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Manifestations of tuberculosis stigma within the healthcare system: The case of Sekondi-Takoradi Metropolitan district in Ghana

Listed author(s):
  • Dodor, Emmanuel Atsu
  • Kelly, Shona J.
Registered author(s):

    Objectives To explore the manifestations of tuberculosis (TB) stigma within the healthcare system.Method Twenty-one individual interviews (16 females and 5 males) and six focus groups (1 with health managers, 1 with staff providing services for TB patients, and 4 with general staff) were conducted among healthcare workers (HCWs) and the generated data analysed using grounded theory principles and procedures.Results TB stigma manifests in three broad and inter-related ways within the healthcare system: behaviour towards TB patients; attitudes towards TB work; and administrative procedures and policies of healthcare mangers. Healthcare workers expressed fear of infection when interacting with TB patients; a fear which intensifies after the confirmation of the diagnosis. For fear of infection, they shuned, avoided, and advocated the segregation of TB patients at home and in the hospitals. They sometimes maltreated the patients, and accused and blamed them for deliberately infecting others. Posting to TB units/wards is viewed as a punishment, with majority indicating refusal to work there or be trained as TB nurse/doctor. They maintained that those working at TB units should be given incentives. Health managers also situated TB units/wards in isolated parts of the hospital, and do not provide adequate tools, equipment, support and supervision for those offering TB services.Conclusions Fear of infection underlies the stigmatisation of TB by HCWs and worsen by administrative procedures and policies of healthcare managers. To help minimise TB stigma, a national guideline for the prevention of TB in HCWs should be developed as this may help protect them and alleviate their fear of infection. Rewarding and motivating HCWs involved in TB control may also improve their attitudes towards TB and those suffering from the disease. Furthermore, interventions to reduce TB stigma should be put in place, and the effects these may have on TB treatment outcomes investigated.

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    Article provided by Elsevier in its journal Health Policy.

    Volume (Year): 98 (2010)
    Issue (Month): 2-3 (December)
    Pages: 195-202

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    Handle: RePEc:eee:hepoli:v:98:y:2010:i:2-3:p:195-202
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    1. Liefooghe, R. & Michiels, N. & Habib, S. & Moran, M. B. & De Muynck, A., 1995. "Perception and social consequences of tuberculosis: A focus group study of tuberculosis patients in Sialkot, Pakistan," Social Science & Medicine, Elsevier, vol. 41(12), pages 1685-1692, December.
    2. Macq, Jean & Solis, Alejandro & Martinez, Guillermo & Martiny, Patrick & Dujardin, Bruno, 2005. "An exploration of the social stigma of tuberculosis in five "municipios" of Nicaragua to reflect on local interventions," Health Policy, Elsevier, vol. 74(2), pages 205-217, October.
    3. Gibson, N. & Cave, A. & Doering, D. & Ortiz, L. & Harms, P., 2005. "Socio-cultural factors influencing prevention and treatment of tuberculosis in immigrant and Aboriginal communities in Canada," Social Science & Medicine, Elsevier, vol. 61(5), pages 931-942, September.
    4. Franco, Lynne Miller & Bennett, Sara & Kanfer, Ruth & Stubblebine, Patrick, 2004. "Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia," Social Science & Medicine, Elsevier, vol. 58(2), pages 343-355, January.
    5. Alexandra Beith & Rena Eichler & Diana Weil, 2007. "Performance-Based Incentives for Health: A Way to Improve Tuberculosis Detection and Treatment Completion?," Working Papers 122, Center for Global Development.
    6. Volinn, Ilse J., 1983. "Health professionals as stigmatizers and destigmatizers of diseases: Alcoholism and leprosy as examples," Social Science & Medicine, Elsevier, vol. 17(7), pages 385-393, January.
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