Date of Award

Spring 5-16-2014

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Lisa Casanova

Second Advisor

Dr. Richard Rothenberg

Abstract

Background: Tuberculosis is primarily caused by the bacterium known as Mycobacterium tuberculosis. The transmission routes of tuberculosis include coughing, talking, and sneezing. Weight loss, fever, and night sweets are the physical symptoms associated with tuberculosis. Due to the high infection rates, tuberculosis has caused stigma, especially in the Sub-Saharan African region. According to Floyd et al. (2009 p. 4)’s World Health Organization report, approximately 30% of the 2008 incident tuberculosis cases occurred in the African continent. Compared to other global regions, the Floyd et al. (2009 p. 10)’s World Health Organization 2008 report noted that the tuberculosis mortality and prevalence rates have not declined among the African regions. This report even stated that the Stop TB Partnership goals may be impossible to achieve in the African regions due to the low detection rates. Tuberculosis stigma may be a contributor to the low detection rates.

Objective: The purpose of the study are to a.Research and identify the potential contributors to 2008 Ghana Demographic and Health Survey participants in selecting the option to keep a family member’s tuberculosis diagnosis a secret; b. note any gender differences in attitude and beliefs towards the selected outcome; and c. to give recommendations for future tuberculosis prevention programs.

Methods: The secondary data analysis was collected from the 2008 Ghana Demographic and Health Survey. The researchers asked 12,323 households to complete the surveys throughout the ten regions of Ghana. Out of this number, only 11,778 households agreed to complete the survey. Household selection was based on the 2000 Ghana census. Among these households, the survey recorded a total of 4,916 women and 4,568 men. Only 4184 women and 4141 men answered the tuberculosis question. SAS 9.3 was used to measure the role of gender, age, region, wealth index, ethnicity, educational attainment, and household location on selecting the tuberculosis stigma status option. The tuberculosis stigma status option is defined as whether participants would keep a family member’s tuberculosis diagnosis a secret or don’t know/ depending on the situation. The statistical analysis section would include a CMH odds ratios calculations and logistic regression models. The CMH odds ratio calculations for each exposure variable used a reference group. A reference group used the lowest number of stigma status events, except for the ethnicity variable. Due to over-representation, the Akan ethnic group for both women and men was used as the reference group. Logistic regression was divided into three parts. The first two parts included a univariate and multivariate logistic regression model. The third part used an interaction model comparing gender and regional status with the other exposure variables.

Results: Females from the 2008 Ghana Demographic and Health Survey are more likely to select the selected outcome compared to males. Females are 1.84 times more likely to choose the option of keeping a family member’s tuberculosis diagnosis a secret (95% CI=1.6659-2.0281, p

Conclusion: The findings of 2008 Ghana Demographic Survey has suggested that women are more likely to choose the stigma status option compared to men. In addition, high CMH odds ratio values for regional status, educational attainment, and age was observed. The Brong Ahafo and the Upper West regions had been attributed with poor tuberculosis funding, stigma, and poverty. These characteristics would result in very low detection rates. In addition, male and female participants between the ages of 15 and 19 year are more likely to select the stigma status option compared to their designated reference group. Only the incomplete secondary category of the female educational attainment group had a notable CMH odds ratio value. In addition to the CMH odds ratios observation, the univariate and multivariate logistic regression models suggested that gender and region had a significant association with stigma status. Future tuberculosis intervention programs in Ghana should target this population at risk. With these findings, the stigma towards tuberculosis in Ghana is still present. As a recommendation, more outreach programs such as social clubs should be tested among the Ghana population

Available for download on Tuesday, May 05, 2015

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