Perceived stigma among patient with pulmonary tuberculosis at public health facilities in southwest Ethiopia: A cross-sectional study

Abstract

Objectives Although tuberculosis (TB) related stigma has a significant impact on the diagnosis, patient adherence with treatment, and recovery from the disease, there is limited evidence from Ethiopia regarding perceived stigma among patient with pulmonary tuberculosis (PTB).The purpose of this study was to assess perceived stigma and associated factors among patient with PTB on treatment in southwest Ethiopia. Methods Institution-based cross-sectional study was conducted from April to May 2019 among 410 patient with PTB. Data were collected by using the perceived tuberculosis stigma scale. Epi data v3.1 and SPSSv23 were used for data entry and analysis. Multivariable logistic regression models were fitted to identify factors associated with perceived stigma. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Result Prevalence of perceived stigma among patient with Pulmonary tuberculosis was 57.1% (95% CI: 52.2, 61.7). Poor social support (AOR = 2.41; 95% CI: 1.06, 5.48), above a month duration of illness (AOR = 2.48; 95% CI: 1.33, 4.64), high perceived stress (AOR = 1.95; 95% CI:1.09, 3.49), current khat use (AOR = 1.88; 95% CI:1.05, 3.37), and presence of depression (AOR = 8.18; 95% CI:4.40, 15.22) were significantly associated with perceived stigma. Patient with HIV co-infection were 5.67 times (AOR = 5.67; 95% CI: 2.32, 13.87) more likely to have Perceived stigma than their counterparts. Conclusion TB related stigma was reported by more than half of the study participant. Stigma reduction measures are needed to lower TB related stigma perceived by the patient, the level of distress associated with it, and to promote the psychological wellbeing of patient with TB.

A systematic review and psychometric appraisal of instruments measuring tuberculosis stigma in Sub-Saharan Africa.

“…This search generated 28 studies in total. Most of the studies were conducted in Ethiopia (Adenager et al, 2017; Ambaw et al, 2019; Asefa & Teshome, 2014; Assefa et al, 2017; Ayana et al, 2019; Duko et al, 2015, 2019; Mohammedhussein, Alenko, et al, 2020; Mohammedhussein, Hajure, et al, 2020; Molla, Mengesha, et al, 2019; Molla, Mekuriaw, Kerebih, 2019), but this review also includes research from 10 additional countries in Sub-Saharan Africa. Thirteen of the 28 studies used a rigorously validated instrument to measure TB or TB/HIV stigma (Bresenham et al, 2020; Duko et al, 2015; Hayes-Larson et al, 2017a, 2017b; Kautzky & Tollman, 2008; Mbuthia et al, 2020; Mohammedhussein, Alenko, et al, 2020; Mohammedhussein, Hajure, et al, 2020; Molla, Mengesha, et al, 2019; Molla, Mekuriaw, Kerebih, 2019; Naidu et al, 2020; Nkambule et al, 2019; Zetola et al, 2012) and are summarized in Table 1.…”

“…Most of the studies were conducted in Ethiopia (Adenager et al, 2017; Ambaw et al, 2019; Asefa & Teshome, 2014; Assefa et al, 2017; Ayana et al, 2019; Duko et al, 2015, 2019; Mohammedhussein, Alenko, et al, 2020; Mohammedhussein, Hajure, et al, 2020; Molla, Mengesha, et al, 2019; Molla, Mekuriaw, Kerebih, 2019), but this review also includes research from 10 additional countries in Sub-Saharan Africa. Thirteen of the 28 studies used a rigorously validated instrument to measure TB or TB/HIV stigma (Bresenham et al, 2020; Duko et al, 2015; Hayes-Larson et al, 2017a, 2017b; Kautzky & Tollman, 2008; Mbuthia et al, 2020; Mohammedhussein, Alenko, et al, 2020; Mohammedhussein, Hajure, et al, 2020; Molla, Mengesha, et al, 2019; Molla, Mekuriaw, Kerebih, 2019; Naidu et al, 2020; Nkambule et al, 2019; Zetola et al, 2012) and are summarized in Table 1. Of the remaining studies, five used proxy indicators or single items to identify stigma (Abioye et al, 2011; Assefa et al, 2017; Muture et al, 2011; Nyangoma et al, 2020; Peltzer et al, 2012) and 10 used questionnaires specifically created for their study to measure stigma (Adenager et al, 2017; Ambaw et al, 2019; Asefa & Teshome, 2014; Ayana et al, 2019; Chileshe & Bond, 2010; Cremers et al, 2015; Levin et al, 2006; Méda et al, 2014; Osei et al, 2015); all of these proxy variables and questionnaires are summarized in Table 2.…”

“…Two additional studies used an instrument developed by Soma and colleagues to measure perceived TB stigma in Ethiopia (Mohammedhussein, Alenko, et al, 2020; Mohammedhussein, Hajure, et al, 2020). The scale was originally developed and piloted in Bangladesh, India, Colombia, and Malawi with 18 items (Somma et al, 2008).…”

“…Among these 13 studies which used a validated instrument, most were conducted in Ethiopia (Duko et al, 2015(Duko et al, , 2019Mohammedhussein, Alenko, et al, 2020;Mohammedhussein, Hajure, et al, 2020;Molla, Mengesha, et al, 2019;Molla, Mekuriaw, Kerebih, 2019). Two studies were conducted in Lesotho (Hayes-Larson et al, 2017a, 2017b, two in South Africa (Bresenham et al, 2020;Naidu et al, 2020), one was conducted in Kenya (Mbuthia et al, 2020), one in Swaziland (Nkambule et al, 2019), and one was conducted in Botswana (Zetola et al, 2012).…”

“…This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Hajure, et al, 2020). The scale was originally developed and piloted in Bangladesh, India, Colombia, and Malawi with 18 items (Somma et al, 2008).…”