Stigma against tuberculosis may hinder non-household contact investigation: a qualitative study in Thailand

Ngamvithayapong-Yanai, Jintana; Luangjina, Sarmwai; Thawthong, Sureerat; Bupachat, Surasit; Imsangaun, W.

doi:10.5588/pha.18.0055

Cited by 28 publications

(26 citation statements)

References 25 publications

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“…As explored in the qualitative study, the other potential reasons for low rate of PTBP detection are hesitancy to disclose the details of TB symptoms due to stigma and distrust about TAs. Some other studies also revealed similar findings [27,28].…”

Section: Discussionsupporting

confidence: 74%

Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed Methods Study on Outcomes and Implementation Challenges

Dey,

Thekkur,

Ghosh

et al. 2019

TropicalMed

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Active case finding (ACF) for tuberculosis (TB) was implemented in 60 selected high TB burden wards of Kolkata, India. Community volunteers called TOUCH (Targeted Outreach for Upliftment of Community Health) agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the “care cascade” of PTBPs that were identified during July to December 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. An explanatory mixed-methods study with a quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Of the 3,86242 individuals that were enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited a referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%). The number needed to screen for one TB patient was 2183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage losses for attending health facilities, and substance abuse among PTBPs. The yield of ACF was suboptimal with low PTBP identification rate and a high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.

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Section: Discussionsupporting

confidence: 74%

Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed Methods Study on Outcomes and Implementation Challenges

Dey,

Thekkur,

Ghosh

et al. 2019

TropicalMed

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“…The prevalence of stigma associated with TB has been shown to vary from 27% to as high as 82% in different settings across the world [ 10 – 13 ]. It was also found to be associated with nonadherence to treatment and treatment failure [ 14 ]; it hampers investigations of household contacts [ 15 ] and causes delay in case detection [ 16 ] and also associated with high mortality due to late presentation [ 17 ]. A study of the trend of TB case notification in Lagos state between 2011 and 2015 showed a decrease in the Case Notification Ratio from 82.9% in 2013 to 72.1% in 2015 [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Knowledge, Attitude, and Determinants of Tuberculosis-Associated Stigma in Rural and Urban Communities of Lagos State, Nigeria

Oladele

Balogun

Odeyemi

et al. 2020

Tuberculosis Research and Treatment

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Background. Tuberculosis (TB) is an important public health concern in Nigeria. TB-associated stigma could lead to delayed diagnosis and care, treatment default, and multidrug resistance. Understanding of TB-associated stigma is therefore important for TB control. The study is aimed at determining and comparing the knowledge, attitude, and determinants of TB-associated stigma. Methodology. This was a comparative cross-sectional study among adults in urban and rural areas of Lagos State, Nigeria. Respondents were selected through a multistage sampling technique and interviewed using a semistructured questionnaire, which contained the Explanatory Model Interviewed Catalogue (EMIC) stigma scale. IBM SPSS Statistics Software package version 20 was used for analysis. Results. A total of 790 respondents were interviewed. High proportions of respondents in rural and urban areas were aware of TB (97.5% and 99.2%, respectively). Respondents in the urban areas had overall better knowledge of TB compared to the rural areas (59.4% vs. 23%; p < 0.001 ), while respondents in the rural areas had a better attitude to TB (60.5% vs. 49.9%; p = 0.002 ). The majority of respondents in rural and urban areas had TB-associated stigma (93% and 95.7%, respectively). The mean stigma score was higher in the urban compared to rural areas ( 17.43 ± 6.012 and 16.54 ± 6.324 , respectively, p = 0.046 ). Marital status and ethnicity were the predictors of TB-associated stigma in the rural communities (AOR-0.257; CI-0.086-0.761; p = 0.014 and AOR–3.09; CI-1.087-8.812; p = 0.034 , respectively), while average monthly income and age of respondents were the predictors of TB-associated stigma in urban areas (AOR–0.274; CI–0.009-0.807; p = 0.019 and AOR-0.212; CI–0.057-0.788; p = 0.021 , respectively). Conclusion. TB-associated stigma is prevalent in both rural and urban areas in this study. There is therefore a need to disseminate health appropriate information through the involvement of the community. Also, innovative stigma reduction activities are urgently needed.

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“…Several studies, including our previous study, 14 have reported that stigma against tuberculosis threatens contact investigation and the effort to end tuber-culosis because index patients keep their illness confidential and conceal information about their contacts. As a result, contacts at high risk of tuberculosis, such as children younger than 5 years of age do not benefit from tuberculosis prevention and care.…”

Section: Lessons Learntmentioning

confidence: 87%

“…The health system should improve health workers' communication and interview skills as these skills will improve the coverage of contacts and the yield of tuberculosis detection. 14,15 Some tuberculosis patients migrate for work to the capital city, Bangkok, but move to their hometown when they are sick. In this case, their contacts are in Bangkok and contact investigation should be performed by the local health service.…”

Section: Lessons Learntmentioning

confidence: 99%

Contact tracing for tuberculosis, Thailand

Imsanguan

Bupachat²,

Wanchaithanawong

et al. 2020

Bull. World Health Organ.

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Problem Despite implementation of universal health coverage in Thailand, gaps remain in the system for screening contacts of tuberculosis patients. Approach We designed broader criteria for contact investigation and new screening practices and assessed the approach in a programmebased operational research study in 2017-2018. Clinic staff interviewed 100 index patients and asked them to give household and nonhousehold contacts an invitation for a free screening and chest X-ray. Contact persons who attended received 250 Thai baht (about 8 United States dollars) allowance for transport. Local setting Chiang Rai province, Thailand, has high rates of tuberculosis notification and a high number of people living in poverty. The coverage of contact investigation in under 5-year-olds was only 33.2% (222 screened out of 668 contacts) over 2011-2015. Relevant changes Index patients identified 440 contacts in total and gave invitation cards to 227 of them. The contact investigation coverage was 81.1% (184/227) and tuberculosis detection among contacts screened was 6.0% (11/184). Of the 11 contacts with active tuberculosis, three did not have tuberculosis symptoms, three were non-household contacts and three were contacts of non-smear-positive tuberculosis patients. The contact investigation coverage of the contacts younger than 5 years was 100% (14/14) and the yield of tuberculosis detection in this age group was 21.4% (3/14). Lessons learnt High coverage of contact investigation with a high yield of tuberculosis detection among contacts can be achieved by applying broader criteria for contact investigation and providing financial support for transportation.

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Stigma against tuberculosis may hinder non-household contact investigation: a qualitative study in Thailand

Abstract: The study is a part of the research project entitled, 'Development of an operations manual and tools for enhancing the coverage of TB contact investigations and reducing their social burden and stigma', funded

Cited by 28 publications

References 25 publications

Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed Methods Study on Outcomes and Implementation Challenges

Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed Methods Study on Outcomes and Implementation Challenges

A Comparative Study of Knowledge, Attitude, and Determinants of Tuberculosis-Associated Stigma in Rural and Urban Communities of Lagos State, Nigeria

Contact tracing for tuberculosis, Thailand

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