Sunday, February 7, 2016

Is Knowledge Regarding Tuberculosis Associated with Stigmatising and Discriminating Attitudes of General Population towards Tuberculosis Patients? Findings from a Community Based Survey in 30 Districts of India

Stigmatising and discriminating attitudes may discourage tuberculosis (TB) patients from actively seeking medical care, hide their disease status, and discontinue treatment. It is expected that appropriate knowledge regarding TB should remove stigmatising and discriminating attitudes. In this study we assessed the prevalence of stigmatising and discriminating attitudes towards TB patients among general population and their association with knowledge regarding TB.

A cross-sectional knowledge, attitude and practice survey was conducted in 30 districts of India in January-March 2011. A total of 4562 respondents from general population were interviewed using semi-structured questionnaires which contained items to measure stigma, discrimination and knowledge on TB.

Of the 4562 interviewed, 3823 were eligible for the current analysis. Of these, 73% (95% CI 71.4–74.2) had stigmatising and 98% (95% CI 97.4–98.3) had discriminating attitude towards TB patients. Only 17% (95% CI 15.6–18.0) of the respondents had appropriate knowledge regarding TB with even lower levels observed amongst females, rural areas and respondents from low income groups. Surprisingly stigmatising (adjusted OR 1.31 (0.78–2.18) and discriminating (adjusted OR 0.79 (0.43–1.44) attitudes were independent of knowledge regarding TB.

Stigmatising and discriminating attitudes towards TB patients remain high among the general population in India. Since these attitudes were independent of the knowledge regarding TB, it is possible that the current disseminated knowledge regarding TB which is mainly from a medical perspective may not be adequately addressing the factors that lead to stigma and discrimination towards TB patients. Therefore, there is an urgent need to review the messages and strategies currently used for disseminating knowledge regarding TB among general population and revise them appropriately. The disseminated knowledge should include medical, psycho-social and economic aspects of TB that not only informs people about medical aspects of TB disease, but also removes stigma and discrimination.

Statements as part of the KAP survey tool to capture stigmatising and discriminating attitudes.
Stigmatising AttitudesNow I Will Make Some Statements About People Suffering From TB. Please Let Me Know How Much You Agree To These?Strongly Agree*Somewhat Agree*Disagree
1A family with TB patient should not be allowed to participate in any social function
2Married female TB patient should be sent off to her parent’s house
3Children with TB should not be allowed to go to school
4Children of parents suffering from TB should not be allowed to go to school
5Daily wage Laborer, suffering from TB should not be allowed to work
6TB patient are threat to community
7TB patients should be left isolated in the community
Discriminating AttitudesWhich of the following you would agree to do?YesNo**DK/CS
1Share a meal with person you know had TB
2If you suspect one of the female member is suffering from TB, would you take her to hospital
3Marry your daughter to a boy knowing had a TB
4Isolate your family member having TB in the house
5Marry your son to a girl who you know had TB
6Send your daughter in law to parent’s house if she had TB in order to protect other family members from TB
* Strongly agree and somewhat agree have been considered as affirmatives for stigmatising attitudes
** Don’t know/Can’t say

Full article at:

Selvakumar Subbian, Editor
International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
Public Health Research Institute at RBHS, UNITED STATES
Competing Interests: The authors have declared that no competing interests exist.
Conceived and designed the experiments: KDS SS SSC. Performed the experiments: KDS. Analyzed the data: KDS SS SSC. Contributed reagents/materials/analysis tools: KDS SS SSC. Wrote the paper: KDS SS SSC.

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