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

PLoS One. 2020 Jan 24;15(1):e0216689. doi: 10.1371/journal.pone.0216689. eCollection 2020.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Disclosure*
  • Family / psychology
  • Family Characteristics
  • Female
  • HIV / pathogenicity
  • HIV Infections / complications
  • HIV Infections / epidemiology
  • HIV Infections / psychology*
  • HIV Infections / virology
  • Humans
  • Islam / psychology
  • Male
  • Mass Screening / psychology
  • Middle Aged
  • Social Stigma
  • Tuberculosis / complications
  • Tuberculosis / diagnosis*
  • Tuberculosis / epidemiology
  • Tuberculosis / psychology*
  • Uganda / epidemiology

Grants and funding

This work was majorly supported by Mbarara University of Science and Technology, with as small part supported by funds from The German Academic Exchange Service or DAAD In-Country/In-Region Scholarship for Postgraduates, Eastern Africa as part of the sponsorship which was awarded to the first author (MN) for her post-graduate studies. No direct funding was received for this study, hence no Grant number. The funder of the study had no role in study design, data collection, analysis, interpretation, or writing of the report. The first and last authors had full access to all data and had final responsibility for the decision to submit the manuscript for publication.