Attitude and social consequences of tuberculosis in Addis Ababa, Ethiopia.

OBJECTIVE To gain a better understanding of the attitude and social consequences of tuberculosis (TB) in Addis Ababa, Ethiopia. DESIGN A cross sectional survey using a structured questionnaire and a qualitative study based on the focus group discussion (FGD) technique. SETTING Eight different kebeles (urban dwellers' associations) of six woredas (next higher administrative level to kebele). SUBJECTS AND METHODS Seven hundred and three participants, comprising 326 males and 377 females were interviewed using the written questionnaire and 36 recent and current TB patients through focus group discussion. Data were analysed using SPSS/PC statistical package. The proportions were compared using univariate and bivariate analyses to show the frequency distribution and evaluate the relationship among different variables. In FGD, topics relevant to the research questions were identified, sorted and analysed. Conclusions were then formulated. MAIN OUTCOME MEASURES Attitude of participants towards TB and its victims and social consequences of being a TB patient. RESULTS Eighty three per cent of the respondents were aware that TB is a disease transmitted from one person to another and 80.1% perceived TB as an extremely severe disease. Of the total, 81.5% answered that TB is caused by cold, 69.0% feel that TB patients are not accepted in the community and 78.3% fear physical contact with TB patients. Most participants of the FGD sessions agreed that TB is a very dangerous, contagious but curable disease and the community has a generally negative attitude towards them. They also think that TB is associated with HIV/AIDS in the society. These attitudes have social consequences particularly the stigmatization and social isolation of TB patients. Four hundred and four (57.5%) respondents were found to be in favour of the short course chemotherapy against 226 (32.1%) choosing the longer course. Clinical improvement and unavailability of some drugs or their cost were the first and second main reasons indicated, respectively, for defaulting by respondents. CONCLUSION The perception by most respondents that tuberculosis is incurable, transmittable and associated with HIV/AIDS, led to the understanding that TB is a very dangerous disease. This, in turn, contributes to social avoidance and the resultant consequences in TB patients. Health education must be stepped-up within the TB control programme, and the psychosocial implications of TB should be given due attention.