Tackling tuberculosis patients' internalized social stigma through patient centred care: an intervention study in rural Nicaragua

Macq, Jean; Solis, Alejandro; Martinez, Guillermo; Martiny, Patrick
January 2008
BMC Public Health;2008, Vol. 8 Issue 1, p154
Academic Journal
Background: We report a patient-centered intervention study in 9 municipalities of rural Nicaragua aiming at a reduction of internalized social stigma in new AFB positive tuberculosis (TB) patients diagnosed between March 2004 and July 2005. Methods: Five out of 9 municipal teams were coached to tailor and introduce patient-centered package. New TB patients were assigned to the intervention group when diagnosed in municipalities implementing effectively at least TB clubs and home visits. We compared the changes in internalized stigma and TB treatment outcome in intervention and control groups. The internalized stigma was measured through score computed at 15 days and at 2 months of treatment. The treatment results were evaluated through classical TB program indicators. In all municipalities, we emphasized process monitoring to capture contextual factors that could influence package implementation, including stakeholders. Results: TB clubs and home visits were effectively implemented in 2 municipalities after June 2004 and in 3 municipalities after January 2005. Therefore, 122 patients were included in the intervention group and 146 in the control group. After 15 days, internalized stigma scores were equivalent in both groups. After 2 months, difference between scores was statistically significant, revealing a decreased internalized stigma in the intervention group and not in the control group. Conclusion: This study provides initial evidences that it is possible to act on TB patients' internalized stigma, in contexts where at least patient centered home visits and TB clubs are successfully implemented. This is important as, indeed, TB care should also focus on the TB patient's wellbeing and not solely on TB epidemics control.


Related Articles

  • TB cases on the rise in Trinidad.  // Caribbean Health;Oct2000, Vol. 3 Issue 3, p6 

    The article focuses on the concern of health service managers concerning the rise of tuberculosis (TB) cases among the prison population in Trinidad and Tobago. The North-West Regional Health Authority, which manages government-run hospitals in the country say their has been an apparent increase...

  • TB prevalence down 30% in China after DOTS.  // Bulletin of the World Health Organization;Sep2004, Vol. 82 Issue 9, p716 

    Cites a study showing the decline of the prevalence of tuberculosis in China after the implementation of the directly observed therapy, short-course (DOTS) control strategy. Estimated number of at risk population receiving the treatment program; Need to improve the detection rate of tuberculosis.

  • Health services performance for TB treatment in Brazil: a cross-sectional study.  // BMC Health Services Research;2011, Vol. 11 Issue 1, p241 

    The article presents a study on health services performance for tuberculosis (TB) treatment in Brazil. This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil. It was found that two types of obstacles are faced for health service...

  • Use of interferon gamma-based assay to diagnose tuberculosis infection in health care workers after short term exposure. Storla, Dag Gundersen; Kristiansen, Ingun; Oftung, Fredrik; Korsvold, Gro Ellen; Gaupset, Monica; Gran, Gerd; Øverby, Anne Kristin; Dyrhol-Riise, Anne Margarita; Bjune, Gunnar Aksel // BMC Infectious Diseases;2009, Vol. 9 Issue 1, Special section p1 

    Background: We intended to assess the risk for health care workers (HCWs) of acquiring M. tuberculosis infection after exposure to patients with sputum-smear positive pulmonary tuberculosis at three University Hospitals (Ullevål, Akershus, and Haukeland) in Norway. Methods: We tested 155...

  • Correspondence. Shoeb, Marwa; de Castilla, Diego Lopez; Pottinger, Paul // Tropical Doctor;Apr2011, Vol. 41 Issue 2, p63 

    Alam Sehat Lestari (ASRI), an Indonesian-American, non-profit organization located on the border of Gunung Palung National Park in west Kalimantan on the island of Borneo, is linking the delivery of health care to the conservation of natural resources. The clinic's experience shows that an...

  • Survey of the Health Facilities Available for Handling Cases of Tuberculosis in the Rural Areas Around Sokoto Metropolis. Garba, H. S.; Zagga, A. D. // Trends in Medical Research;2007, Vol. 2 Issue 4, p199 

    A survey of health facilities available for handling cases of tuberculosis within rural communities around Sokoto metropolis was carried out in the year 2006. A structured questionnaire was designed for the variables and administered to 13 health centers comprising; two dispensaries, four...

  • Factors contributing to the cause of a community outbreak of tuberculosis. Doyle, Y. G.; Graves, P.; Rayner, C.; Gerada, C.; Wakefield, D. // Journal of Public Health;Jun2004, Vol. 26 Issue 2, p193 

    The diagnosis of pulmonary tuberculosis (TB) in a nursery teacher led to a total of 282 adults and children being screened for TB, and 67 of these contracted the condition. Latent and active factors mitigated against earlier diagnosis of the disease during the multiple contacts by the teacher...

  • Clinico-social profile and care seeking behaviour of adult tubercular patients : a cross sectional study. Garg, Ankit Kumar // New Indian Journal of Surgery;Oct2011, Vol. 2 Issue 4, p220 

    India is the highest tuberculosis (TB) burden country in the world and accounts for nearly one fifth of the global burden of tuberculosis, two-third of the cases in South East Asian Region. Every year approximately 1.8 million person develop tuberculosis of which about 0.8 million are new smear...

  • Tuberculosis Associated With Blocking Agents Against Tumor Necrosis Factor-Alpha—California, 2002-2003.  // JAMA: Journal of the American Medical Association;10/13/2004, Vol. 292 Issue 14, p1676 

    Presents a report that summarizes several cases of tuberculosis and provides interim recommendations for tuberculosis prevention and management in recipients of these blocking agents. Description of the cases; Assertion that health care providers should take steps to prevent tuberculosis in...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics