My essay conveys the various myths regarding tuberculosis that prevail in society and how the stigma which arises in part due to these beliefs prevents timely intervention which increases disease burden as a result of being caught up in this vicious cycle and what measures can be taken to curb them.
Growing up, ever since my childhood I have heard about Tuberculosis (TB) being one of the most prevalent and dreaded diseases in our society. Entering into the medical field, as a student, shed some more light on the magnitude of active TB cases, that too, in just a small part of a district in the state of Kerala in the southern part of India. Curiosity getting the better of me has prompted me several times in the past to look into stories regarding myths about TB partly which I have heard about and the others from the internet. The most horrifying story that I came across though, was that of a toddler whose condition eventually got very serious owing to close contact with relatives, who due to the social stigma associated with TB refused to disclose their condition with their loved ones, which inadvertently lead to transmission of infection to this one-year-old kid. Hence, in this article, I would like to discuss some of the myths surrounding this disease and measures that can be taken to break society from its clutches.
One of the most common myths regarding TB is that it is hereditary, and is passed down from parents to children but may have caused a misunderstanding in society, as the bacteria can easily transmit to other household members who have been in close contact with patients for an extended period since it is spread through droplets. Though studies have shown that certain genes may affect the susceptibility of a patient to change from latent infection to an active infection. Another accepted belief is that all TB patients are infectious, when in truth not every TB patient is symptomatic. Latent cases, asymptomatic patients, and those who come in contact with people after 2-3 weeks of treatment are not infectious. A few other convictions that has gripped society include A) TB does not have a cure, B) TB can affect only the lungs, C) TB can spread through shaking hands, kissing, sharing food and utensils, etc., D) If acquired, it is always symptomatic, E) smoking is one of the main risk factors for TB, F) TB is only prevalent in developing countries and low-income societies, G) vaccination provides lifelong immunity, H) if one has acquired TB once, then that person is safe from subsequent infection, I) if a patient coughs, then a passerby can easily get infected, etc. [1,2]
The consequence of these myths results in a hazard that is none other than stigmatization of affected patients in society, which can be attributed mainly to the anticipated risk of transmission to the vulnerable population. It is also associated with HIV, poverty, low social class, and malnutrition, in certain geographic areas. It has been shown to affect women and poor or less educated members in certain societies, more so than others, which in turn increases the impact of health inequalities that these members are already at risk for. Other documented psychosocial concerns that patients face include isolation from society, decreased marriage prospects, divorce, depression, anxiety, negative emotional states, improper knowledge and awareness of the disease and its treatment, lack of social support, and financial crises, which leads to non-adherence to treatment and in turn gives rise to cases of latent TB, drug-resistant TB, multidrug-resistant TB, etc., thereby making the concept of eradication completely invincible.
One of the main methods to curb such stigma is to bust these myths, which would to be address these issues right at the root of the problem, by providing adequate information and counseling. National TB programs exist in all countries where TB is currently prevalent, but for it to be successful, people need to be made aware of firstly the signs and symptoms of TB including low-grade fever along with evening rise of temperature, night sweats, weight loss, loss of appetite, and other symptoms like cough, sputum, and hemoptysis in case of pulmonary TB, and other symptoms like fever, neck lumps, pus collection (cold abscess) in case of extrapulmonary TB, and symptoms which include cough, breathlessness and pleuritic chest pain in case of pleural TB, etc. Since awareness increases the probability of people seeking early treatment thereby decreasing transmission and support in the form of counseling makes them feel less isolated and hence enables adherence to the treatment regime. Programs should be able to provide information regarding TB transmission, control, and risks of non-adherence, and expressed in a form that is easily understood by the public. Tuberculosis community programs can also increase expenses allotted to qualitative studies to identify the key factors which enable such misconceptions to thrive in societies and refine them into policy-level interventions that can be put into action.[4,5]
3) Tola H, Shojaeizadeh D, Garmaroudi G et al. Psychological distress and its effect on tuberculosis treatment outcomes in Ethiopia. Glob Health Action. 2015;8(1):29019. doi:10.3402/gha.v8.29019
4) Naidoo S, Seevnarain K, Nordstrom D. Tuberculosis infection control in primary health clinics in eThekwini, KwaZulu-Natal, South Africa. The International Journal of Tuberculosis and Lung Disease. 2012;16(12):1600-1604. doi:10.5588/ijtld.12.0041
5) Musuka G, Teveredzi V, Mutenherwa F, Chingombe I, Mapingure M. Tuberculosis knowledge, misconceptions/myths in adults: findings from Lesotho, Malawi, Namibia and Zambia Demographic Health Surveys (2013–2016). BMC Res Notes. 2018;11(1). doi:10.1186/s13104-018-3884-6