Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study.
BACKGROUND
Tuberculosis (TB) is a major cause of death. The condition is highly stigmatised, with considerable discrimination towards sufferers. Although there have been several studies assessing the extent of such discrimination, there is little published research explicitly investigating the causes of the stigma and discrimination associated with TB. The objectives of our research were therefore to take the first steps towards determining the causes of discrimination associated with TB.


METHODS
Data collection was performed in Kathmandu, Nepal. Thirty four in-depth interviews were performed with TB patients, family members of patients, and members of the community.


RESULTS
Causes of self-discrimination identified included fear of transmitting TB, and avoiding gossip and potential discrimination. Causes of discrimination by members of the general public included: fear of a perceived risk of infection; perceived links between TB and other causes of discrimination, particularly poverty and low caste; perceived links between TB and disreputable behaviour; and perceptions that TB was a divine punishment. Furthermore, some patients felt they were discriminated against by health workers


CONCLUSIONS
A comprehensive package of interventions, tailored to the local context, will be needed to address the multiple causes of discrimination identified: basic population-wide health education is unlikely to be effective.
Baral
Sushil C
SC
Nuffield Centre for International Health and Development, Leeds Institute for Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK . sushilb@mos.com.np
Karki
Deepak K
DK
Newell
James N
JN
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D005190:Family; D005239:Fear; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D018802:Patient-Centered Care / Q000592:standards; D011203:Poverty / Q000523:psychology; D011287:Prejudice; D015995:Prevalence; D012111:Residence Characteristics; D012923:Social Class; D012934:Social Isolation / Q000523:psychology; D013240:Stereotyping; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology* / Q000635:transmission
Bull World Health Organ. 2007 May;85(5):327
17639210
Health Policy. 2001 Oct;58(1):69-81
11518602
Psychol Health Med. 2006 Aug;11(3):346-52
17130070
Trop Doct. 1998 Jul;28(3):185-6
9700298
Soc Sci Med. 2000 Jan;50(2):247-54
10619693
Int J Tuberc Lung Dis. 1999 Jul;3(7):553-60
10423217
Trop Med Int Health. 2005 Apr;10(4):330-5
15807796
Health Policy. 2005 Oct;74(2):205-17
16153480
Int J Tuberc Lung Dis. 2004 May;8(5):603-8
15137538
Int J Tuberc Lung Dis. 2000 Dec;4(12):1190-1
11144465
Tubercle. 1976 Dec;57(4):275-99
827837
Soc Sci Med. 2005 Apr;60(8):1845-53
15686814
Int J Lepr Other Mycobact Dis. 2004 Dec;72(4):437-47
15755198
Int J Tuberc Lung Dis. 1999 Oct;3(10):862-8
10524582
BMJ. 2004 Jun 19;328(7454):1470
15194599
Int J Tuberc Lung Dis. 2004 Jan;8(1):70-5
14974748