"Their place is beyond the town's border": A qualitative exploration of stigma associated with tuberculosis in rural and urban areas of Lagos, Nigeria.

Tuberculosis (TB) remains a major public health challenge in Nigeria with a minimum yield of various TB control efforts due to sociocultural determinants of health including TB-associated stigma. Therefore, to achieve the Sustainable Development Goal targets for TB control, an understanding and reduction in TB-associated stigma is necessary. The study aims to explore the perspective of community members and investigate the possible ways of mitigating TB-associated stigma in rural and urban areas in Lagos State, Nigeria. Eight focus group discussions (FGD) were conducted among eight homogenous groups of participants living in the community in rural and urban areas of Lagos state who were stratified by gender, between July and November 2017. Analysis of data was done using the modified grounded theory. A total of 86 participants took part in the FGDs. There were various stigmatising behaviours towards people infected with TB in rural and urban communities studied. This includes: Not willing to eat with people suffering from TB, withdrawal from TB patients in social gatherings, verbal abuse of TB patients and refusing to visit their houses because of their illness. There were also misconceptions about the cause of TB in our study which includes spiritual attack, ingestion of cat hair and inhalation of dust. However, participants in the study believed that mitigating the effect of TB-associated stigma will require adequate community education on TB, provision of financial and emotional support to the patients, as well as the involvement of community leaders in TB control activities and stigma reduction interventions. TB-associated stigma exists in rural and urban communities, with a lack of appropriate knowledge of TB and fear of infection as a major determinant in rural and urban areas respectively. Health education and sensitisation about TB, with community leaders as champions could help to mitigate the effect of TB-associated stigma.

[1]  P. Nyasulu,et al.  Knowledge, beliefs, and perceptions of tuberculosis among community members in Ntcheu district, Malawi , 2018, Journal of multidisciplinary healthcare.

[2]  P. Nyasulu,et al.  Factors Influencing Delayed Health Care Seeking Among Pulmonary Tuberculosis Suspects in Rural Communities in Ntcheu District, Malawi , 2016, Qualitative health research.

[3]  O. Akingbade.  Perspectives on Community Tuberculosis Care in Nigeria , 2016 .

[4]  N. Kapata,et al.  Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Zambia , 2015, PloS one.

[5]  J. Bunders-Aelen,et al.  Comparing the perception of community members towards leprosy and tuberculosis stigmatization. , 2015, Leprosy review.

[6]  Masami Hasegawa,et al.  Nursing care process for releasing psychiatric inpatients from long-term seclusion in Japan: modified grounded theory approach. , 2014, Nursing & health sciences.

[7]  E. Tobin,et al.  Community knowledge and attitude to pulmonary tuberculosis in rural Edo state, Nigeria. , 2013, Annals of African medicine.

[8]  K. Ukwaja,et al.  Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study , 2013, BMC Health Services Research.

[9]  T. Bärnighausen,et al.  Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review , 2012, BMC Public Health.

[10]  A. Bhandari,et al.  Stigma related to tuberculosis among patients attending DOTS clinics of Dharan municipality. , 2012, Kathmandu University medical journal.

[11]  G. Pariyo,et al.  Tuberculosis knowledge, attitudes and health-seeking behaviour in rural Uganda. , 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[12]  A. Jurcev-Savicevic.  Attitudes towards tuberculosis and sources of tuberculosis-related information: study on patients in outpatient settings in Split, Croatia. , 2011, Acta clinica Croatica.

[13]  A. Deribew,et al.  Prejudice and misconceptions about tuberculosis and HIV in rural and urban communities in Ethiopia: a challenge for the TB/HIV control program , 2010, BMC public health.

[14]  S. Kelly,et al.  Health professionals as stigmatisers of tuberculosis: Insights from community members and patients with TB in an urban district in Ghana , 2009, Psychology, health & medicine.

[15]  M. Muniyandi,et al.  Psycho-social dysfunction: perceived and enacted stigma among tuberculosis patients registered under revised national tuberculosis control programme. , 2008, The Indian journal of tuberculosis.

[16]  K. Neal,et al.  An exploration of the causes of tuberculosis stigma in an urban district in Ghana. , 2008, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[17]  Norman Sartorius,et al.  Stigma: ignorance, prejudice or discrimination? , 2007, British Journal of Psychiatry.

[18]  Wim H. van Brakel,et al.  Measuring health-related stigma--a literature review. , 2006 .

[19]  C. Reisen,et al.  Confronting Stigma: Community Involvement and Psychological Well-Being Among HIV-Positive Latino Gay Men , 2005 .

[20]  M. Singh,et al.  Knowledge and attitude towards tuberculosis in a slum community of Delhi. , 2002, The Journal of communicable diseases.

[21]  H. Getahun,et al.  Tuberculosis in rural northwest Ethiopia: community perspective. , 2001, Ethiopian medical journal.

[22]  T. Genebo,et al.  Attitude and social consequences of tuberculosis in Addis Ababa, Ethiopia. , 2001, East African medical journal.

[23]  N. Sharma,et al.  Perception of stigma towards TB among patients on DOTS & patients attending general OPD in Delhi. , 2014, The Indian journal of tuberculosis.