Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana

Peter Kipo Leta; Dacosta Awuah Aboagye; Jonathan Mawutor Gmanyami; Richmond Bediako Nsiah; Rachael Georgina Antwi Boasiako; Khadijatu Adiss Yusif; Oscar Lambert; Mercy Negble; Obed Atsu-Ofori; Foster Bediako Gbafu; Mavis Vikpedomo Baalasuuri; John Humphrey Amuasi; Paulina Clara Appiah; Dominic Nyarko; Frank Prempeh; Margaret Morrison; Theodora Konadu Owusu Amponsah; Amponsah Kinsley Osei; Victor Jamoni

doi:doi:10.11648/j.sjph.20251305.12

Research Article |

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Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana

Peter Kipo Leta

, Dacosta Awuah Aboagye

, Jonathan Mawutor Gmanyami

, Richmond Bediako Nsiah^*

, Rachael Georgina Antwi Boasiako

, Khadijatu Adiss Yusif

, Oscar Lambert

, Mercy Negble

, Obed Atsu-Ofori

, Foster Bediako Gbafu

, Mavis Vikpedomo Baalasuuri

, John Humphrey Amuasi

, Paulina Clara Appiah

, Dominic Nyarko

, Frank Prempeh

, Margaret Morrison

, Theodora Konadu Owusu Amponsah

, Amponsah Kinsley Osei

, Victor Jamoni

Published in Science Journal of Public Health (Volume 13, Issue 5)

Received: 16 August 2025 Accepted: 28 August 2025 Published: 19 September 2025

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Abstract

Background: Tuberculosis (TB) continues to be a significant public health issue in Ghana, and stigma and compromised community support are intrinsic barriers to successful treatment, diagnosis, and control. Knowledge of community attitudes and sociodemographic factors that influence stigma is crucial for developing targeted interventions in Nkoranza South Municipality. Methods: This was a cross-sectional study that included 245 randomly selected TB patients aged 18 and older who were currently receiving or had completed treatment between 2016 and 2020 in the Nkoranza South Municipality. Data were collected using a semi-structured questionnaire, administered through the home and healthcare facility by trained enumerators. Using SPSS version 26, Fisher’s Exact Test was used to examine association, and logistic regression was used to assess the impact of socio-demographic factors on stigma and support. Frequencies were used to explore suggestions for reducing stigma and improving TB care, with a statistical significance set at p<0.05. Results: The study revealed that 71.4% of TB patients interviewed reported avoidance by the community. About 17% felt rejected, and only 12% felt accepted by the members of their communities. About 64% reported a lack of support, and 68.2% reported experiencing stigma. TB patients aged 20-39 years had higher odds of experiencing a lack of support (aOR = 3.15, 95% CI: 1.35-7.39, p = 0.008). Respondents practicing other religions, unlike Christianity, had lower odds of stigmatization (aOR = 0.08, 95% CI: 0.01-0.53, p = 0.010) and lack of support (aOR = 0.10, 95% CI: 0.02-0.68, p = 0.019) compared to those practising traditional religion. Ethnic groups such as the Dagaari had lower odds of experiencing stigmatizations (aOR = 0.10, 95% CI: 0.02-0.44, p = 0.002) and lack of support (aOR = 0.19, 95% CI: 0.05-0.74, p = 0.016). Educational level was not significantly associated with stigma or support. TB patients suggested community education, TB awareness creation, and improved staff professionalism as crucial steps to reduce stigma and enhance TB care. Conclusion: TB stigma and support gaps are prevalent in Nkoranza South Municipality, with predominant influences of age, occupation, religion, and ethnicity. The challenges need culturally adapted public health education, improved healthcare professionalism, and sustained community mobilization to optimize the TB outcome and combat stigma. Future studies should investigate whether community-based education and advocacy interventions can reduce stigma associated with TB and increase long-term support for patients.

Published in	Science Journal of Public Health (Volume 13, Issue 5)
DOI	10.11648/j.sjph.20251305.12
Page(s)	257-268
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Tuberculosis, Stigma, Community Support, Sociodemographic Factors, Nkoranza South Municipality

1. Background

Tuberculosis (TB) remains a significant public health threat globally, according to the World Health Organization

[1]

Desanto et al., 2023). Globally, it was estimated that 10 million individuals got infected with and 1.5 million died due to TB in 2021 alone

[3, 4]

. TB is preventable as well as curable, but at present, it remains unacceptably high in low- and middle-income countries such as Ghana, where there are deficiencies in healthcare systems in terms of early diagnosis, access to care, and patient retention in care

[5]

In addition to medical and logistical issues, psychosocial issues like stigma and social exclusion also severely undermine TB control. Stigma associated with TB is complex, and often it relies on disease transmission myths, linkage with HIV/AIDS, and the perception that TB is caused by indecent conduct or personal failure

[6, 7]

. These attitudes foster fear, discrimination, and stigmatization, not just by the public but even by the family and medical practitioners themselves at times

[8, 9]

. Therefore, TB patients will deny care, likely abandon treatment, or hide their diagnosis, all leading to continued transmission and poor results

[10]

In Ghana, some studies

[4, 5]

have established the existence of stigmatizing attitudes towards TB patients, particularly among rural and semi-urban populations. Stigmatization and rejection of TB patients are governed by fear of infection, religious explanations of illness, and social misconceptions. Regardless of national efforts to create awareness and eliminate stigma, such attitudes continue to exist. Additionally, social support, a most critical variable in the improvement of treatment compliance and emotional well-being, is usually absent, adding another layer of complexity to the lives of TB patients.

Stigma and social support are not universally experienced by all groups

[11]

. Different studies have characterized sociodemographic variables like age, gender, education, religion, and occupation as the most critical determinants of experiencing and managing TB-related stigma

[8, 10]

. For instance, youngsters might be ostracized by others, whereas elderly people might receive more respect from society. Religious and cultural systems can also come between in how they influence explanations of illness as well as the level of support or rejection accorded a patient

[12, 13]

Even as there has been increased consciousness of such dynamics, few context-specific studies have explored the way such drivers shape stigma and support at the level of the community in Ghana and, more specifically, in rural areas such as Nkoranza South. The majority of research is conducted with urban dwellers or is too broad to guide focused intervention at the local level. Situational awareness is critical to the development of suitable, culturally appropriate strategies for stigma mitigation and patient support.

The purpose of this research is to examine community perceptions of TB patients and analyze sociodemographic determinants of stigma and support within Ghana's Nkoranza South Municipality. Findings will be used in the design of community-based, culturally appropriate public health interventions that, in addition to countering myths, create supportive communities that enable early detection, treatment compliance, and long-term cure.

2. Methodology

2.1. Study Population, Inclusion and Exclusion Criteria

The study population consisted of TB patients aged 18 years and above who were either currently receiving treatment or had received treatment between 2016 and 2020 and were residents of the Nkoranza South Municipality. Participants were clinically diagnosed with TB in the required age bracket and either actively undergoing or had completed treatment within the specified timeframe. TB patients who were severely ill, TB respondents or those who refused to participate were excluded from this study.

2.2. Sample Size Estimate

In this study, we use Cochran's formula to estimate the sample size, assuming a 95% confidence level (Z = 1.96), a 5% margin of error, and an estimated TB prevalence rate of 18.6%

[14]

. The sample size was calculated to be 233 respondents. A 5% non-response rate was calculated, resulting in an adjusted final sample size of approximately 245 respondents.

2.3. Sampling Method

A probability sampling technique, specifically simple random sampling, was used to select participants for this study. We assigned unique numbers to all registered TB participants in the TB register. We entered all the numbers into Microsoft Excel version 16. A random numbers formula was used to generate 245 random numbers from the Municipal TB register in the Nkoranza South Municipality. All eligible TB patients in the Municipal TB register were considered. The random selection ensured each individual had an equal chance of being included in the study.

2.4. Data Collection Tools and Techniques

A semi-structured questionnaire with open and closed-ended questions was used to capture respondents’ socio-demographic data and experiences regarding stigma, support and the attitude faced in the community by TB patients. We pre-tested the questionnaire on a group of 10 TB patients who shared similar characteristics but were not part of the final sample. The pre-test was carried out to assess the clarity and relevance of the questions. Following the pre-test, the questionnaire was reviewed and refined to ensure its accuracy and appropriateness for the study objectives. We carried out the data collection through follow-up visits to participants’ homes and healthcare facilities in the Nkoranza South Municipality. During these visits, trained research assistants administered the questionnaire in the face-to-face interview format, ensuring participants’ understanding of the questions and enabling them to freely respond. All participants were provided with informed consent before participation, ensuring ethical standards were maintained throughout the data collection process.

2.5. Data Cleaning and Management, and Data Analysis

The data collected were entered into an Epi Info version 7. Validation checks were performed to identify inconsistencies and missing data. Missing data were addressed through participants' follow-ups. Consistency checks were applied across variables before being securely stored on password-protected devices, with a backup copy created to prevent loss. Preceding the cleaning and validation, the final dataset was exported into SPSS version 20 for statistical analysis.

The data for this study were analyzed using descriptive and inferential statistics to examine factors influencing stigmatization and lack of support among TB patients. Community attitudes towards TB patients were explored using frequencies and proportions, and were presented in a bar chart. Descriptive statistics summarized respondents' demographics and the prevalence of community attitudes towards TB patients, stigmatization and support and were presented with bar charts. We used Fisher’s Exact Test to assess the association between respondents' socio-demographics and stigmatization and support for TB patients. The data used in this study violated the Chi-Square rule, which requires expected cell counts to be less than 5; therefore, Fisher’s Exact Test was used. Logistics regression was used to assess the impact of socio-demographic variables on stigmatization and the lack of support faced by TB patients. All predictor variables that showed statistical significance in Fisher’s Exact test were included in the bivariate logistic regression. Statistically significant predictor variables identified in the bivariate regression analysis were included in the multivariate logistic regression to control for confounding factors. Only the adjusted odds ratios were used for discussion, as they account for potential confounding factors, and 95% confidence intervals (CI) and p-values were reported to assess the statistical significance of the results. We used frequencies to explore TB patients’ suggestions for reducing stigma and improving TB case detection. All bivariate and multivariate analyses were set at a statistical significance of p < 0.05. All descriptive and inferential statistics were done using SPSS version 20.

Table 1. Sociodemographic Characteristics of TB Patients in the Study (n = 245).

Variables	Frequency (n=245)	Percent
Age Level
<20 yrs	10	4.1
20 – 39 yrs	137	55.9
40 – 59 yrs	59	24.1
60 yrs and above	39	15.9
Sex
male	174	71.0
female	71	29.0
Educational level
Middle / JHS	52	21.2
No formal education	52	21.2
Primary	33	13.5
SHS/Vocational	71	29.0
Tertiary	37	15.1
Occupation
Civil servant	33	13.5
Farmer	85	34.7
Other	56	22.9
Trader	71	29.0
Religion
Christianity	201	82.0
Others	35	14.3
Traditional	9	3.7
Ethnicity
Bono	165	67.3
Dagaari	33	13.5
Dagomba	20	8.2
Mamprusi	8	3.3
Others	19	7.8
Marital status
Cohabitation	17	6.9
Divorced	7	2.9
Married	155	63.3
Single	55	22.4
Widowed	11	4.5

3. Result

3.1. Socio-demographic Characteristics

Table 1 presents the socio-demographic characteristics of the study respondents (n = 245). The majority of respondents were aged 20-39 years (55.9%), with a larger proportion of males (71%) compared to females (29%). Most respondents had either a Senior High School/Vocational qualification or had no formal education (21.2%). The most common occupations were farming (34.7%) and trading (29%). Christianity is the dominant religion (82%), and the Bono make up the largest proportion (67.3%). Most respondents (63.3%) were married, while 22% were single.

3.2. Perceived Stigma, Community Attitudes, and Support Toward TB Patients

Figure 1 illustrates the attitudes of community members towards TB patients in the study. A majority of TB patients (71.4%) reported being avoided by community members, while about 17% felt rejected. Only about 12% of TB patients felt accepted by the community.

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Figure 1. Community Attitudes Toward TB Patients in the Study Area (n = 245).

Figure 2 shows the extent of stigmatization experienced by TB patients in this study. Most respondents (68.2%) reported experiencing stigmatization, while about 32% indicated they did not face stigma.

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Figure 2. Proportion of TB Patients Reporting Experiences of Stigmatization (n = 245).

Figure 3 illustrates the level of support experienced by TB patients in this study. A majority of respondents (63.7%) reported a lack of support, while 36.3% indicated they did receive support.

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Figure 3. Reported Levels of Support Received by TB Patients (n = 245).

3.3. Association Between Demographic Factors and Stigmatization and Support Among TB Patients

Table 2 presents the results of a Fisher’s exact test conducted to examine the relationship between demographic factors and stigmatisation and support for TB patients. The analysis revealed that age (P< .001), educational level (p = 0.009), occupation (p = 0.003), religion (P<.001) and ethnicity (p = 0.003) were significantly associated with stigmatization. Again, respondents' age (P< .001), occupation (P = 0.008), religion (P<.001) and ethnicity (P<.001) were significantly linked to support for TB patients.

Table 2. Association Between Sociodemographic Characteristics and Experiences of Stigmatization and Support Among TB Patients (n = 245).

Variables/Categories	Experience Stigmatization n=245(%)		Fisher's Exact Test p-value	Lack of support n=245(%)		Fisher's Exact Test p-value
Variables/Categories	No	Yes	Fisher's Exact Test p-value	No	Yes	Fisher's Exact Test p-value
Age Group			P<.001	no	yes	P<.001
<20 yrs	3(30.0)	7(70.0)		4(40.0)	6(60.0)
20 – 39 yrs	29(21.2)	108(78.8)		35(25.5)	102(74.5)
40 – 59 yrs	24(40.7)	35(59.3)		28(47.5)	31(52.5)
60 yrs and above	22(56.4)	17(43.6)		22(56.4)	17(43.6)
Sex			0.546			1.000
male	53(30.5)	121(69.5)		63(36.2)	111(63.8)
female	25(35.2)	46(64.8)		26(36.6)	45(63.4)
Educational level			0.009			0.244
Middle / JHS	18(34.6)	34(65.4)		18(34.6)	34(65.4)
No formal education	24(46.2)	28(53.8)		24(46.2)	28(53.8)
Primary	14(42.4)	19(57.6)		15(45.5)	18(54.5)
SHS/Vocational	15(21.1)	56(79.9)		21(29.6)	50(70.4)
Tertiary	7(18.9)	30(81.1)		11(29.7)	26(70.3)
Occupation			0.003			0.008
Civil servant	6(18.2)	27(81.8)		9(27.3)	24(72.7)
Farmer	30(35.3)	55(64.7)		32(37.6)	53(62.4)
Other	27(48.2)	29(51.8)		30(53.6)	26(46.4)
Trader	15(21.1)	56(78.9)		18(25.4)	53(74.6)
Religion			P<.001			P<.001
Christianity	51(25.4)	150(74.6)		63(31.3)	138(68.7)
Others	25(71.4)	10(28.6)		24(68.6)	11(31.4)
Traditional	2(22.2)	7(77.8)		2(22.2)	7(77.8)
Ethnicity			0.003			P<.001
Bono	44(26.7)	121(73.3)		46(27.9)	119(72.1)
Dagaari	20(60.6)	13(39.4)		22(66.7)	11(33.3)
Dagomba	8(40.0)	12(60.0)		11(55.0)	9(45.0)
Mamprusi	1(12.5)	7(87.5)		3(37.5)	5(62.5)
Others	5(26.3)	14(73.7)		7(36.8)	12(63.2)
Marital status			0.311			0.520
Cohabitation	3(17.6)	14(82.4)		6(35.3)	11(64.7)
Divorced	3(42.9)	4(57.1)		4(57.1)	3(42.9)
Married	50(32.3)	105(67.7)		54(34.8)	101(65.2)
Single	16(29.1)	39(70.9)		19(34.5)	36(65.5)
Widowed	6(54.5)	5(45.5)		6(54.5)	5(45.5)

A logistic regression analysis was conducted to examine the effect of the association between demographic factors and stigmatization and support for TB patients, as illustrated in Table 3. After controlling for possible confounding, the results indicated that respondents aged 20-39 years had significantly higher odds of experiencing a lack of support (aOR = 3.15, 95% CI: 1.35-7.39, p = 0.008) compared to those aged 60 years and above. Respondents in the ‘other’ occupation category had significantly lower odds of experiencing stigmatization (aOR = 0.15, 95% CI: 0.05-0.42, P<.001) and lack of support (aOR = 0.22, 95% CI: 0.10-0.55, P = 0.001) compared to traders. Compared to those practising traditional religion, respondents who belong to other groups had lower odds of facing stigmatization (aOR = 0.08, 95% CI: 0.01-0.53, p = 0.010) and lack of support (aOR = 0.10, 95% CI: 0.02-0.68, p = 0.019). Ethnic groups such as Dagaari had significantly lower odds of experiencing both stigmatization (aOR = 0.10, 95% CI: 0.02-0.44, p = 0.002) and lack of support (aOR = 0.19, 95% CI: 0.05-0.74, p = 0.016) compared to respondents in the ‘other’ group. Education level was not significantly associated with either outcome.

Table 3. Adjusted Logistic Regression Analysis of Demographic Factors Associated with Stigmatization and Lack of Support Among TB Patients.

Variables/ Categories	Stigmatization				Lack of support
Variables/ Categories	cOR (95%CI)	P-value	aOR (95%CI)	P-value	cOR (95%CI)	P-value	aOR (95%CI)	P-value
Age Group
<20 yrs	3.02(0.68-13.44)	0.147	3.82(0.92-6.52)	0.145	1.94(0.47-7.99)	0.358	3.29(0.66-16.37)	0.146
20 – 39 yrs	4.82(2.27-10.24)	P<.001	2.4(0.92-6.52)	0.072	3.77(1.80-7.91)	P<.001	3.15(1.35-7.39)	0.008
40 – 59 yrs	1.89(0.83-4.28)	0.128	1.64(0.62-4.31)	0.318	1.43(0.64-3.23)	0.386	1.60(0.64-4.00)	0.314
60 yrs and above	Ref		Ref		Ref		Ref
Educational level
Middle / JHS	0.44(0.16-1.20)	0.109	0.46(0.10-2.13)	0.323	-	-	-	-
No formal education	0.27(0.10-0.73)	0.010	0.38(0.7-2.02)	0.259
Primary	0.32(0.11-0.93)	0.036	0.39(0.07-2.04)	0.263
SHS/Vocational	0.87(0.32-2.37)	0.787	1.07(0.26-4.45)	0.923
Tertiary	Ref		Ref
Occupation
Civil servant	1.21(0.42-3.45)	0.728	0.56(0.11-2.86)	0.482	0.91(0.36-2.31)	0.835	0.66(0.23-1.87)	0.432
Farmer	0.49(0.23-1.01)	0.054	0.69(0.27-1.79)	0.443	0.56(0.28-1.12)	0.103	0.67(0.30-1.47)	0.316
Other	0.29(0.13-0.62)	0.002	0.15(0.05-0.42)	P<.001	0.29(0.14-0.62)	0.001	0.22(0.10-0.55)	0.001
Trader	Ref		Ref		Ref		Ref
Religion
Christianity	0.84(0.17-4.18)	0.832	0.42(0.07-2.58)	0.351	0.63(0.13-3.10)	0.566	0.25(0.41-1.56)	0.139
Others	0.11(020-0.65)	0.014	0.08(0.01-0.53)	0.010	0.13(0.02-0.74)	0.021	0.10(0.02-0.68)	0.019
Traditional	Ref		Ref		Ref		`
Ethnicity
Bono	0.98(0.33-2.89)	0.974	0.25(0.07-0.98)	0.046	1.51(0.56-4.07)	0.416	0.67(0.21-2.14)	0.503
Dagaari	0.23(0.67-0.80)	0.021	0.10(0.02-0.44)	0.002	0.29(0.90-0.95)	0.041	0.19(0.05-0.74)	0.016
Dagomba	0.54(0.14-2.08)	0.368	0.22(0.04-1.12)	0.068	0.48(0.13-1.72)	0.258	0.20(0.05-0.92)	0.039
Mamprusi	2.50(0.24-25.72)	0.441	2.09(0.10-45.28)	0.639	0.97(0.18-5.37)	0.974	0.66(0.10-4.54)	0.676
Others	Ref		Ref		Ref		Ref

Table 4 presents the suggestions from TB patients on reducing stigma and improving case detection. The most common recommendations made by TB patients were community education and advocacy (98.8%), the creation of awareness (99.6%), and support to TB patients (99.2%). All respondents (100%) emphasized the importance of good staff professionalism as a key factor in improving TB care and reducing stigma.

3.4. TB Patients' Suggestions for Reducing Stigma and Improving TB Case Detection

Table 4. TB Patients’ Recommendations for Reducing Stigma and Enhancing Case Detection.

TB patients' suggestions for reducing stigma and improving TB case detection	Frequency	Percent
Community education and advocacy	242	98.8
Creation of awareness	244	99.6
Support for TB patients	243	99.2
Good staff professionalism	245	100

4. Discussion

Experiences of stigmatization, stigmatization, support from the community among TB patients were studied in Ghana, Nkoranza South Municipality, along with basic sociodemographic determinants of the region. The results indicate high levels of stigmatization and poor support from the community, as witnessed in such environments of the sub-Saharan region of Africa

[8]

Our study revealed that most community members socially excluded TB patients, and 68.2% reported stigmatization. This conforms with previous studies that illustrate that the longstanding resilience of stigma remains a stumbling block towards TB control

[9, 15-17]

. Parallel rejection by community members was underscored by Desanto et al. (2023), but focusing on fear and misconception as the impetuses of stigma

[2]

. The low rate of community acceptance (12%) revealed in this current study illustrates these trends. It indicates that despite continued awareness campaigns for TB, stigma is firmly entrenched in Nkoranza South Municipality, which underscores the need for targeted intervention to reduce the menace of TB stigmatization.

As expected, the most recent estimates of stigmatization against TB patients are fractionally higher in rural and peri-urban areas than in urban areas, as evidenced in our finding, placing rural or peri-urban ones like Nkoranza South more at risk of stigma

[4, 5, 16]

. Conversely, other studies recorded higher stigmatization prevalence in urban areas compared to rural settings

[1, 18]

. This may be due to more formal public health education and increased exposure to TB interventions in these urban areas.

Consensually, in our study, most respondents had no support from society and the community. This corroborates other studies, which documented stigma and lack of support for TB patients and attributed it to fear of transmission to others, leading to rejection by society

[8, 11]

. Lack of support demotivates adherence to drugs and outcomes, as established in the literature

[8, 19]

. However, our finding contradicts the revelation documented by Carvalho et al., which stipulated that most respondents felt supported in their communities

[20]

We must recognise that although conceptual links between support and stigma were identified, they do not need to occur simultaneously. For instance, patients might be protected from visible stigma but still lack adequate emotional or financial support. This subtle distinction is critically important when designing interventions that not only aim to reduce stigma but also bolster family and community systems

[6]

In this current study, strong correlations were found among stigmatization/support and different sociodemographic indicators, such as religion, work status, ethnic origin, and age. Young adults aged 20-39 years had lower levels of support, and this could be because of increased social mobility and peer pressure, perhaps adding to stigmatization

[21, 22]

. Older generations are likely to be more valued by peers or have more consistent patterns of support.

We further observed that occupation, religion and ethnicity were also key predictors of stigmatization among TB patients. Members of the 'other' ethnic group and religious conservative believers were more likely to be stigmatized and less likely to be helped. These can be understood as evidence of a higher incidence of more embedded cultural misbeliefs and faith-based interpretation of illness. In contrast, our finding is not in conformity with another study in South Africa and Kenya, which documented no relations between region, occupation and stigmatization against TB patients

[12, 13]

. This variation can be explained by such factors as the type of education at various levels or the impact of social norms created on the basis of individuals' knowledge level in South Africa. Furthermore, the variation for occupation with studies elsewhere could be an indication of the probability that traders, having contact with a wide proportion of the populace, are under more public observation and scrutiny.

We found no correlation between education status and stigma against TB patients or support offered to them in their communities. This is in line with another study in South Africa, where stigmatization against TB patients did not correlate with higher education

[12]

Our study found that, across all groups, respondents strongly demanded community education, awareness, and enhanced professionalism among healthcare workers. The findings again validate the necessity of comprehensive, community-oriented interventions that address the WHO End TB Strategy's emphasis on social protection and stigma mitigation

[23]

. Worldwide focus on professionalism among health workers brings into focus the role of health workers not only as providers of service but also as planners who influence popular attitudes towards TB

[24]

5. Conclusion

Our study suggests the widespread prevalence of TB stigma and poor support in the Nkoranza South Municipality. Sociodemographic determinants, particularly age, occupation, religion, and ethnicity, are key drivers of the patient experience. Findings necessitate a focus on culture-sensitive interventions, long-term public health education, and better healthcare professional conduct to end stigma and improve TB control in Nkoranza South Municipality and other comparable settings. Future studies should investigate whether community-based education and advocacy interventions can reduce stigma associated with TB and increase long-term support for patients.

Strengths and Limitations

The strength of this research lies in its focus on a relatively understudied rural Ghanaian population, providing valuable insights into how sociodemographic determinants influence TB stigma and support. However, its cross-sectional nature limits causal inference, and the use of self-reported data may introduce social desirability bias.

Abbreviations

cOR	Crude Odds Ratio
aOR	Adjusted Odds Ratio
Ref	Reference Category
CI	Confidence Interval
TB	Tuberculosis

Acknowledgments

We would like to extend our warm appreciation to the Nkoranza South Municipal Health Directorate for their kind collaboration in conducting this research. We also owe a great debt of gratitude to all participants for their time and experiences offered freely in conducting this study.

Author Contributions

Peter Kipo Leta: Conceptualization, Methodology, Formal analysis, Data curation, Writing - original draft, Writing - review & editing, Project administration

Dacosta Awuah Aboagye: Conceptualization, Methodology, Writing - original draft, Writing - review & editing

Richmond Bediako Nsiah: Conceptualization, Methodology, Validation, Data curation, Writing - original draft, Writing - review & editing, Project administration

John Humphrey Amuasi: Methodology, Writing - review & editing

Jonathan Mawutor Gmanyami: Validation, Writing - review & editing

Foster Bediako Gbafu: Validation, Visualization

Dominic Nyarko: Validation, Resources, Data curation, Supervision

Mavis Vikpedomo Baalasuuri: Validation, Visualization, Writing - review & editing

Victor Jamoni: Formal analysis, Data curation, Visualization, Writing - review & editing

Margaret Morrison: Formal analysis

Paulina Clara Appiah: Resources, Data curation, Supervision

Frank Prempeh: Resources, Visualization, Supervision

Oscar Lambert: Data curation

Mercy Negble: Formal analysis

Rachael Georgina Antwi Boasiako: Data curation, Writing - original draft

Khadijatu Adiss Yusif: Data curation

Obed Atsu-Ofori: Data curation, Project administration

Theodora Konadu Owusu Amponsah: Writing - original draft, Visualization

Amponsah Kinsley Osei: Writing - review & editing

Funding

The Authors had no funding for this study.

Ethics Approval and Consent to Participate

This was a cross-sectional survey of patients with TB that had been approved and reviewed by the Nkoranza South Municipal Health Research Committee. The study adhered to the Declaration of Helsinki (1964) and all subsequent amendments.

Consent was received from all participants before data was collected. The participants were informed about the voluntariness of their participation, the ability to withdraw at any time, and that all information provided would be kept confidential and only used for research purposes.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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[5]	Gyimah FT, Dako-gyeke P. Perspectives on TB patients ’ care and support : a qualitative study conducted in Accra Metropolis, Ghana. Globalization and Health. 2019; 9: 1-9. Available from: https://doi.org/10.1186/s12992-019-0459-9
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[7]	Bodur MS, Çil B. A Research on Healthcare Professionals ’ Stigma Towards Tuberculosis Patients. Thoracic Research and Practice. 2025; 26(3): 88-96. Available from: https://doi.org/10.4274/ThoracResPract.2024.24079
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[24]	Ereso BM, Sagbakken M, Gradmann C, Yimer SA. Determinants of an unfavorable treatment outcome among tuberculosis patients in the Jimma Zone, Southwest Ethiopia. Scientific Reports. 2024; 1-11. Available from: https://doi.org/10.1038/s41598-024-78084-0

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APA Style

Leta, P. K., Aboagye, D. A., Gmanyami, J. M., Nsiah, R. B., Boasiako, R. G. A., et al. (2025). Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana. Science Journal of Public Health, 13(5), 257-268. https://doi.org/10.11648/j.sjph.20251305.12

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ACS Style

Leta, P. K.; Aboagye, D. A.; Gmanyami, J. M.; Nsiah, R. B.; Boasiako, R. G. A., et al. Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana. Sci. J. Public Health 2025, 13(5), 257-268. doi: 10.11648/j.sjph.20251305.12

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AMA Style

Leta PK, Aboagye DA, Gmanyami JM, Nsiah RB, Boasiako RGA, et al. Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana. Sci J Public Health. 2025;13(5):257-268. doi: 10.11648/j.sjph.20251305.12

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@article{10.11648/j.sjph.20251305.12,
  author = {Peter Kipo Leta and Dacosta Awuah Aboagye and Jonathan Mawutor Gmanyami and Richmond Bediako Nsiah and Rachael Georgina Antwi Boasiako and Khadijatu Adiss Yusif and Oscar Lambert and Mercy Negble and Obed Atsu-Ofori and Foster Bediako Gbafu and Mavis Vikpedomo Baalasuuri and John Humphrey Amuasi and Paulina Clara Appiah and Dominic Nyarko and Frank Prempeh and Margaret Morrison and Theodora Konadu Owusu Amponsah and Amponsah Kinsley Osei and Victor Jamoni},
  title = {Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana
},
  journal = {Science Journal of Public Health},
  volume = {13},
  number = {5},
  pages = {257-268},
  doi = {10.11648/j.sjph.20251305.12},
  url = {https://doi.org/10.11648/j.sjph.20251305.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjph.20251305.12},
  abstract = {Background: Tuberculosis (TB) continues to be a significant public health issue in Ghana, and stigma and compromised community support are intrinsic barriers to successful treatment, diagnosis, and control. Knowledge of community attitudes and sociodemographic factors that influence stigma is crucial for developing targeted interventions in Nkoranza South Municipality. Methods: This was a cross-sectional study that included 245 randomly selected TB patients aged 18 and older who were currently receiving or had completed treatment between 2016 and 2020 in the Nkoranza South Municipality. Data were collected using a semi-structured questionnaire, administered through the home and healthcare facility by trained enumerators. Using SPSS version 26, Fisher’s Exact Test was used to examine association, and logistic regression was used to assess the impact of socio-demographic factors on stigma and support. Frequencies were used to explore suggestions for reducing stigma and improving TB care, with a statistical significance set at pResults: The study revealed that 71.4% of TB patients interviewed reported avoidance by the community. About 17% felt rejected, and only 12% felt accepted by the members of their communities. About 64% reported a lack of support, and 68.2% reported experiencing stigma. TB patients aged 20-39 years had higher odds of experiencing a lack of support (aOR = 3.15, 95% CI: 1.35-7.39, p = 0.008). Respondents practicing other religions, unlike Christianity, had lower odds of stigmatization (aOR = 0.08, 95% CI: 0.01-0.53, p = 0.010) and lack of support (aOR = 0.10, 95% CI: 0.02-0.68, p = 0.019) compared to those practising traditional religion. Ethnic groups such as the Dagaari had lower odds of experiencing stigmatizations (aOR = 0.10, 95% CI: 0.02-0.44, p = 0.002) and lack of support (aOR = 0.19, 95% CI: 0.05-0.74, p = 0.016). Educational level was not significantly associated with stigma or support. TB patients suggested community education, TB awareness creation, and improved staff professionalism as crucial steps to reduce stigma and enhance TB care. Conclusion: TB stigma and support gaps are prevalent in Nkoranza South Municipality, with predominant influences of age, occupation, religion, and ethnicity. The challenges need culturally adapted public health education, improved healthcare professionalism, and sustained community mobilization to optimize the TB outcome and combat stigma. Future studies should investigate whether community-based education and advocacy interventions can reduce stigma associated with TB and increase long-term support for patients.
},
 year = {2025}
}

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TY  - JOUR
T1  - Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana

AU  - Peter Kipo Leta
AU  - Dacosta Awuah Aboagye
AU  - Jonathan Mawutor Gmanyami
AU  - Richmond Bediako Nsiah
AU  - Rachael Georgina Antwi Boasiako
AU  - Khadijatu Adiss Yusif
AU  - Oscar Lambert
AU  - Mercy Negble
AU  - Obed Atsu-Ofori
AU  - Foster Bediako Gbafu
AU  - Mavis Vikpedomo Baalasuuri
AU  - John Humphrey Amuasi
AU  - Paulina Clara Appiah
AU  - Dominic Nyarko
AU  - Frank Prempeh
AU  - Margaret Morrison
AU  - Theodora Konadu Owusu Amponsah
AU  - Amponsah Kinsley Osei
AU  - Victor Jamoni
Y1  - 2025/09/19
PY  - 2025
N1  - https://doi.org/10.11648/j.sjph.20251305.12
DO  - 10.11648/j.sjph.20251305.12
T2  - Science Journal of Public Health
JF  - Science Journal of Public Health
JO  - Science Journal of Public Health
SP  - 257
EP  - 268
PB  - Science Publishing Group
SN  - 2328-7950
UR  - https://doi.org/10.11648/j.sjph.20251305.12
AB  - Background: Tuberculosis (TB) continues to be a significant public health issue in Ghana, and stigma and compromised community support are intrinsic barriers to successful treatment, diagnosis, and control. Knowledge of community attitudes and sociodemographic factors that influence stigma is crucial for developing targeted interventions in Nkoranza South Municipality. Methods: This was a cross-sectional study that included 245 randomly selected TB patients aged 18 and older who were currently receiving or had completed treatment between 2016 and 2020 in the Nkoranza South Municipality. Data were collected using a semi-structured questionnaire, administered through the home and healthcare facility by trained enumerators. Using SPSS version 26, Fisher’s Exact Test was used to examine association, and logistic regression was used to assess the impact of socio-demographic factors on stigma and support. Frequencies were used to explore suggestions for reducing stigma and improving TB care, with a statistical significance set at pResults: The study revealed that 71.4% of TB patients interviewed reported avoidance by the community. About 17% felt rejected, and only 12% felt accepted by the members of their communities. About 64% reported a lack of support, and 68.2% reported experiencing stigma. TB patients aged 20-39 years had higher odds of experiencing a lack of support (aOR = 3.15, 95% CI: 1.35-7.39, p = 0.008). Respondents practicing other religions, unlike Christianity, had lower odds of stigmatization (aOR = 0.08, 95% CI: 0.01-0.53, p = 0.010) and lack of support (aOR = 0.10, 95% CI: 0.02-0.68, p = 0.019) compared to those practising traditional religion. Ethnic groups such as the Dagaari had lower odds of experiencing stigmatizations (aOR = 0.10, 95% CI: 0.02-0.44, p = 0.002) and lack of support (aOR = 0.19, 95% CI: 0.05-0.74, p = 0.016). Educational level was not significantly associated with stigma or support. TB patients suggested community education, TB awareness creation, and improved staff professionalism as crucial steps to reduce stigma and enhance TB care. Conclusion: TB stigma and support gaps are prevalent in Nkoranza South Municipality, with predominant influences of age, occupation, religion, and ethnicity. The challenges need culturally adapted public health education, improved healthcare professionalism, and sustained community mobilization to optimize the TB outcome and combat stigma. Future studies should investigate whether community-based education and advocacy interventions can reduce stigma associated with TB and increase long-term support for patients.

VL  - 13
IS  - 5
ER  -

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Author Information

Peter Kipo Leta

Public Health Department, Ghana Health Service, Accra, Ghana

Contact Email

http://orcid.org/0009-0001-4735-2623
Dacosta Awuah Aboagye

Administrative Department, A1 Hospital, Kumasi, Ghana

Contact Email

http://orcid.org/0009-0006-0809-8921
Jonathan Mawutor Gmanyami

School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Implementation Research, Bernhard Nocht Institute of Tropical Medicine, Hamburg, Germany

Contact Email

http://orcid.org/0000-0002-3046-1508
Richmond Bediako Nsiah

Public Health Department, Ghana Health Service, Accra, Ghana

Contact Email

http://orcid.org/0000-0002-5029-2529
Rachael Georgina Antwi Boasiako

Public Health Department, Ghana Health Service, Accra, Ghana

Contact Email

http://orcid.org/0009-0005-6651-8632
Khadijatu Adiss Yusif

Public Health Department, Ghana Health Service, Accra, Ghana

Contact Email

http://orcid.org/0009-0006-9002-3792
Oscar Lambert

School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Governance Department, Ubora Foundation Africa, Accra, Ghana; Department of Health Education, Global Health Insight and Education, Accra, Ghana

Contact Email

http://orcid.org/0009-0003-7065-566X
Mercy Negble

Nursing and Midwifery Department, Garden City University, Kumasi, Ghana

Contact Email

http://orcid.org/0009-0009-3697-2657
Obed Atsu-Ofori

School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Contact Email

http://orcid.org/0009-0005-4764-1256
Foster Bediako Gbafu

School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Contact Email

http://orcid.org/0009-0007-5881-1243
Mavis Vikpedomo Baalasuuri

Department of Vocational Training, University of Cape Coast, Cape Coast, Ghana

Contact Email

http://orcid.org/0009-0001-6745-5320
John Humphrey Amuasi

Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana; School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Implementation Research, Bernhard Nocht Institute of Tropical Medicine, Hamburg, Germany

Contact Email

http://orcid.org/0000-0002-8640-2662
Paulina Clara Appiah

Public Health Department, Ghana Health Service, Accra, Ghana

http://orcid.org/0009-0000-3309-1429
Dominic Nyarko

Public Health Department, Ghana Health Service, Accra, Ghana

Contact Email

http://orcid.org/0009-0007-1924-4952
Frank Prempeh

Public Health Department, Ghana Health Service, Accra, Ghana

Contact Email

http://orcid.org/0009-0000-0076-4957
Margaret Morrison

Membership and Regional Operations Directorate, National Health Insurance Authority, Accra, Ghana

Contact Email

http://orcid.org/0009-0003-2595-3481
Theodora Konadu Owusu Amponsah

School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Contact Email

http://orcid.org/0000-0002-4245-4516
Amponsah Kinsley Osei

Public Health Department, Ghana Health Service, Accra, Ghana

Contact Email

http://orcid.org/0009-0008-2133-8947
Victor Jamoni

Public Health Department, Ghana Health Service, Accra, Ghana

Contact Email

http://orcid.org/0009-0007-4067-1641

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Ethics Approval and Consent to Participate
Conflicts of Interest
References
Cite This Article
Author Information

Plain Text BibTeX RIS

APA Style

Leta, P. K., Aboagye, D. A., Gmanyami, J. M., Nsiah, R. B., Boasiako, R. G. A., et al. (2025). Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana. Science Journal of Public Health, 13(5), 257-268. https://doi.org/10.11648/j.sjph.20251305.12

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ACS Style

Leta, P. K.; Aboagye, D. A.; Gmanyami, J. M.; Nsiah, R. B.; Boasiako, R. G. A., et al. Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana. Sci. J. Public Health 2025, 13(5), 257-268. doi: 10.11648/j.sjph.20251305.12

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AMA Style

Leta PK, Aboagye DA, Gmanyami JM, Nsiah RB, Boasiako RGA, et al. Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana. Sci J Public Health. 2025;13(5):257-268. doi: 10.11648/j.sjph.20251305.12

Copy | Download

@article{10.11648/j.sjph.20251305.12,
  author = {Peter Kipo Leta and Dacosta Awuah Aboagye and Jonathan Mawutor Gmanyami and Richmond Bediako Nsiah and Rachael Georgina Antwi Boasiako and Khadijatu Adiss Yusif and Oscar Lambert and Mercy Negble and Obed Atsu-Ofori and Foster Bediako Gbafu and Mavis Vikpedomo Baalasuuri and John Humphrey Amuasi and Paulina Clara Appiah and Dominic Nyarko and Frank Prempeh and Margaret Morrison and Theodora Konadu Owusu Amponsah and Amponsah Kinsley Osei and Victor Jamoni},
  title = {Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana
},
  journal = {Science Journal of Public Health},
  volume = {13},
  number = {5},
  pages = {257-268},
  doi = {10.11648/j.sjph.20251305.12},
  url = {https://doi.org/10.11648/j.sjph.20251305.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjph.20251305.12},
  abstract = {Background: Tuberculosis (TB) continues to be a significant public health issue in Ghana, and stigma and compromised community support are intrinsic barriers to successful treatment, diagnosis, and control. Knowledge of community attitudes and sociodemographic factors that influence stigma is crucial for developing targeted interventions in Nkoranza South Municipality. Methods: This was a cross-sectional study that included 245 randomly selected TB patients aged 18 and older who were currently receiving or had completed treatment between 2016 and 2020 in the Nkoranza South Municipality. Data were collected using a semi-structured questionnaire, administered through the home and healthcare facility by trained enumerators. Using SPSS version 26, Fisher’s Exact Test was used to examine association, and logistic regression was used to assess the impact of socio-demographic factors on stigma and support. Frequencies were used to explore suggestions for reducing stigma and improving TB care, with a statistical significance set at pResults: The study revealed that 71.4% of TB patients interviewed reported avoidance by the community. About 17% felt rejected, and only 12% felt accepted by the members of their communities. About 64% reported a lack of support, and 68.2% reported experiencing stigma. TB patients aged 20-39 years had higher odds of experiencing a lack of support (aOR = 3.15, 95% CI: 1.35-7.39, p = 0.008). Respondents practicing other religions, unlike Christianity, had lower odds of stigmatization (aOR = 0.08, 95% CI: 0.01-0.53, p = 0.010) and lack of support (aOR = 0.10, 95% CI: 0.02-0.68, p = 0.019) compared to those practising traditional religion. Ethnic groups such as the Dagaari had lower odds of experiencing stigmatizations (aOR = 0.10, 95% CI: 0.02-0.44, p = 0.002) and lack of support (aOR = 0.19, 95% CI: 0.05-0.74, p = 0.016). Educational level was not significantly associated with stigma or support. TB patients suggested community education, TB awareness creation, and improved staff professionalism as crucial steps to reduce stigma and enhance TB care. Conclusion: TB stigma and support gaps are prevalent in Nkoranza South Municipality, with predominant influences of age, occupation, religion, and ethnicity. The challenges need culturally adapted public health education, improved healthcare professionalism, and sustained community mobilization to optimize the TB outcome and combat stigma. Future studies should investigate whether community-based education and advocacy interventions can reduce stigma associated with TB and increase long-term support for patients.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Exploring Community Attitudes and Sociodemographic Determinants of Stigma and Support Towards Tuberculosis Patients: A Cross-Sectional Study in Nkoranza South Municipality, Ghana

AU  - Peter Kipo Leta
AU  - Dacosta Awuah Aboagye
AU  - Jonathan Mawutor Gmanyami
AU  - Richmond Bediako Nsiah
AU  - Rachael Georgina Antwi Boasiako
AU  - Khadijatu Adiss Yusif
AU  - Oscar Lambert
AU  - Mercy Negble
AU  - Obed Atsu-Ofori
AU  - Foster Bediako Gbafu
AU  - Mavis Vikpedomo Baalasuuri
AU  - John Humphrey Amuasi
AU  - Paulina Clara Appiah
AU  - Dominic Nyarko
AU  - Frank Prempeh
AU  - Margaret Morrison
AU  - Theodora Konadu Owusu Amponsah
AU  - Amponsah Kinsley Osei
AU  - Victor Jamoni
Y1  - 2025/09/19
PY  - 2025
N1  - https://doi.org/10.11648/j.sjph.20251305.12
DO  - 10.11648/j.sjph.20251305.12
T2  - Science Journal of Public Health
JF  - Science Journal of Public Health
JO  - Science Journal of Public Health
SP  - 257
EP  - 268
PB  - Science Publishing Group
SN  - 2328-7950
UR  - https://doi.org/10.11648/j.sjph.20251305.12
AB  - Background: Tuberculosis (TB) continues to be a significant public health issue in Ghana, and stigma and compromised community support are intrinsic barriers to successful treatment, diagnosis, and control. Knowledge of community attitudes and sociodemographic factors that influence stigma is crucial for developing targeted interventions in Nkoranza South Municipality. Methods: This was a cross-sectional study that included 245 randomly selected TB patients aged 18 and older who were currently receiving or had completed treatment between 2016 and 2020 in the Nkoranza South Municipality. Data were collected using a semi-structured questionnaire, administered through the home and healthcare facility by trained enumerators. Using SPSS version 26, Fisher’s Exact Test was used to examine association, and logistic regression was used to assess the impact of socio-demographic factors on stigma and support. Frequencies were used to explore suggestions for reducing stigma and improving TB care, with a statistical significance set at pResults: The study revealed that 71.4% of TB patients interviewed reported avoidance by the community. About 17% felt rejected, and only 12% felt accepted by the members of their communities. About 64% reported a lack of support, and 68.2% reported experiencing stigma. TB patients aged 20-39 years had higher odds of experiencing a lack of support (aOR = 3.15, 95% CI: 1.35-7.39, p = 0.008). Respondents practicing other religions, unlike Christianity, had lower odds of stigmatization (aOR = 0.08, 95% CI: 0.01-0.53, p = 0.010) and lack of support (aOR = 0.10, 95% CI: 0.02-0.68, p = 0.019) compared to those practising traditional religion. Ethnic groups such as the Dagaari had lower odds of experiencing stigmatizations (aOR = 0.10, 95% CI: 0.02-0.44, p = 0.002) and lack of support (aOR = 0.19, 95% CI: 0.05-0.74, p = 0.016). Educational level was not significantly associated with stigma or support. TB patients suggested community education, TB awareness creation, and improved staff professionalism as crucial steps to reduce stigma and enhance TB care. Conclusion: TB stigma and support gaps are prevalent in Nkoranza South Municipality, with predominant influences of age, occupation, religion, and ethnicity. The challenges need culturally adapted public health education, improved healthcare professionalism, and sustained community mobilization to optimize the TB outcome and combat stigma. Future studies should investigate whether community-based education and advocacy interventions can reduce stigma associated with TB and increase long-term support for patients.

VL  - 13
IS  - 5
ER  -

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