Knowledge, perceived stigma and health care seeking behavior of tuberculosis patients attending respiratory medicine clinic (RMC) of Indhira Gandhi Memorial Hospital (IGMH) / Aminath Aroosha

Abstract

Background: Despite the fact that tuberculosis is a preventable and curable disease, it causes ill-health in millions of people each year and in 2015 it was one of the top 10 causes of death worldwide, ranking above HIV/AIDS as one of the leading causes of death from an infectious disease. With a population of about 357 415, Maldives has an estimated prevalence and incidence rate of all forms of TB respectively of 56 and 41 per 100 000 population respectively, in 2014.

Objective: This study aims to understand the TB patient's knowledge and perception of stigma regarding TB and the associating care seeking behaviors in order to provide helpful data for the improvement of public health education regarding tuberculosis.

Method: A qualitative study design was used to conduct individual in-depth interviews using a semi- structured, open ended question guide to gather data from 10 tuberculosis patients attending the respiratory medicine clinic for their DOTS and follow up. Any local patient 18 years and above was included in the study using the purposive sampling method.

Findings: The results showed a reasonably good level of knowledge among patients diagnosed with tuberculosis about the disease itself. Patients possess some knowledge regarding the modes of transmission, general symptoms, duration of treatment, TB /HIV related and the risk factors. Stigma was highly perceived among the patients and fear of stigmatization and discrimination existed among majority of the patients. Even though the fear of isolation and avoidance existed, most patients are supported by family and friends. Factors that influenced care seeking behavior include thinking the symptoms were due to another illness and preference of self-treatment. The median delay in care seeking is about 1 - 2 weeks. Study results also suggest that the majority of people preferred a public health facility for diagnosis and treatment, even though few preferred private practitioners including traditional healers. But it took some time for the referral of the patient to the respiratory medicine clinic for initiation of treatment.

Conclusion: In conclusion, the knowledge of TB is reasonably good for this study population and it was observed that inappropriate care seeking behavior and stigma towards TB existed. The national TB control program needs to invest in social mobilization and education of communities to mitigate early health care seeking.

KEY WORDS: Knowledge, perceived stigma, Care seeking behaviour, Delay in seeking care