Background: Tuberculosis is primarily caused by the bacterium known as
Mycobacterium tuberculosis. The transmission routes of tuberculosis include coughing,
talking, and sneezing. Weight loss, fever, and night sweets are the physical symptoms
associated with tuberculosis. Due to the high infection rates, tuberculosis has caused
stigma, especially in the Sub-Saharan African region. According to Floyd et al. (2009 p.
4)’s World Health Organization report, approximately 30% of the 2008 incident
tuberculosis cases occurred in the African continent. Compared to other global regions,
the Floyd et al. (2009 p. 10)’s World Health Organization 2008 report noted that the
tuberculosis mortality and prevalence rates have not declined among the African regions.
This report even stated that the Stop TB Partnership goals may be impossible to achieve
in the African regions due to the low detection rates. Tuberculosis stigma may be a
contributor to the low detection rates.
Objective: The purpose of the study are to a.Research and identify the potential
contributors to 2008 Ghana Demographic and Health Survey participants in selecting the
option to keep a family member’s tuberculosis diagnosis a secret; b. note any gender
differences in attitude and beliefs towards the selected outcome; and c. to give
recommendations for future tuberculosis prevention programs.
Methods: The secondary data analysis was collected from the 2008 Ghana Demographic
and Health Survey. The researchers asked 12,323 households to complete the surveys
throughout the ten regions of Ghana. Out of this number, only 11,778 households agreed
to complete the survey. Household selection was based on the 2000 Ghana census.
Among these households, the survey recorded a total of 4,916 women and 4,568 men.
Only 4184 women and 4141 men answered the tuberculosis question. SAS 9.3 was used
to measure the role of gender, age, region, wealth index, ethnicity, educational
attainment, and household location on selecting the tuberculosis stigma status option. The
tuberculosis stigma status option is defined as whether participants would keep a family
member’s tuberculosis diagnosis a secret or don’t know/ depending on the situation. The
statistical analysis section would include a CMH odds ratios calculations and logistic
regression models. The CMH odds ratio calculations for each exposure variable used a
reference group. A reference group used the lowest number of stigma status events,
except for the ethnicity variable. Due to over-representation, the Akan ethnic group for
both women and men was used as the reference group. Logistic regression was divided
into three parts. The first two parts included a univariate and multivariate logistic
regression model. The third part used an interaction model comparing gender and
regional status with the other exposure variables.
Results: Females from the 2008 Ghana Demographic and Health Survey are more likely
to select the selected outcome compared to males. Females are 1.84 times more likely to
choose the option of keeping a family member’s tuberculosis diagnosis a secret (95%
CI=1.6659-2.0281, p<0.0001). The most notable adjusted CMH odd ratio values was
observed among the secondary exposure variables of regional location, educational
attainment, and the 5 year age groups. Male participants in the 2008 Ghana Demographic
and Health Survey who lived in the Upper West region were 7.3577 times more likely to
2
select the stigma status option compared to female participants (95% CI=4.5096-12.0044,
p<.0001) compared to the Upper East reference group . Women in the Brong Ahafo
region were 6.5803 times more likely to select the stigma status option compared to the
other regions of Ghana (95% CI=4.6332-9.3456, p<0.0001). Women in the incomplete
secondary educational attainment group were 1.98 times more likely to choose the stigma
status option compared to the female reference group higher education. Male and female
participants between the ages of 15 and 19 years old are almost two times more likely to
keep a family member’s tuberculosis diagnosis a secret compared to the other age groups.
The univariate model and multivariable logistic regression model has shown that gender
and regional status had the highest significant association with stigma status. The
interaction model suggested that these two variables served as the main interaction effect.
Conclusion: The findings of 2008 Ghana Demographic Survey has suggested that
women are more likely to choose the stigma status option compared to men. In addition,
high CMH odds ratio values for regional status, educational attainment, and age was
observed. The Brong Ahafo and the Upper West regions had been attributed with poor
tuberculosis funding, stigma, and poverty. These characteristics would result in very low
detection rates. In addition, male and female participants between the ages of 15 and 19
year are more likely to select the stigma status option compared to their designated
reference group. Only the incomplete secondary category of the female educational
attainment group had a notable CMH odds ratio value. In addition to the CMH odds
ratios observation, the univariate and multivariate logistic regression models suggested
that gender and region had a significant association with stigma status. Future
tuberculosis intervention programs in Ghana should target this population at risk. With
these findings, the stigma towards tuberculosis in Ghana is still present. As a
recommendation, more outreach programs such as social clubs should be tested among
the Ghana population