator of the Relationship Between (Dis) Empowering Processes and Psychological Empowerment. J Community Psychol. 2010; 38 (5): 607–21.
[38] Beals KP, Peplau LA, Gable SL. Stigma management and well-being: The role of perceived social support, emotional processing, and suppression. Personal Soc Psychol Bull. 2009; 35 (7): 867–79.
[39] Soomro MH, Qadeer E, Khan MA, Morkve O. Treatment supporters and their impact on treatment outcomes in routine tuberculosis program conditions in district Rawalpindi, Pakistan. J Med. 2013; 14 (1): 40–6.
[40] Olukolade R, Health F, Ogbuji QC, Health F, Kusimo O, Osho J, et al. Role of treatments supporters beyond monitoring daily drug intake for TB-patients: Findings from a qualitative study in Nigeria. 2017; (April).
[41] Deogratias Muhandiki W, Eliaimringi Matemba L, Gabriel Mabega N, Michael Kisonga R, Heriel Matechi E, Omary Kigumi H, et al. Tuberculosis-Related Stigma Among Healthcare Workers in Tanzania: Level, Experience and Manifestations. Am J Heal Res. 2023; 11 (1): 23–30.
[42] Atsu DE, Dodor EA, Neal K, Kelly S. Dodor, Emmanuel Atsu (2009) An exploration of the causes, manifestations and consequences of tuberculosis stigma in an urban district in Ghana. PhD thesis, University of Nottingham. An exploration of the causes, manifestations and consequences of. Int J Tuberulosis Lung Dis [Internet]. 2009; 12 (9): 215. Available from: https://www.researchgate.net/publication/45491497_An_exploration_of_the_causes_manifestations_and_consequences_of_tuberculosis_stigma_in_an_urban_district_in_Ghana%0Ahttp://hdl.handle.net/10068/969821%5Cnhttp://www.opengrey.eu/item/display/10068/969821%0A
Cite This Article
  • APA Style

    Paul Kapyolo, E., Deogratius Muhandiki, W., Gabriel Mabega, N., Eliaimringi Matemba, L., Phares Mwing’a, G., et al. (2023). Magnitude and Consequences of TB-Related Stigma Experienced by People with Tuberculosis in Tanzania. European Journal of Preventive Medicine, 11(6), 82-89. https://doi.org/10.11648/j.ejpm.20231106.11

    Copy | Download

    ACS Style

    Paul Kapyolo, E.; Deogratius Muhandiki, W.; Gabriel Mabega, N.; Eliaimringi Matemba, L.; Phares Mwing’a, G., et al. Magnitude and Consequences of TB-Related Stigma Experienced by People with Tuberculosis in Tanzania. Eur. J. Prev. Med. 2023, 11(6), 82-89. doi: 10.11648/j.ejpm.20231106.11

    Copy | Download

    AMA Style

    Paul Kapyolo E, Deogratius Muhandiki W, Gabriel Mabega N, Eliaimringi Matemba L, Phares Mwing’a G, et al. Magnitude and Consequences of TB-Related Stigma Experienced by People with Tuberculosis in Tanzania. Eur J Prev Med. 2023;11(6):82-89. doi: 10.11648/j.ejpm.20231106.11

    Copy | Download

  • @article{10.11648/j.ejpm.20231106.11,
      author = {Eliakimu Paul Kapyolo and Wilbard Deogratius Muhandiki and Ndakibae Gabriel Mabega and Lucas Eliaimringi Matemba and Gerald Phares Mwing’a and Petro Michael Mnyagatwa and Oscar Leonard Kaswaga and Hamimu Omary Kigumi and Emmanuel Heriel Matechi and Onay Godson Lwanzali and Riziki Michael Kisonga and Mangi Job Ezekiel},
      title = {Magnitude and Consequences of TB-Related Stigma Experienced by People with Tuberculosis in Tanzania},
      journal = {European Journal of Preventive Medicine},
      volume = {11},
      number = {6},
      pages = {82-89},
      doi = {10.11648/j.ejpm.20231106.11},
      url = {https://doi.org/10.11648/j.ejpm.20231106.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20231106.11},
      abstract = {Background: TB-related stigma is a barrier to ending TB. Because of stigma, patients with TB can be delayed in seeking treatment, receiving a diagnosis, initiating and completing treatment, and consequently increasing the transmission of the disease within a community. Information regarding the magnitude and consequences of TB-related stigma in Tanzania are generally missing in our setting. The study aimed to generate such information to inform the planning and implementation of TB-related stigma reduction strategies. Methods: Between September 2021 and February 2022, a cross-sectional survey was conducted to collect data on TB-related stigma among people with or who had TB (PWTB) in five regions of Tanzania. The survey utilized adapted structured questionnaires developed by the Stop TB Partnership. Data collection was carried out through face-to-face interviews. Data were analyzed using SPSS version 26, and the results were presented in tables. Results: The study recruited a total of 418 PWTB, with 276 (66%) being male and 86 (18.4%) having TB-HIV co-infection. Among the participants, 86 PWTB (20.6%) reported experiencing stigma due to their TB status. The most common settings where PWTB encountered stigma were within their families (50%), communities (36%), and workplaces (10%). Delays in seeking care (16.7%), obtaining an accurate diagnosis (15%), and initiating treatment (27%) were identified as the most common consequences associated with TB-related stigma. Participants' region, age, education level, and type of TB were factors significantly associated with experiencing TB-related stigma. Conclusion: This study revealed a moderate level of TB-related stigma experienced by TB patients, primarily originating from family members, neighbors, and co-workers. Furthermore, the findings emphasized the impact of TB-related stigma on the delay in seeking medical care for TB diagnosis and treatment. Therefore, this study highlights the need for the prompt inclusion of TB stigma reduction strategies in the TB prevention and control program in Tanzania.
    },
     year = {2023}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Magnitude and Consequences of TB-Related Stigma Experienced by People with Tuberculosis in Tanzania
    AU  - Eliakimu Paul Kapyolo
    AU  - Wilbard Deogratius Muhandiki
    AU  - Ndakibae Gabriel Mabega
    AU  - Lucas Eliaimringi Matemba
    AU  - Gerald Phares Mwing’a
    AU  - Petro Michael Mnyagatwa
    AU  - Oscar Leonard Kaswaga
    AU  - Hamimu Omary Kigumi
    AU  - Emmanuel Heriel Matechi
    AU  - Onay Godson Lwanzali
    AU  - Riziki Michael Kisonga
    AU  - Mangi Job Ezekiel
    Y1  - 2023/12/11
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ejpm.20231106.11
    DO  - 10.11648/j.ejpm.20231106.11
    T2  - European Journal of Preventive Medicine
    JF  - European Journal of Preventive Medicine
    JO  - European Journal of Preventive Medicine
    SP  - 82
    EP  - 89
    PB  - Science Publishing Group
    SN  - 2330-8230
    UR  - https://doi.org/10.11648/j.ejpm.20231106.11
    AB  - Background: TB-related stigma is a barrier to ending TB. Because of stigma, patients with TB can be delayed in seeking treatment, receiving a diagnosis, initiating and completing treatment, and consequently increasing the transmission of the disease within a community. Information regarding the magnitude and consequences of TB-related stigma in Tanzania are generally missing in our setting. The study aimed to generate such information to inform the planning and implementation of TB-related stigma reduction strategies. Methods: Between September 2021 and February 2022, a cross-sectional survey was conducted to collect data on TB-related stigma among people with or who had TB (PWTB) in five regions of Tanzania. The survey utilized adapted structured questionnaires developed by the Stop TB Partnership. Data collection was carried out through face-to-face interviews. Data were analyzed using SPSS version 26, and the results were presented in tables. Results: The study recruited a total of 418 PWTB, with 276 (66%) being male and 86 (18.4%) having TB-HIV co-infection. Among the participants, 86 PWTB (20.6%) reported experiencing stigma due to their TB status. The most common settings where PWTB encountered stigma were within their families (50%), communities (36%), and workplaces (10%). Delays in seeking care (16.7%), obtaining an accurate diagnosis (15%), and initiating treatment (27%) were identified as the most common consequences associated with TB-related stigma. Participants' region, age, education level, and type of TB were factors significantly associated with experiencing TB-related stigma. Conclusion: This study revealed a moderate level of TB-related stigma experienced by TB patients, primarily originating from family members, neighbors, and co-workers. Furthermore, the findings emphasized the impact of TB-related stigma on the delay in seeking medical care for TB diagnosis and treatment. Therefore, this study highlights the need for the prompt inclusion of TB stigma reduction strategies in the TB prevention and control program in Tanzania.
    
    VL  - 11
    IS  - 6
    ER  - 

    Copy | Download

Author Information
  • Department of Clinical Research, National Institute for Medical Research, Dodoma Medical Research Centre, Dodoma, Tanzania

  • Department of Research and Consultancy, Geita Health Training Institutes, Geita, Tanzania

  • Department of Health Research Information and Regulatory Affairs, National Institute for Medical Research, Dar es Salaam, Tanzania

  • Department of Clinical Research, National Institute for Medical Research, Dodoma Medical Research Centre, Dodoma, Tanzania

  • Department of Clinical Research, National Institute for Medical Research, Dodoma Medical Research Centre, Dodoma, Tanzania

  • Department of Clinical Research, National Institute for Medical Research, Dodoma Medical Research Centre, Dodoma, Tanzania

  • Department of Mathematics and Statistics, University of Dodoma, Dodoma, Tanzania

  • Department of Preventive Services, Ministry of Health, National Tuberculosis and Leprosy Programme, Dodoma, Tanzania

  • Department of Preventive Services, Ministry of Health, National Tuberculosis and Leprosy Programme, Dodoma, Tanzania

  • Department of Preventive Services, Ministry of Health, National Tuberculosis and Leprosy Programme, Dodoma, Tanzania

  • Department of Preventive Services, Ministry of Health, National Tuberculosis and Leprosy Programme, Dodoma, Tanzania

  • Department of Behavioral Science, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

  • Sections