Tuberculosis (TB) is one of chronic infectious disease which is caused by Mycobacterium tuberculosis and become the leading causes of morbidity and mortality worldwide (1, 2). It is a key public health concern in Ethiopia: in 2009/2010, it was the second most important
cause of death (3). Ethiopia is ranked seventh among the 22 high-burden countries that account for 81% of all cases of TB and 80% of all TB deaths worldwide. According to WHO 2013 global TB control report, Ethiopia ranks 7th among the 22 high burden countries in the world and 2nd in Africa (4). Ethiopia is also one of 27 countries identified as having a high prevalence of multidrug resistant TB (MDR-TB). The burden of MDR-TB in these countries accounts for 86% of cases worldwide (3, 5).
Stigma is typically a social construct, experienced or anticipated that is shaped by
interpersonal attribute and norms of social institution (6,7). Enacted stigma concerns with experience of discriminations by other members of society resulting from social inferiority while perceived or internalized stigma concerns with discrimination resulting from enacted stigma and sense of unworthy and guilty (8,9). The stigmatized individual often internalizes this sense of disvalue and adopts a set of self-regarding attitudes about the marked characteristic including shame, disgust, and guilt (10). These attitudes produce a set of behaviors that include hiding the stigmatized trait, withdrawing from interpersonal relationships, or increasing risky behavior (11, 12). Stigmatization is conceptually distinct from discrimination, another social determinant of health in that the primary goal of discrimination is exclusion, not necessarily for the target to feel ashamed or guilty (13, 14). Stigmatized individuals can, however, suffer discrimination and status loss at the hands of the broader community, whose norms have caused them to be perceived as undesirable (10-15). Stigmatization is a complex process involving institutions, communities, inter- and intra-personal attitudes. While it has been recognized as an important social determinant of health and health disparities, the difficulties in identifying, characterizing, measuring, and tracking changes in stigmatization over time have made it challenging to justify devoting resource intensive interventions to the problem (10-16).
Tuberculosis (TB) is a historically stigmatized disease and the stigma associated with it affects the institution, community and interpersonal factors. Stigma stands as decreasing attribute which arises from social interaction and is related to the power dominance and difference (17). As TB is highly stigmatized disease which can be experienced and felt at different social setting like home, work place and community (18). It has considerable impact on health that render patients to refute disease and medical services through discouraging health seeking behavior which leads to distortion of health condition making difficult to treat that increases infectivity and communicability of the disease (18, 19).
Tuberculosis is known to be a social illness. In addition, tuberculosis is accepted as a stigmatizing disease as well. There are several studies carried out about diagnosis, treatment and prevention strategies of TB, however, few researches focusing on psychosocial outcomes of the disease such as stigmatizing, depression, anxiety, and loneliness (20, 21, 22). This issue is very important for the all health professionals should be aware and can play an important role in the patient’s ability to avoid the psychosocial consequences.
Therefore understanding the stigmatization of TB has importance in reducing the impact on health of patients and medical services provided by the health institution. Little is known about perceived stigma among patients with tuberculosis in Ethiopia and limited
published research which focuses exclusively on patients with tuberculosis in Ethiopia regarding prevalence of perceived stigma. We therefore conducted cross-sectional study on this hospital where outpatient service is provided for patients group in order to estimate the magnitude of stigma perceived by patients and to identify socio-demographic and other factors which might contribute to perceived stigma in this setting.