Subjective experiences of stigma related to tuberculosis: A qualitative exploration at peri-urban, Bangladesh

Abstract

Sukanta Paul, Afzal Aftab, Mahfuza Rifat, Shaila Nazneen, Raia Azmi, Shahed Hossain

Background: Stigma related to tuberculosis (TB) is still a global public health challenge. However, only a few attempts were found till date that explored the stigmatization experiences of pulmonary TB patients at the peri-urban context. This study provides a grounded description on the stigmatization experiences of TB from the perspective of TB patients and community people at resource-poor peri-urban settings in Bangladesh. Methods: The study was conducted in two districts of Bangladesh under Bangladesh Rural Advancement Committee, a non-governmental development organization (BRAC) TB Control Programme. Study participants were chosen conveniently. In total, 17 in-depth interviews with pulmonary TB patients (Nine female and eight male) and five focus group discussions with community people (three female and two male) were conducted. Data were audiotaped, transcribed into English, and coded accordingly. Finally, the thematic analysis was used to analyze the data. Results: The findings highlight that TB stigma is still prevailing in the community. Many of the TB patients and discussants revealed about the isolation of eating utensils, drinking glasses, and sometimes bed by family members due to fear of TB transmission, especially during the first 2 months of diagnosis. For men, concealment of disease was explained as fear of being shunned. For young women, TB preventing one’s eligibility for marriage was the main reason for hiding their TB diagnosis. Anticipated avoidance from family members, especially children due to fear of transmitting TB was commonly found in both male and female TB patients. Change in behavioral and psychological aspects, the problem in the family and conjugal life, avoid sexual intercourse, inability to work, lower self-esteem, and discrimination in workplaces, as well as public Directly Observed Therapy, Short course facilities due to TB, were also documented in this study. Frontline health workers were found to be suggesting incorrectly about the route of TB transmission to some of the TB patients. Conclusion: Stigma exists in the personal life and social context of the TB patients which also adversely affects their psychosocial aspects of life. The information gleaned from this study will be useful for effective TB control strategies in Bangladesh.