Non-disclosure of tuberculosis diagnosis by patients to their household members in south western Uganda


Autoři: Miria Nyangoma aff001;  Francis Bajunirwe aff002;  Daniel Atwine aff001
Působiště autorů: Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda aff001;  Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda aff002;  Department of Clinical Research, Epicentre, Mbarara, Mbarara, Uganda aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0216689

Souhrn

Background

Tuberculosis (TB) non-disclosure by adult patients to all household members is a setback to TB control efforts. It reduces the likelihood that household contacts will seek early TB screening, initiation on preventive or curative treatment, but also hinders the implementation of infection controls and home-based directly observed treatment. Therefore, the purpose of this study was to determine the level of TB non-disclosure, its predictors and the effects of disclosure among adult TB patients in Uganda.

Methods

We conducted a cross-sectional study at a large regional referral hospital in Mbarara, south-western Uganda. Questionnaires were administered to collect patients’ sociodemographic and their TB disclosure data. Non-disclosure was considered if a patient did not reveal their TB diagnosis to all household members within 2 weeks post-treatment initiation. Univariate and multivariate logistic regression models were fitted for predictors of non-disclosure.

Results

We enrolled 62 patients, 74% males, mean age of 32 years, and median of five people per household. Non-disclosure rate was 30.6%. Post-disclosure experiences were positive in 98.3% of patients, while negative experiences suggestive of severe stigma occurred in 12.3% of patients. Being female (OR 6.5, 95% CI: 1.4–29.3) and belonging to Muslim faith (OR 12.4, 95% CI: 1.42–109.1) were significantly associated with TB non-disclosure to household members.

Conclusions

There is a high rate of TB non-disclosure to all household members by adult patients in rural Uganda, particularly among women and muslim patients. Interventions enhancing TB disclosure at household level while minimizing negative effects of stigma should be developed and prioritized.

Klíčová slova:

HIV – HIV infections – Islam – Patients – Religion – Tuberculosis – Tuberculosis diagnosis and management – Uganda


Zdroje

1. World Health Organization. Global Tuberculosis Report Geneva. 2019. Available from: http://www.who.int/tb/publications/global_report/en/.

2. World Health Organisation. Ministry of Health and partners review the National TB prevalence survey report. 2017 [cited 2017 10th September]; Available from: http://www.afro.who.int/news/ministry-health-and-partners-review-national-tb-prevalence-survey-report.

3. Bacaër N., Ouifki R., Pretorius C., Wood R. & Williams B. Modeling the joint epidemics of TB and HIV in a South African township. J Math Biol., 2008. 57(4): p. 557–93. doi: 10.1007/s00285-008-0177-z 18414866

4. Middelkoop K., Bekker L.G., Myer L., Dawson R. & Wood R. Rates of tuberculosis transmission to children and adolescents in a community with a high prevalence of HIV infection among adults. Clin Infect Dis, 2008. 47(3): p. 349–55. doi: 10.1086/589750 18558885

5. Johnstone-Robertson S., Lawn S.D., Welte A., Bekker L.G. & Wood R. Tuberculosis in a South African prison—a transmission modelling analysis. S Afr Med J, 2011. 101(11): p. 809–13. 22272961

6. Riley R.L., Mills C.C., Nyka W., Weinstock N., Storey P.B., Sultan L.U., Riley M.C. & Wells W.F. Aerial dissemination of pulmonary tuberculosis. A two-year study of contagion in a tuberculosis ward. 1959. Am J Epidemiol., 1995. 142(1): p. 3–14. doi: 10.1093/oxfordjournals.aje.a117542 7785671

7. World Health Organization. Treatment of tuberculosis: Guidelines for treatment of drug-susceptible tuberculosis and patient care. 2017. Available from: https://apps.who.int/iris/bitstream/handle/10665/255052/9789241550000-eng.pdf

8. World Health Organization. Treatment of Tuberculosis guidelines. 2016 [cited 2017 30th July]; Available from: http://apps.who.int/iris/bitstream/10665/44165/1/9789241547833_eng.pdf.

9. Pasipanodya J. G., McIlleron H., Burger A., Wash P. A., Smith P. and G. T. Serum drug concentrations predictive of pulmonary tuberculosis outcomes. J. Infect. Dis., 2013. 208: p. 1464–1473. doi: 10.1093/infdis/jit352 23901086

10. Gumbo T., Louie A., Deziel M. R., Liu W., Parsons L. M. and S. M. Concentration-dependent Mycobacterium tuberculosis killing and prevention of resistance by rifampin. Antimicrob. Agents Chemother, 2007. 51: p. 3781–3788.

11. Munro S. A., Lewin S. A., Smith H. J., Engel M. E., Fretheim A. and Volmink J. Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS medicine, 2007. 4(7): p. e238. doi: 10.1371/journal.pmed.0040238 17676945

12. Gebremariam M.K., Bjune G.A., and Frich J.C., Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study. BMC Public Health 2010. 10: p. 651. doi: 10.1186/1471-2458-10-651 21029405

13. Cremers A.L., De Laat M.M., Kapata N., Gerrets R., Klipstein-Grobusch K. & Grobusch M.P. Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Zambia. PLoS ONE, 2015. 10(3): p. e0119861. doi: 10.1371/journal.pone.0119861 25806955

14. Lee R.S., Radomski N., Proulx J.F., Manry J., Mcintosh F., Desjardins F., et al. "Reemergence And Amplification Of Tuberculosis In The Canadian Arctic". Journal of Infectious Diseases 2015. 211(12): p. 1905–1914. doi: 10.1093/infdis/jiv011 25576599

15. World Health Organisation (2015). Implementing The END TB Strategy: The essentials. Geneva, Switzerland, World Health Organization. Available from: https://www.who.int/tb/publications/2015/end_tb_essential.pdf

16. Rouillon A., Perdrizet S., and Parrot R., Transmission of tubercle bacilli: The effects of chemotherapy. Tubercle, 1976. 57(4): p. 275–99. doi: 10.1016/s0041-3879(76)80006-2 827837

17. Daniel W. W. Biostatistics: A Foundation for Analysis in the Health Sciences. 1999, 7th edition. New York: John Wiley & Sons.

18. World Health Organisation. (2017). "Ethics guidance for the implementation of the End TB Strategy." Available from: http://www.who.int/tb/publications/2017/ethics-guidance/en/.

19. Amo-Adjei J. (2016). “Individual, household and community level factors associated with keeping tuberculosis status secret in Ghana.” BMC Public Health 16:1196. doi: 10.1186/s12889-016-3842-y 27887600

20. Hardon A. P., Akurut D., Comoro C., Ekezie C., Irunde H. F., Gerrits T., et al., Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa. AIDS Care, 2007. 19(5): p. 658–665. doi: 10.1080/09540120701244943 17505927

21. Kansiime N., Atwine D., Nuwamanya S., and Bagenda F. Effect of Male Involvement on the Nutritional Status of Children Less Than 5 Years: A Cross Sectional Study in a Rural Southwestern District of Uganda. Journal of Nutrition and Metabolism, 2017. 2017: p. 1–9.

22. Zou J., Yamanaka Y., John M., Watt M., Ostermann J. and Thielman N. (2009). "Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes." BMC Public Health 9: 75. doi: 10.1186/1471-2458-9-75 19261186

23. Wynne A., Richter S., Banura L. and Kipp W. (2014). "Challenges in tuberculosis care in Western Uganda: Health care worker and patient perspectives." International Journal of Africa Nursing Sciences 1: 6–10.

24. Shrestha A., Bhattarai D., Thapa B., Basel P. and Wagle RR. (2017). "Health care workers' knowledge, attitudes and practices on tuberculosis infection control, Nepal." BMC Infect Dis. 17(1): 724. doi: 10.1186/s12879-017-2828-4 29149873


Článek vyšel v časopise

PLOS One


2020 Číslo 1