Social stigma among tuberculosis patients attending an urban health training centre in central India: a cross-sectional study

INTRODUCTION

TB continues to rank among the foremost causes of illness and death globally, with India accounting for a disproportionately large share of the world’s caseload.¹ Apart from its physical effects, the disease often exposes those affected to emotional strain, discriminatory treatment and unfavourable attitudes within their communities.

These pressures can drive patients to conceal their condition, withdraw socially, postpone seeking care and adhere poorly to therapy, thereby weakening TB control and diminishing quality of life.² Quantifying how widespread stigma is and what drives it, is therefore a prerequisite for designing interventions that work.

METHODS

This cross-sectional study was carried out between November 2025 and April 2026 among tuberculosis patients attending the urban health training centre (UHTC) of a tertiary care teaching hospital in Central India. Eligibility was restricted to diagnosed TB patients aged 18 years or older who were enrolled for treatment and follow-up at the centre and consented to take part. Those who were severely ill, unable to complete the questionnaire or declined participation were not included. Eighty participants were recruited through convenience sampling; eligible patients presenting at the UHTC over the study period were enrolled consecutively until the target sample size was reached. Information was gathered through a pre-tested, semi-structured questionnaire that captured socio-demographic details (age, sex, education, occupation and socio-economic status) alongside disease-related particulars (type of TB and phase of treatment). The level of social stigma was measured using the validated Van Rie TB Stigma Scale.^3,4 Total scores were used to classify participants into low (0–14), moderate (15–29) or high (30–44) stigma categories.

Data were entered into Microsoft Excel and analysed in Jamovi. Results were summarised as frequencies and percentages, with means and standard deviations where appropriate. The Chi-square test or Fisher’s exact test when expected cell counts were small, was used to examine associations between stigma category and socio-demographic variables; statistical significance was set at a p value below 0.05.

Approval was granted by the Institutional Ethics Committee and each participant provided written informed consent prior to enrolment.

RESULTS

A total of 80 tuberculosis patients participated. The majority belonged to the 18–30 years age group (27.5%), followed by 31–40 years (25.0%), 41–50 years (22.5%), 51–60 years (15.0%) and above 60 years (10.0%). Males constituted 60.0% (n=48) and females 40.0% (n=32).

Secondary school education was the commonest (30.0%) and unskilled workers formed the largest occupational group (32.5%), as detailed in table 1.

Nearly half of the participants (47.5%) belonged to the upper lower socio-economic class, while 25.0% belonged to the lower class (Table 2).

Pulmonary tuberculosis was observed in 70.0% (n=56) of participants and extrapulmonary tuberculosis in 30.0% (n=24) (Figure 1). With respect to treatment status, 57.5% (n=46) were in the continuation phase and 42.5% (n=34) in the intensive phase (Figure 2). Assessment using the Van Rie TB stigma scale revealed that 22.5% (n=18) had low stigma, 47.5% (n=38) moderate stigma and 30.0% (n=24) high stigma. Thus, more than three-fourths (77.5%) experienced moderate-to-high TB-related social stigma (Figure 3).

Item-wise responses to the stigma scale are presented in Table 3. A substantial proportion of participants perceived negative community attitudes towards individuals with TB; more than half agreed that people may avoid eating or drinking with TB patients, feel uncomfortable being near them, keep their distance, fear them or discourage their children from interacting with them. Association analysis showed that educational status (p=0.59) and occupation (p=0.68) were not significantly associated with stigma levels (Tables 4 and 5). However, socio-economic status was significantly associated with stigma (Fisher’s exact test, p=0.017), with higher stigma among participants from lower socio-economic classes (Table 6).

χ²=2.84, p=0.59 (not significant).

χ²=3.11; p=0.68 (not significant).

Fisher’s exact test; p=0.017 (significant).

DISCUSSION

This study examined the burden of social stigma among tuberculosis patients attending an UHTC in Central India. Moderate stigma was reported by 47.5% and high stigma by 30.0%, so that more than three-quarters (77.5%) carried a moderate-to-high stigma burden. The persistence of such levels, despite sustained public health efforts and therapeutic advances, indicates that stigma remains a substantial psychosocial obstacle in TB care.

These results sit comfortably alongside other Indian reports. Rajpal et al recorded moderate stigma in 66% of TB patients, whereas Kallepalli et al documented stigma in 59%, with a mean score of 31.1±3.25.7 Rathod and Shetty noted a mean stigma score of 20.76±6.40 in Gujarat and Baskaran et al, found stigma in 69.3% of patients in Puducherry.^5,6,8 Taken together, these figures point to a problem that is widespread across the country. Item-level responses revealed that many participants sensed unfavourable community attitudes avoidance of social contact, fear of proximity, hesitation to share food or drink and unease about children mixing with affected persons. Perceptions of this kind can foster social isolation, encourage concealment of the diagnosis, delay help-seeking and undermine adherence to treatment.^9,10 Neither educational status nor occupation showed a significant relationship with stigma. Socio-economic status, by contrast, was significantly linked to it (p=0.017), with higher stigma concentrated among the lower socio-economic groups. This pattern may stem from restricted access to health information, poorer awareness of how TB spreads and is treated and the heightened exposure of economically disadvantaged groups to social discrimination.^11-13

Several limitations should be noted. Because the work was based at a single urban health training centre and used convenience sampling, its findings may not extend to all settings. Its cross-sectional nature does not permit conclusions about cause and effect and reliance on self-report leaves room for social-desirability bias. Even so, the results underline that TB stigma remains a real barrier to effective tuberculosis control.^14,15

Measures that raise community awareness, dispel misconceptions, reinforce patient counselling and nurture supportive attitudes will be central to reducing stigma and improving treatment outcomes.

CONCLUSION

A sizeable share of the TB patients studied carried a moderate-to-high stigma burden and stigma was greater among those of lower socio-economic standing. Strengthening focused community awareness, patient counselling and supportive TB services is needed to lessen stigma and improve treatment outcomes.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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