Research Article: Knowledge, attitude and perceived stigma towards tuberculosis among pastoralists; Do they differ from sedentary communities? A comparative cross-sectional study

Date Published: July 17, 2017

Publisher: Public Library of Science

Author(s): Bezawit Temesgen Sima, Tefera Belachew, Fekadu Abebe, Madhukar Pai.

http://doi.org/10.1371/journal.pone.0181032

Abstract

Ethiopia is ninth among the world high tuberculosis (TB) burden countries, pastoralists being the most affected population. However, there is no published report whether the behavior related to TB are different between pastoralist and the sedentary communities. Therefore, the main aim of this study is to assess the pastoralist community knowledge, attitude and perceived stigma towards tuberculosis and their health care seeking behavior in comparison to the neighboring sedentary communities and this may help to plan TB control interventions specifically for the pastoralist communities.

A community-based cross-sectional survey was carried out from September 2014 to January 2015, among 337 individuals from pastoralist and 247 from the sedentary community of Kereyu district. Data were collected using structured questionnaires. Three focus group discussions were used to collect qualitative data, one with men and the other with women in the pastoralist and one with men in the sedentary groups. Data were analyzed using Statistical Software for Social Science, SPSS V 22 and STATA.

A Lower proportion of pastoralists mentioned bacilli (bacteria) as the cause of PTB compared to the sedentary group (63.9% vs. 81.0%, p<0.01), respectively. However, witchcraft was reported as the causes of TB by a higher proportion of pastoralists than the sedentary group (53.6% vs.23.5%, p<0.01), respectively. Similarly, a lower proportion of pastoralists indicated PTB is preventable compared to the sedentary group (95.8% vs. 99.6%, p<0.01), respectively. Moreover, majority of the pastoralists mentioned that most people would reject a TB patient in their community compared to the sedentary group (39.9% vs. 8.9%, p<0.001), respectively, and the pastoralists expressed that they would be ashamed/embarrassed if they had TB 68% vs.36.4%, p<0.001), respectively. The finding indicates that there is a lower awareness about TB, a negative attitude towards TB patients and a higher perceived stigma among pastoralists compared to their neighbor sedentary population. Strategic health communications pertinent to the pastoralists way of life should be planned and implemented to improve the awareness gap about tuberculosis.

Partial Text

Tuberculosis (TB) is a major global health problem, responsible for ill health among millions of people each year [1]. In 2015 TB was one of the top 10 causes of death worldwide and the leading cause of death from an infectious disease ranking above HIV/AIDS [2]. Based on the world health organization Global Report 2016 [2], there were 10.4 million new TB cases in 2015 and 1.4 million TB deaths. Moreover, there were 0.4 million deaths from TB disease among HIV-positive people and approximately 250 000 deaths from (multi-drug resistant/resistant to rifampicin) MDR/RR -TB [2]. Most of the estimated number of cases in 2015 occurred in Asia (61%) and WHO Africa region (26%) and 80% of the HIV-positive TB cases are in Africa [2].

The main objective of this study was to assess and compare the pastoralist’s knowledge, attitude and perceived stigma towards TB and health seeking behavior to the neighboring sedentary community in the Fentale district, Eastern Ethiopia.

The results of the present study showed that there is a significant knowledge gap about the causes, signs and symptoms, mode of transmission, prevention, and treatment of TB among the pastoralists compared to their neighboring sedentary population. The proportion of the pastoralists who have indicted bacilli as the cause of TB is lower compared to the sedentary group. It is higher than the studies conducted in Afar and Somali pastoralists and non-pastoral community in Ethiopia [4, 10–12, 15] and elsewhere [17], it is difficult to give a sound reason for the difference but it could be related to the geographical location and sources of information about TB [12, 18]. Rather, most pastoralists in this study have a misconception about the causes of TB, for instance, witchcraft, hard work, and sexual overindulgence were mentioned as the causes of TB. Moreover, misconception about the causes of TB and factors for exposure to the disease, like sharing utensils and unventilated house were reported among most pastoralists as causes of TB compared with sedentary group. These results are in agreement with other studies conducted in Afar and Somali pastoralist [7, 10, 12] and in the non-pastoral community in Ethiopia [16]. For example, studies in Afar and Shinille area pastoralists shows that 38% and 10% respondents mentioned that starvation and poverty as the causes of TB, respectively.

We found that TB is familiar to both the pastoralist and sedentary communities in this study area. However, the pastoralists had a higher knowledge gap about TB, such as the cause of TB, a negative attitude such as feeling fear or embarrassment if had TB, high overall perceived stigma and a more frequent visit to TH’s for their illness compared to the sedentary community. The existing TB control strategy is not working the same way for the pastoralist compared to the sedentary community in the raising awareness about TB. To overcome this challenge, new TB control strategy involving traditional healers and volunteer CHW’s should be adapted for the pastoralist community which could be pertinent to their lifestyle. Health education interventions and social mobilization by integrating and training traditional healers/CHW’s should be considered to address the traditional beliefs about the causes of TB, to avoid unfavorable attitude towards TB, to avoid causes of stigma and increase health care seeking behavior in the pastoralist community.

 

Source:

http://doi.org/10.1371/journal.pone.0181032

 

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