Stigmatization and social discrimination of pulmonary tuberculosis patients in Kotamobagu City, North Sulawesi: A qualitative study

Authors

DOI:

https://doi.org/10.70347/svsthya.v2i1.79

Keywords:

tuberculosis, Stigmatization, discrimination, social construction, qualitative research, Indonesia

Abstract

Tuberculosis (TB) remains a significant public health challenge, particularly in developing countries such as Indonesia. In Kotamobagu city, North Sulawesi, despite being recognized as one of Indonesia's most tolerant cities, patients with TB face persistent stigmatization and discrimination.  This study aimed to examine the social construction of discrimination against TB patients in Kotamobagu city, focusing on how these perceptions develop and persist. This qualitative study employed a constructivist paradigm and utilized Berger and Luckman's social construction theory. Data were collected through in-depth interviews and direct observations of 16 informants, including patients with TB, healthcare workers, family members, neighbors, and colleagues. The analysis was conducted via NVIVO 12 Plus software following a systematic thematic approach. The study revealed complex patterns of stigmatization and discrimination across familial, community, and workplace settings. Network analysis revealed interconnected stigmatization factors, with physical isolation emerging as a primary preventive reaction within families. Social distancing behaviors have been documented in both familial and workplace environments. This research identified multiple pathways through which stigmatization affects patients' lives, including social isolation, psychological impact, and treatment adherence. Fear of transmission has emerged as the primary driver of discriminatory behaviors, leading to various forms of social exclusion and workplace ostracism. TB-related stigma and discrimination in Kotamobagu manifest through complex social mechanisms that significantly affect patients' psychological well-being and treatment outcomes. These findings emphasize the need for comprehensive interventions that address both the structural and interpersonal aspects of stigma, particularly in workplace and family settings.

Downloads

Download data is not yet available.

Author Biographies

Hairil Akbar, Doctoral Program of Sociology, Postgraduate Program, Universitas Negeri Makassar

Doctoral Program of Sociology, Postgraduate Program, Universitas Negeri Makassar

Syamsu A. Kamaruddin, Department of Sociology, Postgraduate Program, Universitas Negeri Makassar

Department of Sociology, Postgraduate Program, Universitas Negeri Makassar

Arlin Adam, Department of Public Health, Faculty of Health, Universitas Mega Buana Palopo

Department of Public Health, Faculty of Health, Universitas Mega Buana Palopo

References

Islam MA, Kundu S, Hanis TM, Hajissa K, Musa KI. A global bibliometric analysis on antibiotic-resistant active pulmonary tuberculosis over the last 25 years (1996–2020). Antibiotics 2022;11:1012. https://doi.org/10.3390/antibiotics11081012.

Sweileh WM, AbuTaha AS, Sawalha AF, Al-Khalil S, Al-Jabi SW, Zyoud SH. Bibliometric analysis of worldwide publications on multi-, extensively, and totally drug – resistant tuberculosis (2006–2015). Multidiscip Respir Med 2016;11:45. https://doi.org/10.1186/s40248-016-0081-0.

Abdullah M, Humayun A, Imran M, Bashir MA, Malik AA. A bibliometric analysis of global research performance on tuberculosis (2011–2020): Time for a global approach to support high-burden countries. J Family Community Med 2022;29:117–24. https://doi.org/10.4103/jfcm.jfcm_112_22.

Shah D, Bhide S, Deshmukh R, Smith JP, Kaiplyawar S, Puri V, et al. Test and treat approach for tuberculosis infection amongst household contacts of drug-susceptible pulmonary tuberculosis, Mumbai, India. Front Tuberc 2024;2:1454277. https://doi.org/10.3389/ftubr.2024.1454277.

Utomo B, Chan CK, Mertaniasih NM, Soedarsono S, Fauziyah S, Sucipto TH, et al. Comparison epidemiology between Tuberculosis and COVID-19 in East Java Province, Indonesia: An analysis of regional surveillance data in 2020. Trop Med Infect Dis 2022;7:83. https://doi.org/10.3390/tropicalmed7060083.

Setyawan MF, Mertaniasih NM, Utomo B, Soedarsono S, Adnyana IMDM, Eljatin DS, et al. An analysis of the trend of incidences and fatality of pulmonary tuberculosis in East Java from 2015-2020: A lesson from COVID-19. Nat J Comm Med 2023;14:308–15. https://doi.org/10.55489/njcm.140520232903.

Alsayed SSR, Gunosewoyo H. Tuberculosis: pathogenesis, current treatment regimens and new drug targets. Int J Mol Sci 2023;24:5202. https://doi.org/10.3390/ijms24065202.

Alavi-Naini R, Sharifi-Mood B, Metanat M. Association between tuberculosis and smoking. Int J High Risk Behav Addict 2012;1:71–4. https://doi.org/10.5812/ijhrba.5215.

Duko B, Bedaso A, Ayano G, Yohannis Z. Perceived stigma and associated factors among patient with tuberculosis, Wolaita Sodo, Ethiopia: Cross-Sectional Study. Tuberc Res Treat 2019;2019:1–5. https://doi.org/10.1155/2019/5917537.

Yin X, Yan S, Tong Y, Peng X, Yang T, Lu Z, et al. Status of tuberculosis‐related stigma and associated factors: a cross‐sectional study in central China. Trop Med Int Health 2018;23:199–205. https://doi.org/10.1111/tmi.13017.

Dinas Kesehatan Provinsi Sulawesi Utara. Profil Kesehatan Provinsi Sulawesi Utara. Sulawesi Utara: 2022.

RSUD Kota Kotamobagu. Profil Kesehatan Rumah Sakit Umum Daerah Kota Kotamobagu. Kotamobagu: 2022.

Tabong PT-N, Akweongo P, Adongo PB. Community beliefs about tuberculosis in Ghana: Implications for the end tuberculosis global agenda. Cogent Med 2021;8:1870069. https://doi.org/10.1080/2331205X.2020.1870069.

Potty RS, Kumarasamy K, Adepu R, Reddy RC, Singarajipura A, Siddappa PB, et al. Community health workers augment the cascade of TB detection to care in urban slums of two metro cities in India. J Glob Health 2021;11:04042. https://doi.org/10.7189/jogh.11.04042.

Dodor EA, Kelly S. ‘We are afraid of them’: Attitudes and behaviours of community members towards tuberculosis in Ghana and implications for TB control efforts. Psychol Health Med 2009;14:170–9. https://doi.org/10.1080/13548500802199753.

Dharma FA. The social construction of reality: Peter L. Berger’s Thoughts about social reality. Kanal J Ilmu Kom 2018;7:1–9. https://doi.org/10.21070/kanal.v6i2.101.

Paulus AY, Sulaeman, Mayasari AC, Ayu JD, Musniati N, Sari MP, et al. Biostatistika Epidemiologi. 1st ed. Bandung: CV. Media Sains Indonesia; 2023.

Adnyana IMDM. Populasi dan Sampel. In: Darwin M, editor. Metode Penelitian Pendekatan Kuantitatif. 1st ed., Bandung: CV. Media Sains Indonesia; 2021, p. 103–16.

Quílez-Robres A, Lozano-Blasco R, Íñiguez-Berrozpe T, Cortés-Pascual A. Social, family, and educational impacts on anxiety and cognitive empathy derived from the COVID-19: study on families with children. Front Psychol 2021;12:562800. https://doi.org/10.3389/fpsyg.2021.562800.

Zhang R, Wang MS, Toubiana M, Greenwood R. Stigma beyond levels: Advancing research on stigmatization. Acad Manag Ann 2021;15:188–222. https://doi.org/10.5465/annals.2019.0031.

Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep 2010;125:34–42. https://doi.org/10.1177/00333549101250S407.

Dutta GK, Rahman MdM, Bhattacharyya DS, Rahman MdM, Dey PK, Nur ME, et al. Social stigmatisation among tuberculosis patients and community people in Bangladesh: an exploratory study. Prev Med Res Rev 2025;2:9–15. https://doi.org/10.4103/PMRR.PMRR_196_24.

Kamble B, Singh S, Jethani S, Chellaiyan D V, Acharya B. Social stigma among tuberculosis patients attending DOTS centers in Delhi. J Family Med Prim Care 2020;9:4223. https://doi.org/10.4103/jfmpc.jfmpc_709_20.

Gupta N, Vedi S, Garg S, Loo E, Li J, Kunimoto DY, et al. Harnessing innate immunity to treat Mycobacterium tuberculosis infections: heat-killed caulobacter crescentus as a novel biotherapeutic. Cells 2023;12:560. https://doi.org/10.3390/cells12040560.

Alsoukhni MA, Khader Y, Abaza H, Wilson N, Satyanarayana S. Tuberculosis-related knowledge, behaviors, stigmatizing attitude, and discrimination among refugees, migrants, and the general population in Jordan. SAGE Open Med 2023;11:20503121231187744. https://doi.org/10.1177/20503121231187743.

Thakur G, Thakur S, Thakur H. Status and challenges for tuberculosis control in India – Stakeholders’ perspective. Indian J Tuberc 2021;68:334–9. https://doi.org/10.1016/j.ijtb.2020.10.001.

Verma R, Moreira FMF, do Prado Morais AO, Walter KS, dos Santos PCP, Kim E, et al. Detection of M. tuberculosis in the environment as a tool for identifying high-risk locations for tuberculosis transmission. Sci Total Environ 2022;843:156970. https://doi.org/10.1016/j.scitotenv.2022.156970.

Li Q, Wang F. An epidemiological model for tuberculosis considering environmental transmission and reinfection. Math 2023;11:2423. https://doi.org/10.3390/math11112423.

Padmanabhan N, S. P. A study to assess the stigma related to tuberculosis among directly observed treatment short-course (DOTS) providers and patients on DOTS therapy attending DOTS centres of Mandya City, Karnataka, India. Int J Community Med Public Health 2016:2817–24. https://doi.org/10.18203/2394-6040.ijcmph20163367.

Dea D, Karo MB, Wati PK. Exploring the Impact of meditation therapy on CD4 levels in HIV/AIDS patients at Karawang Hospital. Svāsthya: Trends in General Medicine and Public Health 2024;1:e20. https://doi.org/10.70347/svsthya.v1i2.20.

Amo-Adjei J. Individual, household and community level factors associated with keeping tuberculosis status secret in Ghana. BMC Public Health 2016;16:1196. https://doi.org/10.1186/s12889-016-3842-y.

Rodat S. Approaches to stigmatization: process, forms and consequences. Limba Și Literatura–Repere Identitare În … 2020:219–27. https://www.ceeol.com/search/article-detail?id=967235.

Suwankeeree W, Picheansathian W. Strategies to promote adherence to treatment by pulmonary tuberculosis patients. Int J Evid Based Healthc 2014;12:3–16. https://doi.org/10.1097/01.XEB.0000444614.17658.46.

Chaychoowong K, Watson R, Barrett DI. Perceptions of stigma among pulmonary tuberculosis patients in Thailand, and the links to delays in accessing healthcare. J Infect Prev 2023;24:77–82. https://doi.org/10.1177/17571774231152720.

Polat H, Turan GB, Tan M. Determining the relationship between stigmatization and social support in tuberculosis patients. J Clin Tuberc Other Mycobact Dis 2024;37:100502. https://doi.org/10.1016/j.jctube.2024.100502.

Ashaba C, Musoke D, Tsebeni Wafula S, Konde-Lule J. Stigma among tuberculosis patients and associated factors in urban slum populations in Uganda. Afr Health Sci 2021;21:1640–50. https://doi.org/10.4314/ahs.v21i4.18.

Oladele DA, Idigbe IE, Ekama SO, Gbajabiamila T, Ohihoin AG, David AN, et al. “Their place is beyond the town’s border”: A qualitative exploration of stigma associated with tuberculosis in rural and urban areas of Lagos, Nigeria. Health Soc Care Community 2021;29:1789–98. https://doi.org/10.1111/hsc.13287.

Fibbi R, Midtbøen AH, Simon P. Concepts of Discrimination. IMISCOE Research Series. 1st ed., Cham: Sp; 2021, p. 13–20. https://doi.org/10.1007/978-3-030-67281-2_2.

Dodor EA, Neal K, Kelly S. An exploration of the causes of tuberculosis stigma in an urban district in Ghana. Int J Tuberc Lung D 2008;12:1048–54.

Chen X, Xu J, Chen Y, Wu R, Ji H, Pan Y, et al. The relationship among social support, experienced stigma, psychological distress, and quality of life among tuberculosis patients in China. Sci Rep 2021;11:24236. https://doi.org/10.1038/s41598-021-03811-w.

Fadele A, Aina-Pelemo A. Overcoming Discrimination on Grounds of Race, Disability, Gender, LGBTQIA in Nigeria: Role of Constitutions. SSRN Electronic Journal 2023. https://doi.org/10.2139/ssrn.4652160.

Adnyana IMDM. Mpox, STIs, and HIV in the LGBTQIA2S+ community: What can be learned from bibliometric analysis? Research Square 2023:1–28. https://doi.org/10.21203/rs.3.rs-3666062/v1.

Juliasih NN, Sakinah LF, Sari RM, Winarso H, Siahaan SCPT, Gunawan EJ. Determinants of transmission prevention behavior among Tuberculosis patients in Surabaya, Indonesia. Infect Prev Pract 2024;6:100404. https://doi.org/10.1016/j.infpip.2024.100404.

Craciun OM, Torres M del R, Llanes AB, Romay-Barja M. Tuberculosis knowledge, attitudes, and practice in middle- and low-income countries: a systematic review. J Trop Med 2023;2023:1–15. https://doi.org/10.1155/2023/1014666.

Shah HD, Nazli Khatib M, Syed ZQ, Gaidhane AM, Yasobant S, Narkhede K, et al. Gaps and interventions across the diagnostic care cascade of tb patients at the level of patient, community and health system: A qualitative review of the literature. Trop Med Infect Dis 2022;7:136. https://doi.org/10.3390/tropicalmed7070136.

Dhingra VK, Khan S. A sociological study on stigma among TB patients in Delhi. Indian J Tuberc 2010;57:12–8.

Abbas Ali M, Gupta V, Divakar Addanki RN, Mannava AS, Parashar KD. A cross-sectional study to assess stigma associated with tuberculosis in patients, family members, and health care staff in central India. Indian J Tuberc 2024;71:S237–44. https://doi.org/10.1016/j.ijtb.2024.04.001.

Ball E, Steffens MC, Niedlich C. Racism in Europe: Characteristics and intersections with other social categories. Front Psychol 2022;13:789661. https://doi.org/10.3389/fpsyg.2022.789661.

Ashaba C, Musoke D, Tsebeni Wafula S, Konde-Lule J. Stigma among tuberculosis patients and associated factors in urban slum populations in Uganda. Afr Health Sci 2021;21:1640–50. https://doi.org/10.4314/ahs.v21i4.18.

Brown S. Visibility or Impact? International efforts to defend LGBTQI+ rights in Africa. J Hum Rights Pract 2023;15:506–22. https://doi.org/10.1093/jhuman/huad006.

Sukumani JT, Lebese RT, Khoza LB, Risenga PR. Experiences of family members caring for tuberculosis patients at home at Vhembe district of the Limpopo Province. Curationis 2012;35:1–8. https://doi.org/10.4102/curationis.v35i1.54.

Mainga T, Gondwe M, Stewart RC, Mactaggart I, Shanaube K, Ayles H, et al. Conceptualization, detection, and management of psychological distress and mental health conditions among people with tuberculosis in Zambia: a qualitative study with stakeholders’ and TB health workers. Int J Ment Health Syst 2022;16:34. https://doi.org/10.1186/s13033-022-00542-x.

Abubakar JD, Mohammed A, Danimoh AM, Bashorun TA, Okeke L IW. Treatment outcomes of tuberculosis and human immunodeficiency virus co-infection among patients attending DOTS Centre at Specialist Hospital Gombe, North Eastern Nigeria. Jewel J Med Sci 2020;1:158–65. https://doi.org/10.5281/zenodo.5576819.

Downloads

Published

2024-12-28

How to Cite

Akbar, H., Kamaruddin, S. A., & Adam, A. (2024). Stigmatization and social discrimination of pulmonary tuberculosis patients in Kotamobagu City, North Sulawesi: A qualitative study. Svāsthya: Trends in General Medicine and Public Health, 2(1), e79. https://doi.org/10.70347/svsthya.v2i1.79

Issue

Section

Original Articles