title: Individual, household and community level factors associated with keeping tuberculosis status secret in Ghana.
abstract: In tuberculosis (TB) control, early disclosure is recommended for the purposes of treatment as well as a means of reducing or preventing person-to-person transmission of the bacteria. However, disclosure maybe avoided as a means of escaping stigma, and possible discrimination. This study aimed at providing insights into factors associated with intentions of Ghanaians to keep positive TB diagnosis in their families' a secret.
  
  
  
  The paper was based on data from the 2014 Ghana Demographic and Health Survey. Descriptive statistics of proportions with Chi-square test and binary logistic regression were used to identify individual, household and community level factors that predicted the outcome variable (keeping TB secret).
  
  
  
  Women were more inclined (33%) than men (25%) to keep TB in the family a secret. Views about keeping TB secret declined with age for both sexes. For women, higher education had a positive association with whether TB in the family would be kept a secret or not but the same was not observed for men. In a multivariable regression model, the strongest predictor of keeping TB secret was whether the respondent would keep HIV secret, and this was uniform among women (OR = 6.992, p < 0.001) and men (OR = 9.870, p < 0.001).
  
  
  
  Unwillingness towards disclosing TB status in Ghana is associated with varied socioeconomic and demographic characteristics, which may be driven by fears of stigma and discrimination. Addressing TB-related stigma and discrimination can enhance positive attitudes towards TB disclosure. For an infectious disease such as TB, openness towards status disclosure is important for public health.
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya. jamo-adjei@aphrc.org.|Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. jamo-adjei@aphrc.org.
authors.forename: Joshua
authors.identifier: 0000-0001-8394-1874
authors.initials: J
authors.lastname: Amo-Adjei
mesh_terms: D000293:Adolescent; D000328:Adult; D005191:Family Characteristics; D005260:Female; D005869:Ghana; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D057545:Social Stigma; D014376:Tuberculosis / Q000523:psychology*; D055815:Young Adult
keywords: Disclosure; Ghana; Secret; Tuberculosis status