Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study

Data collection was performed in Kathmandu, Nepal. Thirty four in-depth interviews were performed with TB patients, family members of patients, and members of the community.Causes of self-discrimination identified included fear of transmitting TB, and avoiding gossip and potential discrimination. Causes of discrimination by members of the general public included: fear of a perceived risk of infection; perceived links between TB and other causes of discrimination, particularly poverty and low caste; perceived links between TB and disreputable behaviour; and perceptions that TB was a divine punishment. Furthermore, some patients felt they were discriminated against by health workersA comprehensive package of interventions, tailored to the local context, will be needed to address the multiple causes of discrimination identified: basic population-wide health education is unlikely to be effective.Tuberculosis (TB) is a leading cause of adult death in the world, killing 1.7 million people each year. Globally, 14.6 million people have active TB disease: each year 8.9 million people develop active TB [1]. The impact of TB is such that in 1993 WHO declared TB to be a global emergency.TB is closely associated with poverty: although all ranks of society get the disease, the poor are at greatest risk, both because they are in greater contact with other sufferers (because of overcrowding at home, at work, travelling and socialising), and because their immune system is weakened due to poor nutrition [2]. A major impact of TB on marginalised people with little social capital is to push them into abject poverty, because it destroys their ability to earn money or subsist through their work, and because the diagnostic and treatment processes are often costly.TB is transmitted by droplets in the air produced when an infected person coughs, and inhaled by surrounding people [3]. The only effective approach to TB control is to rapidly diagnose and treat TB patients, thereby breaking the