Tuberculosis related stigma and its effect on the delay for sputum examination under the Revised National Tuberculosis Control Program in India

Chakrabartty, Arupkumar; Basu, Pampa; Ali, Kazi Monjur; Sarkar, Aditi Kishore; Ghosh, Debidas

doi:10.1016/j.ijtb.2017.08.032

Cited by 18 publications

(8 citation statements)

References 7 publications

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“…TB-related stigma was independently associated with non-submission of sputum, consistent with findings from a study in India [22]. Several studies have reported high perception of TB-associated stigma [23][24][25][26][27], and specific actions are needed to counter this [28,29].…”

Section: Discussionsupporting

confidence: 81%

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

et al. 2020

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BackgroundGhana's national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment. MethodsA prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression. ResultsA total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84-42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87-23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05-0.33). ConclusionThe majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.

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Section: Discussionsupporting

confidence: 81%

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

et al. 2020

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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: 75%

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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“…20 Stigmatisation is regarded as a significant reason for a delay in diagnosis and failure to maintain treatment. 9,21,22 It is also associated with a low BMI and depression. 23 For the above reasons, individuals, such as in the reported case, do not disclose symptoms for fear of being ostracised or shunned by their families and friends.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis-related stigma contributing to a ‘hidden’ disease at autopsy

Heath

Byard

2019

Med Sci Law

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A 29-year-old African immigrant to Australia was found dead in bed. She had no known medical history, except for recent weight loss and hip/leg pain. Autopsy examination revealed extensive tuberculous consolidation with widespread cavitation of the lungs, with multiple caseating granulomas containing large numbers of acid fast bacilli on histology. Similar granulomas were also present in lymph nodes of the porta hepatis, mediastinum and pulmonary hilum, and within the liver, spleen and mesentery. Mycobacterial polymerase chain reaction analysis confirmed tuberculous infection. Her serum was negative for human immunodeficiency virus infection. Death was due to disseminated tuberculosis. In many parts of Africa, there are negative cultural associations attached to tuberculosis, which often leads to a delay in diagnosis. The case demonstrates the extent of active disease that may be uncovered at autopsy in decedents from societies where tuberculosis is stigmatised and therefore concealed. It also emphasises the risk of infection for forensic workers.

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Tuberculosis related stigma and its effect on the delay for sputum examination under the Revised National Tuberculosis Control Program in India

Cited by 18 publications

References 7 publications

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

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

Tuberculosis-related stigma contributing to a ‘hidden’ disease at autopsy

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