Stigma and misinformation about TB are still major barriers to TB screening and treatment in some countries, the 36th International Conference on Lung Health heard last week in Paris. Without dispelling some of the myths about TB and its treatment, national programmes are unlikely to identify people with latent infection because many do not consider themselves to be at risk, and so the chances of catching people before they reach the infectious stage of active, smear-positive TB are lessened. This in turn prevents a country from containing its TGB epidemic.
The Churches Health Association of Zambia (CHAZ), an interdenominational umbrella for church and community-based health care, provides 30% of health services in Zambia, and approaching half of all health care in rural areas. The organisation wanted to find out how popular beliefs about TB affected the uptake of screening and treatment, and how these could be addressed in a national education programme.
Focus group research revealed a range of misconceptions about TB that may contribute to the poor uptake of TB treatment and screening:
- `TB is incurable`
- `TB causes impotence`
- `TB can be contracted by sharing eating utensils`
- `TB=AIDS, so all TB patients have AIDS and so will die`
- `TB treatment kills`
- `TB is contracted by having penetrative sex with, or eating food that has been prepared by, a woman who has just given birth, is menstruating or has recently miscarried`
- `Extramarital sexual activities of either parent can cause TB in offspring`.
A comparison between Zambia and South Africa showed a widespread tendency to blame others for the introduction of TB into a community, with women especially vulnerable to blame in Zambia.
Popular myths about TB emphasised the contribution of dusty, polluted air to the onset of TB, as well as drinking and smoking, environmental factors such as poor housing, cold weather and wet weather, but respondents generally did not recognise the enormous role of crowded places such as bars, buses and other poorly ventilated places in spreading TB.
A national radio and TV campaign was developed in collaboration with Zambian National Broadcasting to correct misconceptions about TB. The campaign resulted in a substantial increase in TB screening and DOTS acceptance at CHAZ health facilities in Zambia. The number of people who underwent screening rose from 2000 in the last quarter of 2004 to 11,000 in the second quarter of 2005, while DOTS uptake rose from 1750 in the last quarter of 2004 to 3000 in the third quarter of 2005.
Tamba L, Sichinga K. Scale up tuberculosis control: development of information, education and communication materials for behaviour change. Int J Tuberculosis Lung Dis 9(11 sup 1): S138, 2005.
Bond V et al. Rapid assessment of popular knowledge about TB in 24 communities in Zambia and South Africa within a community randomozed clinical control trial. Int J Tuberculosis Lung Dis 9(11 sup 1): S142, 2005.