Prevalence of perceived stigma and associated factors among patients with tuberculosis in Napak district, Karamoja region, Uganda: A cross-sectional study
Victor Lomonyang, Saadick Mugerwa Ssentongo, Ronald Khamasi, Richard JJuuko Kyakuwa, Andrew Katawera, Patricia Nahirya Ntege, William Kasozi, Tadeo Nsubuga, Brenda Picho, Frehd Nghania, Daniel Esogu, Ssekiswa Lwanga Zimwaguyiza, Alexander Mugume, Denise Birungi, Dithan KiraggaBackground
Tuberculosis (TB) remains a leading cause of infectious disease mortality globally. Stigma is a critical social determinant that undermines health-seeking behavior and treatment adherence, threatening TB control. The Karamoja region in Uganda has the highest TB burden and continues to face unique challenges that affect treatment success.
Objectives
This study aimed to determine the prevalence of perceived TB stigma and the factors associated with it among patients with tuberculosis in Napak district, Karamoja.
Design
A cross-sectional study was conducted among 385 TB patients aged ≥18 years from three public health facilities in Napak district.
Methods
Data were collected via structured interviews using simple random sampling. Perceived stigma was measured using the Van Rie TB Stigma Scale (VTSS), which ranges from 0 to 36 points using a four-point Likert scale. The primary outcome was perceived TB stigma. Individuals with a stigma score greater than the median were categorised as having high stigma, and those at or below the median had low TB stigma. A modified Poisson regression model with robust standard errors was used to identify the factors associated with perceived stigma. A p-value < 0.05 was considered significant.
Results
We enrolled 385 participants. Overall, 59.5% (n=229) were male, and 43.4% (n=167) were aged ≥43 years. The prevalence of high TB stigma was 43.1% (n=166) (95% CI: 38.2-48.1%). In adjusted analysis, high TB stigma was significantly more likely among participants with secondary education (aRR: 1.53; 95% CI: 1.14-2.06, p=0.005) as compared to those with no education, those who did not have adequate social support (aRR: 1.36; 95% CI: 1.07-1.72, p=0.01) as compared to those who had. In addition, participants with overall poor knowledge and perception of TB (aRR: 1.72; 95% CI: 1.28-2.30, p < 0.001) had high TB stigma as compared to those with good knowledge of TB.
Conclusions
Perceived stigma is prevalent among TB patients in the Napak district and is strongly associated with having secondary-level education, lack of social support, and having poor knowledge and perception of TB. Interventions must integrate community education to demystify transmission and reduce fear, while strengthening psychosocial support systems to reduce stigma among TB patients.