A COMPARATIVE STUDY OF KNOWLEDGE, ATTITUDE AND DETERMINANTS OF TUBERCULOSIS ASSOCIATED STIGMA IN RURAL AND URBAN COMMUNITIES OF LAGOS STATE

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A COMPARATIVE STUDY OF KNOWLEDGE, ATTITUDE AND DETERMINANTS OF TUBERCULOSIS ASSOCIATED STIGMA IN RURAL AND URBAN COMMUNITIES OF LAGOS STATE

Abstract

Background: Tuberculosis (TB) is a disease of global public health concern with significant morbidity and mortality particularly in Sub-Saharan Africa and Nigeria ranked 3rd among countries with high TB burden globally. The new global end TB strategy recognized among many other things the important role of sociological variables particularly TB associated stigma. TB associated stigma could lead to delayed diagnosis, delayed treatment seeking behavior and default from treatment which could in-turn result in multi-drug resistant TB. Understanding of TB associated stigma and efforts at reducing stigma in both rural and urban community is important for TB control. The study therefore aimed to determine and compare the knowledge, attitude and determinants of TB associated stigma in rural and urban areas of Lagos state.
Methodology: This was a comparative cross sectional study carried out among adult ≥ 18 years in Badagry and Mainland Local government areas of Lagos state. A multi-staged sampling technique was used to select respondents for the study. A semi-structured interviewer administered questionnaire adapted from WHO Guide To Developing Knowledge, Attitude And Practice Surveys and Explanatory Model Interviewed Catalogue (EMIC) stigma scale was used to collect data. Focus group discussion was also carried out to further explore community knowledge, attitude and TB associated stigma and ways of mitigating it. IBM SPSS Statistics Software package version 20 was used to analyze the questionnaires and a thematic framework analysis was used to analyze the FGDs
Results: A total of 790 community members were interviewed in rural and urban communities of Badagry and Lagos Mainland areas of Lagos state. The mean age, level of education and average monthly income of respondents were significantly higher in urban areas compared to rural area. Higher proportion of respondents in rural and urban areas were aware of TB (97.5%
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and 99.2% respectively) and the source of information about TB was radio, family and friends, television and through health workers. Respondents in the urban areas had overall better knowledge of cause, symptoms, mode of transmission, prevention and treatment of TB compared to the rural areas (59.4% vs. 23%; p<0.001; OR =4.896: CI-3.584-6.689) while respondents in the rural areas had better attitude to TB (60.5% vs. 49.9%; p=0.002). Greater proportion of respondents in rural and urban areas had TB associated stigma (93% and 95.7% respectively) and the mean stigma score was higher in the urban areas compared to rural areas (17.43±6.012 and 16.54±6.324 respectively). Marital status and ethnicity were found to be predictors of TB associated stigma in the rural communities (AOR- 0.257; CI-0.086-0.761; p = 0.014 and AOR – 3.09; CI-1.087-8.812;p = 0.034 respectively) while average monthly income and age of respondents were found to be predictors of TB associated stigma in urban areas (AOR – 0.274; CI – 0.0093-0.807;p = 0.019 and AOR -0.212; CI – 0.057-0.788; p =0.021 respectively). The respondents in communities under study believed that improved sensitization about TB cause and treatment as well as provision of financial and social support could help in reducing the TB associated stigma.
Conclusion: The knowledge of TB cause, symptoms, mode of transmission, prevention and cure is higher in urban areas compared to rural area though the rural areas had better attitude to TB. Tuberculosis associated stigma is however similarly prevalent in the rural and urban areas in this study with different predictors in these two settings. There is therefore a need to engage in community enlightenment program particularly in rural areas on knowledge of TB and to engage community’s leaders in this effort as well as in stigma reduction activities towards achievement of end TB strategy.