Multilevel analysis of stigmatising beliefs and perceptions about tuberculosis among women of reproductive age in Nigeria

Abstract

While existing Nigerian studies have provided evidence of diverse socio-demographic and cultural practices influencing Tuberculosis (TB) stigma, there is rarely any Nigerian study that explores multilevel influences on TB beliefs and perceptions. This paper examines the multilevel factors influencing stigmatising beliefs and perceptions about Tuberculosis among Women of reproductive age in Nigeria. The study analysed the 2024 Nigeria Demographic and Health Survey (NDHS). A weighted sample size of 25,096 women of childbearing age was analysed. The outcome variable was TB beliefs and perceptions, categorised into stigmatising and non-stigmatising beliefs. The explanatory variables were selected based on the socio-ecological model. Six intrapersonal-level variables, namely, age of women, women’s educational attainment, work status, and media exposure, health insurance enrollment, and alcohol consumption were selected. At the interpersonal-level, three variables namely, household size, household wealth quintile, and health care decision were selected. At the community-level, four variables, namely, type of place of residence, geographic region, community literacy level, and community knowledge of TB transmission were selected. A two-level mixed-effects logistic regression model was fitted. Statistical significance was set at 5%. The majority (75.0%) of respondents reported stigmatising beliefs and perceptions about TB. Being aged 25–34 years (aOR = 0.875, 95% CI: 0.787–0.972); being aged 35 years or older (aOR = 0.751, 95% CI: 0.672–0.839); attaining higher education (aOR = 0.630, 95% CI: 0.527–0.754); non-consumption of alcohol (aOR = 832, 95% CI: 0.742–0.932); being resident in communities with high literacy level (aOR = 0.606, 95% CI: 0.488–0.752); and being resident in communities with high knowledge of TB transmission (aOR = 0.736, 95% CI: 0.602–0.901) were associated with lower odds of TB stigmatising belief, while Southern women were associated with higher odds of stigmatising belief (aOR = 1.220, 95% CI: 1.038–1.433). The ICC across the three models fitted confirm that more than 20% of the share of overall variance in TB stigmatising beliefs could be attributed to the community level. TB stigma is associated with different factors operating at multiple levels of the social environment. In addition to more initiatives targeting younger people and people who regularly consume alcohol, a door-to-door initiative is imperative to address TB stigma and discrimination in Nigeria. Not applicable.