Social Stigmatization in Tuberculous Patient: A Hospital Based Survey in Lahore, Pakistan

Abstract

Background: Inadequate knowledge regarding Tuberculosis leads to stigmatization due to perceived risk of transmission of disease. It is pertinent to comprehend the origin of Tuberculosis stigma so as to reduce its impact on health as geographic and cultural variation may play an important role. Aim was to assess perception of stigma among patients and discriminations faced
by them within the family and society.

Methods: A cross sectional study was conducted on 300 Tuberculosis patients of Gulab Devi Chest Hospital, Lahore, Pakistan after IRB clearance. Interviews were conducted after taking consent, using a validated questionnaire adopted from a previously published study. Perceptions of the participants were addressed regarding stigma related to Tuberculosis especially regarding their fears associated with disclosing their disease within and outside their families, experiencing of loneliness, losing of friends and feeling hurt on the reaction of their families, friends and outsiders. Chi square was chosen as the test of significance with a p-value of <0.05 considered significant.

Results: Mean age was 42.5±17 with male predominance (median 42, IQR 13.5), 239 (79.7%) having an income less than 25,000. Participants and spouses were mostly illiterate 154 (51.3%) and 161 (53.6%) respectively, 239 (79%) being self-employed. They 213 (71%) were not afraid to disclose their disease to their families and others, while 175 (58.3%) were not worried of being a burden on their family. On the contrary 158 (52.7%) felt hurt at the reaction of others on disclosing their disease (p=0.000, CI=12.57 – 35.52). Many had lost friends 216 (72%) and were experiencing loneliness (p=0.000, CI=29.95 – 52.24). Fear of visiting tuberculosis clinics was observed in 200 (67%). Participants had no fear of being perceived as AIDS patients 235 (78.3%) (p=0.000, CI=8.58 – 32.26).They had no fear of developing AIDS 243(81%) Tuberculosis 190 (63.3%) due to smoking, drinking or other risky behaviors (p=0.03, CI= 0.50 – 30.22).

Conclusions: This study concludes that substantial stigmatization and discrimination was being faced at community as compared to family level attributed to strong family bonds in countries like Pakistan.
Key words: Tuberculosis, Stigmatization, Pakistan