Tuberculosis- and Diabetes Mellitus-Associated Knowledge, Stigma, and Health-Seeking Behaviour in Ghana

Tuberculosis [TB] and diabetes mellitus (DM) remain major public health concerns worldwide. TB negatively affects an individual's glucose tolerance, increasing the risk of developing DM. Similarly, DM reduces the host's ability to fight TB infection and increases the likelihood of developing TB and poor response to TB medication. This study analysed stigma and health-seeking behaviour in a sub-district of Accra Metropolis.

We used a mixed-methods research approach involving a cross-sectional survey and in-depth interviews to explore community knowledge, stigma, and health-seeking behaviour related to TB and DM. A total of 437 individuals were selected for a survey using a simple random sampling technique, while 22 participants, including three TB patients, four nurses, one medical doctor, four students from a nursing and midwifery school, five students from a school of hygiene, and five community members, were involved in the study. Healthcare providers and patients were purposively selected, while students and community members were recruited through convenience sampling. Descriptive and logistic regression analyses were performed on the quantitative data using STATA, while the qualitative data were thematically analysed using the MAXQDA software.

Participants' age, sex, and educational levels were significantly associated with their knowledge of TB and DM. Males were 0.600 times as likely as females to be knowledgeable about DM (95% CI: 0.386-0.934, p = 0.024). Social determinants of health, such as poverty, local beliefs, stigma, and negative attitudes from healthcare workers, may influence TB patients' preference for traditional remedies over biomedical treatment.

Therefore, we observed that addressing cultural barriers, stigma, and financial costs related to TB and diabetes care will help increase patients' willingness for biomedical treatment.