Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Zambia

Abstract

BackgroundStigma is one of the many factors hindering tuberculosis (TB) control by negatively affecting hospital delay and treatment compliance. In Zambia, the morbidity and mortality due to TB remains high, despite extended public health attempts to control the epidemic and to diminish stigma.Study AimTo enhance understanding of TB-related stigmatizing perceptions and to describe TB patients’ experiences of stigma in order to point out recommendations to improve TB policy.MethodsWe conducted a mixed method study at Kanyama clinic and surrounding areas, in Lusaka, Zambia; structured interviews with 300 TB patients, multiple in-depth interviews with 30 TB patients and 10 biomedical health workers, 3 focus group discussions with TB patients and treatment supporters, complemented by participant observation and policy analysis of the TB control program. Predictors of stigma were identified by use of multivariate regression analyses; qualitative analysis of the in-depth interviews, focus group discussions and participant observation was used for triangulation of the study findings.ResultsWe focused on the 138/300 patients that described TB-related perceptions and attitudes, of whom 113 (82%) reported stigma. Stigma provoking TB conceptions were associated with human immunodeficiency virus (HIV)-infection, alleged immoral behaviour, (perceived) incurability, and (traditional) myths about TB aetiology. Consequences of stigma prevailed both among children and adults and included low self-esteem, insults, ridicule, discrimination, social exclusion, and isolation leading to a decreased quality of life and social status, non-disclosure, and/or difficulties with treatment compliance and adherence. Women had significantly more stigma-related problems than men.ConclusionsThe findings illustrate that many TB patients faced stigma-related issues, often hindering effective TB control and suggesting that current efforts to reduce stigma are not yet optimal. The content and implementation of sensitization programs should be improved and more emphasis needs to be placed on women and children.

Individualizing management of extensively drug-resistant tuberculosis: diagnostics, treatment, and biomarkers

“…Outcome determinants in XDR-TB patients are, not limited to HIV coinfection or the specific therapeutic regimens applied, but include also overall the access to drugs [10], the utilization of care which can often be hampered by stigma [11], and the level of care available. High levels of care for drug-resistant TB or among HIV coinfected patients do not necessarily need to be hospitalized [12].…”

The Association Between Perceived Stigma Towards Tuberculosis and the Implementation of Diagnosis Procedure on Tuberculosis Screening Program in Denpasar, Bali, Indonesia

“…It will be very useful to plan proper education and knowledge to reduce the perceived stigma (Somma et al, 2008;Arcêncio et al, 2014).Similar finding is found in several studies regarding TB screening, case finding and consequence of TB stigma. A comprehensive health education to raise awareness and reduce the perceived stigma towards TBis main recommendation in those studies (Kidd et al, 2009;Arcêncio et al, 2014;Cremers et al, 2015;Craig et al, 2017).…”

Tuberculosis patients’ pre-hospital delay and non-compliance with a longstanding DOT programme: a mixed methods study in urban Zambia

“…Details on Kanyama (clinic) and the tuberculosis programme have been reported elsewhere in detail [10]. …”

“…Often, vulnerable populations are afflicted as TB is closely related to issues of stigma, (economic) inequality, and poverty [5]. Stigma often leads to the discrimination or social exclusion of TB patients, negatively influencing their health care seeking behaviour [10]. Poverty complicates access to health care as people are unable to stop working or to pay for public transport; and hunger aggravates side effects of TB treatment.…”

“…The first analysis of our TB patients’ Adherence and Compliance (TBAC) study focused on TB-related stigma in Lusaka, Zambia [10]; the current analysis aims to investigate the influence of perceptions and cultural, social, economic, and organisational factors on TB patients’ pre-hospital delay and compliance with care provided by the Zambian NTP.…”