Background
Methods
Study setting and population
Study design and sampling
Sample size for the quantitative study
Study area
Qualitative studies
Data collection
Data analysis
Ethics approval and consent to participate
Results
Sociodemographic and economic characteristics
General population
General population | Families of TB patients | TB patients | |||||
---|---|---|---|---|---|---|---|
Variables | Categories | Number | % | Number | % | Number | % |
Gender | Male | 835 | 46.8 | 407 | 48.7 | 488 | 57.8 |
Female | 948 | 53.2 | 429 | 51.3 | 356 | 42.2 | |
Age in years | 18–30 | 872 | 48.9 | 405 | 48.4 | 251 | 29.7 |
31–60 | 828 | 46.4 | 414 | 49.5 | 246 | 29.1 | |
>60 | 83 | 4.7 | 17 | 2.0 | 164 | 19.4 | |
Relationship | Head | 869 | 48.7 | 329 | 39.4 | 93 | 11.0 |
Spouse | 597 | 33.5 | 248 | 29.7 | 52 | 6.2 | |
Son/Daughter | 266 | 14.9 | 160 | 19.1 | 38 | 4.5 | |
Other relative | 44 | 2.5 | 88 | 10.5 | 396 | 46.9 | |
Non-relative | 7 | 0.4 | 11 | 1.3 | 189 | 22.4 | |
Marital Status | Married | 1176 | 66 | 543 | 65.0 | 186 | 22.0 |
Never married | 343 | 19.2 | 203 | 24.3 | 7 | 0.8 | |
Divorced | 143 | 8 | 46 | 5.5 | 4 | 0.5 | |
Widowed | 107 | 6 | 38 | 4.5 | 434 | 51.4 | |
Living together | 14 | 0.8 | 6 | 0.7 | 283 | 33.5 | |
Educational Status | Illiterate | 537 | 30.1 | 283 | 33.9 | 66 | 7.8 |
Read and write only | 128 | 7.2 | 51 | 6.1 | 57 | 6.8 | |
Primary | 517 | 29 | 227 | 27.2 | 4 | 0.5 | |
Secondary | 398 | 22.3 | 173 | 20.7 | 292 | 34.7 | |
Above secondary | 203 | 11.4 | 102 | 12.2 | 40 | 4.7 | |
Occupation | Employed | 210 | 11.8 | 126 | 15.1 | 263 | 31.2 |
House wife | 393 | 22 | 178 | 21.3 | 163 | 19.3 | |
Farmer | 322 | 18.1 | 178 | 21.3 | 85 | 10.1 | |
Daily laborer | 179 | 10 | 80 | 9.6 | 102 | 12.1 | |
Trader | 381 | 21.4 | 121 | 14.5 | 114 | 13.5 | |
Student | 136 | 7.6 | 84 | 10.0 | 203 | 24.1 | |
No job/dependent | 114 | 6.4 | 47 | 5.6 | 103 | 12.2 | |
House maid | 38 | 2.1 | 19 | 2.3 | 85 | 10.1 | |
Other | 10 | 0.6 | 3 | 0.4 | 109 | 12.9 | |
Wealth Quintile | Lowest | 355 | 19.9 | 166 | 19.9 | 102 | 12.1 |
Second | 350 | 19.6 | 169 | 20.2 | 18 | 2.1 | |
Third | 365 | 20.5 | 162 | 19.4 | 8 | 0.9 | |
Fourth | 352 | 19.7 | 173 | 20.7 | 168 | 19.9 | |
Highest | 361 | 20.2 | 166 | 19.9 | 169 | 20.0 |
Families of TB patients
TB patients
Attitudes about and stigma toward tuberculosis
General population
Variables | # | % | |
---|---|---|---|
Do you think you can get TB (n = 1668) | 756 | 45.3 | |
Reaction if you were found out that you have TB (N = 1668) | Cope with it | 1076 | 64.5 |
Fear | 532 | 31.9 | |
Surprise | 80 | 4.8 | |
Shame | 55 | 3.3 | |
Embarrassment | 33 | 2 | |
Sadness or hopelessness | 78 | 4.7 | |
Other | 9 | 0.5 | |
Who would you talk to about your illness if you had TB? (N = 1668) | Doctor/other medical worker | 1380 | 82.7 |
Spouse | 358 | 21.5 | |
Parent | 450 | 27 | |
Children | 169 | 10.1 | |
Other family member | 428 | 25.7 | |
Close friend | 276 | 16.5 | |
No one | 18 | 1.1 | |
Others | 5 | 0.03 | |
What would you do if you thought you had symptoms of TB? | Go to public health facility | 1598 | 95.8 |
Go to private health facility | 233 | 14 | |
Go to pharmacy | 46 | 2.8 | |
Go to spiritual/traditional healer | 25 | 1.5 | |
Pursue other self-treatment options | 4 | 0.2 | |
Others | 2 | 0.1 | |
Don’t know | 11 | 0.7 | |
If you would not go to health facility, what is the reason? (N = 24) | Not sure where to go | 7 | 29.2 |
Cost | 11 | 45.8 | |
Transportation related | 2 | 8.3 | |
Don’t trust health workers | 4 | 16.7 | |
Would be cured by religion | 1 | 0.1 | |
If you had symptoms of TB, at what point would you go to the health facility? | Immediately | 1080 | 64.7 |
In few days | 305 | 18.3 | |
One to 2 weeks | 172 | 10.3 | |
After 2 weeks | 93 | 5.6 | |
I will not go to health facility | 14 | 0.8 | |
Other | 4 | 0.2 | |
How expensive do you think TB diagnosis and treatment in this country? | It is free of charge | 782 | 46.9 |
It is reasonably priced | 187 | 11.2 | |
It is moderately expensive | 139 | 8.3 | |
It is very expensive | 142 | 8.5 | |
Don’t know | 418 | 25.1 | |
Know people who have/had TB | 815 | 48.9 | |
Statement closest to your feeling about people with TB | I feel compassion and desire to help | 1142 | 68.5 |
I feel compassion but tend to stay away from these people | 208 | 12.5 | |
It is their problem and I don’t want to get TB by trying to help them | 74 | 4.4 | |
I fear them because they may infect me | 98 | 5.9 | |
I have no particular feeling | 145 | 8.7 | |
Other | 1 | 0.1 | |
How TB patient usually regarded/treated In your community? | Most people reject him/her | 342 | 20.5 |
Most people are friendly, but they generally try to avoid | 295 | 17.7 | |
The community mostly supports and helps him/her | 683 | 40.9 | |
I don’t have the experience | 345 | 20.7 | |
Others | 3 | 0.2 |
Stigma related questions (N = 1668) | Agree | Indifferent | Disagree | |||
---|---|---|---|---|---|---|
# | % | # | % | # | % | |
If yourself got TB, you would want it to remain secret. | 198 | 11.9 | 61 | 3.7 | 1409 | 84.5 |
If a member of your family got TB, you would want it to remain secret. | 194 | 11.6 | 63 | 3.8 | 1411 | 84.6 |
If you had TB, others would think less of you. | 302 | 18.1 | 164 | 9.8 | 1202 | 72.1 |
If you had TB, you would be ashamed or embarrassed. | 250 | 14.9 | 79 | 4.7 | 1339 | 80.3 |
If you had TB, others would avoid you. | 403 | 24.2 | 205 | 12.3 | 1060 | 63.6 |
If you had TB, you would be asked to stay away from a social group. | 251 | 15.1 | 191 | 11.5 | 1226 | 73.5 |
If you had TB, you would not disclose even to a confidant | 164 | 9.8 | 91 | 5.5 | 1413 | 84.7 |
If you had TB, you would think less of yourself. | 273 | 16.4 | 108 | 6.5 | 1287 | 77.2 |
If you had TB, others would think less of your family. | 109 | 6.5 | 43 | 2.6 | 1516 | 90.9 |
Families of TB patients
TB patients
Stigma score and factors associated with stigma
General population
Variables | Stigma High | Stigma Low | COR (95% CI) | AOR (95%CI) | |
---|---|---|---|---|---|
# (%) | # (%) | ||||
Gender | Male | 293 (37.4) | 490 (62.6) | 0.91 (0.74–1.1) | NA |
Female | 352 (39.8) | 533 (60.2) | 1 | ||
Education | Not able to read and write | 220 (46.5) | 253 (53.5) | 1 | 1 |
Read and write only | 48 (40.7) | 70 (59.3) | 0.79(0.52–1.19) | 0.9(.57–1.38) | |
Primary | 180 (37.0) | 306 (63.0) | 0.68 (0.52–0.88) | 0.84(.63–1.11) | |
Secondary | 143 (36.8) | 246 (63.2) | 0.67 (0.51–0.88) | 0.92 (0.68–1.25) | |
Above secondary | 54 (26.7) | 148 (73.3) | 0.42 (0.29–0.6) | 0.58 (0.39–0.87)a | |
Wealth | Lowest | 122 (39.9) | 184 (60.1) | 1.53 (1.11–2.11) | 0.83 (0.55–1.25) |
Second | 146 (45.3) | 176 (54.7) | 1.91 (1.4–2.62) | 0.97 (0.65–1.43) | |
Third | 137 (40.7) | 200 (59.3) | 1.58 (1.15–2.16) | 0.88 (0.61–1.28) | |
Fourth | 132 (38.2) | 214 (61.8) | 1.42 (1.04–1.95) | 0.85 (0.6–1.2) | |
Highest | 108 (30.3) | 249 (69.7) | 1 | 1 | |
Setting | Rural | 314 (42.5) | 425 (57.5) | 1.33 (1.1–1.63) | 0.95 (0.75–1.21) |
Urban | 331 (35.6) | 598 (64.4) | 1 | 1 | |
Knowledge score | High | 280 (33.5) | 555 (66.5) | 0.65 (0.53–0.79) | 0.62 (0.49–0.78)a |
Low | 365 (43.8) | 468 (56.2) | 1 | 1 | |
Region | Oromia | 192 (58.4) | 137 (41.6) | 1 | 1 |
Amhara | 121 (36.1) | 214 (63.9) | 0.4 (0.3–0.55) | 0.35 (0.25–0.49)a | |
SNNP | 81 (25.5) | 237 (74.5) | 0.24 (0.18–0.34) | 0.23 (0.16–0.32)a | |
Tigray | 95 (53.7) | 82 (46.3) | 0.83 (0.57–1.19) | 0.8 (0.55–1.17) | |
Benshangul Gumuz | 43 (48.3) | 46 (51.7) | 0.67 (0.42–1.07) | 0.61 (0.37–0.98)a | |
Gambella | 19 (23.2) | 63 (76.8) | 0.22 (0.12–0.38) | 0.22 (0.12–0.38)a | |
Addis Ababa | 22 (12.7) | 151 (87.3) | 0.1 (0.06–0.17) | 0.1 (0.06–0.17)a | |
Dire Dawa | 35 (43.2) | 46 (56.8) | 0.54 (0.33–0.89) | 0.54 (0.33–0.91)a | |
Harari | 37 (44.0) | 47 (56.0) | 0.56 (0.35–0.91) | 0.54 (0.32–0.88)a |
Families of TB patients
TB patients
Variables N = 823 | Agree | Indifferent | Disagree | |||
---|---|---|---|---|---|---|
# | % | # | % | # | % | |
Family members are cooperative towards me | 621 | 75.5 | 33 | 4.0 | 169 | 20.6 |
Utensils are separated for me | 620 | 75.3 | 27 | 3.3 | 176 | 21.4 |
I have fear of reduction of family income | 378 | 45.9 | 75 | 9.1 | 370 | 44.9 |
Threat of loss of job/wages | 267 | 32.5 | 84 | 10.2 | 472 | 57.4 |
Most people behave differently | 209 | 25.4 | 67 | 8.1 | 547 | 66.5 |
Feel isolated within the family | 126 | 15.3 | 49 | 6.0 | 648 | 78.8 |
Family members avoid me | 76 | 9.3 | 36 | 4.4 | 711 | 86.4 |
I have increased sadness | 305 | 37.1 | 79 | 9.6 | 439 | 53.4 |
Socioeconomic consequences of TB on the patients
Qualitative findings
“…TB patients have difficulty of getting houses to rent because of the fear of transmission of TB to people who live in the same compound…” (Addis Ababa, Female, FGD).
“My husband’s family stigmatized me a lot. Since they knew that I am a TB patient, they didn’t sleep in our house. They sleep outdoors. They are not also willing to eat with me. ...Before I was infected with TB, our social life with other people was great. The social life of DD community is well known. But after they knew that I am a TB patient, only one of my neighbors sometimes comes to visit me. In order not to come to my house frequently, she used to say I am tired and I have a lot of work to do at home” (Dire Dawa, Female TB patient).
“…acquiring TB may be considered as a curse…” (Addis Ababa, Female, FGD).
Family members reported that they supported TB patients by providing nutritious food, arranging a separate bedroom, accompanying them when they go to collect drugs from the health centers/health posts, and allowing them to have adequate rest.“We should not discriminate [against] TB patients, rather we should help them with diets, proper care and anything else they require…” (Southern Nations, Nationalities, and Peoples’ Region, Male, FGD).