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ORIGINAL RESEARCH ARTICLE Table of Contents  
Ahead of print publication
Social stigma and associated factors among COVID-19 survivors at a tertiary care centre from Visakhapatnam


1 Department of Community Medicine, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, Andhra Pradesh, India
2 Department of Community Medicine, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India

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Date of Submission14-Jul-2022
Date of Decision10-Sep-2022
Date of Acceptance15-Sep-2022
 

  Abstract 


Background: From the early days of the HIV epidemic to the current COVID-19 crisis, a major challenge around infectious diseases has been dealing with the deep-seated stigma around affected populations. There is a paucity of literature on the prevalence of social stigma among patients who survived after COVID-19 infection in India.
Objective: The objective is to estimate the prevalence of social stigma and its associated factors among COVID-19 survivors.
Methodology: It was a cross-sectional study conducted among 150 COVID-19 survivors with predesigned questionnaire using a simple random sampling technique in a tertiary care center from October to November 2020. Social stigma was measured for different socio-demographic parameters and compared.
Results: Of 150 study subjects, 29.3% of them faced social discrimination. Majority of them were discriminated by neighbors (75%) and even by their family members and 11.4% not allowed them into community/village. 50% had fear of infecting others and 55.3% of them blamed themselves for getting COVID-19 infection. 18% had faced social devaluation by others. 23.3% lost their job due to COVID-19 and 40.7% had economic loss.
Conclusion: COVID-19-related stigma was widespread among participants. Social discrimination was more with increased age, female gender, among educated people, in joint families, among married individuals, in upper social class and those who had a long hospital stay; however, it was not significantly associated statistically.

Keywords: COVID-19 survivors, discrimination, social stigma


How to cite this URL:
Latha BS, Moses PM, Karini D, Narni H. Social stigma and associated factors among COVID-19 survivors at a tertiary care centre from Visakhapatnam. MRIMS J Health Sci [Epub ahead of print] [cited 2023 Mar 30]. Available from: http://www.mrimsjournal.com/preprintarticle.asp?id=359954





  Introduction Top


The COVID-19 pandemic, caused by SARSCOV2, is of unprecedented global public health concern.[1] Human fear arises from the anxiety about a disease of an unknown etiology and potential fatal outcomes during outbreaks or pandemics, mostly when measures such as quarantine and isolation are implemented to protect the community.[2],[3] COVID-19 pandemic has produced panic in people in India and in other countries as well. Stigma which is associated with COVID-19 poses a serious concern to human lives, globally several incidents of stigmatization of health-care workers, COVID-19 patients, and survivors have occurred during this pandemic. With respect to social stigma associated with COVID-19, an incident happened where a pregnant woman was allegedly abandoned by her family in India after she gave birth to a child at a hospital in Maharashtra and was found positive for SARS-CoV-2. In some cases, COVID-19 survivors in India were stalked in social media.[4]

A major challenge of infectious diseases has been dealing with the deep-rooted stigma around affected individuals. Research shows that from the early days of the HIV epidemic to the current COVID-19 crisis, stigma and misinformation were among key factors that prevented people from seeking testing and care until it was too late.[5]

Discrimination, exclusion, and a low literacy status were associated social stigma. However, few cases of social stigma have also been reported in high-income countries with higher than average levels of education.[6]

Health education is one of the important tools to tackle stigma. Health education defined by the WHO is any combination of learning experiences adapted to assist persons and communities to improve their health status by ameliorating their knowledge and affecting their behaviors and attitudes.[7],[8] Previously stigma has been associated with different communicable diseases and resulted in discrimination against these patient groups, which caused negative consequences both on the individuals and society.[9] With the above background, the present study was an attempt to study the socio-demographic profile, social stigma, and its associated factors among COVID-19 survivors.


  Methodology Top


A cross-sectional study was conducted among COVID-19 survivors in a Tertiary Care Centre at Visakhapatnam from October 2020 to November 2020. COVID-19 survivors aged more than 18 years who belong to Visakhapatnam, and those who had completed 2 weeks of home quarantine after the discharge were included in the study. Those who were not well even after 2 weeks from the discharge were excluded. A total of 1507 patients were discharged from the hospital, of them, 1000 belong to Visakhapatnam and aged more than 18 years. The sample size was calculated using below formula for estimating proportion from the finite population. As there were no previous studies, we have done a pilot study among 30 COVID-19 survivors to calculate as prevalence of social stigma, i.e., 11.76%.

Here, P = 11.76%, alpha error – 5%, estimation error – 5%, n = 1000, sample size (n) =138. Hence, the minimum sample size required for this study was 138, but to make it a round figure, we have included 150 study participants. Sampling was done by simple random technique. From the sampling frame of 1000 subjects, 150 were selected using computer-generated random numbers. Ethical clearance was obtained from institutional ethics committee before starting the study. After explaining the purpose of the study and gaining confidentiality of the study subjects, the verbal informed consent was taken from them obtaining the study procedure, and data were collected by telephonic interview using predesigned semi-structured questionnaire.


  Results Top


Socio-demographic profile of the study subjects from [Table 1] shows that in the present study majority of the COVID-19 survivors (45.3%) were in the age group of 18–40 years. Around three-quarter were male subjects; one-third of them were educated up to graduation and above. Majority of them were Hindus by religion, married, and living in nuclear families. 73.3% were urban residents and 38% belong to lower middle class according to modified Kuppuswamy (February 2019) socioeconomic status classification.
Table 1: Baseline characteristics of COVID-19 survivors

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[Table 2] shows social stigma and its related factors. 85.4% of the subjects had stayed in the hospital for 1–2 weeks. 29.3% had faced social discrimination and majority were abused verbally by their family/relatives/friends/colleagues. 4% of them did not get family support due to fear of getting COVID-19 infection. Half of them had a fear of infecting others and blaming themselves.
Table 2: Distribution of participants according to social stigma

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[Table 3] depicts the univariate analysis of socio-demographic variables and social discrimination. Among the COVID-19 survivors, the proportion of social discrimination was high among older age (>60 years) group as compared to other age groups. Female gender, educated persons, Christian and Muslim communities, joint families, married individuals, and those who had long hospital stay had faced more social discrimination, and however, it was not significantly associated statistically.
Table 3: Association between social discrimination with socio demographic variables

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  Discussion Top


Stigma and discrimination were associated with past infectious disease outbreaks such as influenza A (H1N1), bubonic plague, Asiatic flu, cholera, Ebola virus disease, Zika virus, HIV, tuberculosis, SARS, and MERS.[10] With the outbreak of the COVID-19 pandemic, infected individuals are labeled, stereotyped, and discriminated because of a perceived link, leading to rise in stigmatization and unmeasurable miseries.[11]

There was a paucity of literature on stigma related to COVID-19 survivors except some case descriptions, so in this view, we are comparing the study results with case narrations, lived experiences of COVID19 survivors, and studies on health-care workers. There are few blogs of the COVID-19 survivors about their experience during their hospital stay, yet no descriptive data are available.[12] In this view, this study was conducted to assess the social stigma among COVID-19 survivors.

In the present study, social stigma was experienced by nearly one-third of the study subjects, in line with this in a study by Jain et al., health-care workers have experienced severe social stigma during the COVID-19 pandemic.[13] The heightened picture of social stigma is manifested among Bihari community living in the Geneva Camp of Dhaka city who were rejected by the local hospital and forced to self-quarantine.[14] It is clear that COVID-19 pandemic has shown no difference toward general public and health-care workers as well. The social stigma was more because of fear of acquiring infection leading to death.

In this study, COVID-19 survivors faced many issues like social discrimination by not allowing them into community and not talking to them. Similar findings were found in a study by Ashek Mahmud et al. where study subjects had experienced harassment, discrimination, life insecurity, psychological disorder, loss of social capital, shattering family bond, and social solidarity that work as a barrier to community well-being.[15] As stigma is a multidimensional challenge, the consequences of such would be many and some may be serious, affecting the person in various aspects such as physical, financial, and psychological.

Majority of the COVID-19 survivors were discriminated by their neighbors (75%) and very few subjects were discriminated even by their family members. 6.8% of them were blamed by others for getting infected. In other studies, some people have self-blamed for being infected and felt guilty of infecting dear ones.[16] Discrimination by family members and self-blaming would have adverse concerns on mental health of the infected individuals. Hence, there is an urgent need to educate family members and near ones to support the affected individuals during the unprecedented happens.

About 63.6% of study subjects were discriminated verbally by their family/relatives/friends/colleagues. 25% of them were abandoned by their family and friends. Half of them had a fear of infecting others and blamed themselves for getting COVID-19 infection. Similarly, a 23-year-old male had experienced verbal abuse by his friend for getting infection from him and another individual, a leader had blamed himself for being infected.[16] It shows that COVID-19 infection is having the impact on psychosocial status of the individuals.

18% of the COVID-19 survivors faced social devaluation by others. They were discriminated by not talking to them (77.3%) and not allowed into community/village (11.4%). Likewise, social devaluation was experienced by health-care workers at workplace and at residence as well.[17],[18] Social devaluation might be because of the misconceptions about infections and perception of infection as a curse or sin.

The factors associated with social discrimination were in accordance with a study by Jain et al.[13] 23.3% lost their job due to COVID-19 and 40.7% had economic losses as well. From these findings, we can conclude that previous infectious diseases which were associated with social stigma were more prevalent among low literacy and economic classes, but now, it is observed among all irrespective of educational and social status.


  Conclusion Top


COVID-19-related stigma was widespread among participants. Social discrimination was more with increased age, female gender, among educated people, in joint families, among married individuals, in upper social class and those who had long hospital stay; however, it was not significantly associated statistically. However, patients with good social support and doctor–patient communication will be less succumbed to abnormal practice of stigma.

Recommendations

Imparting health education to raise the awareness and to bring out changes in behavior and attitude toward infected individuals would help in reducing stigma associated with these diseases. Emphasis should be on the role of family, social support, and doctor–patient relationships in decreasing the stigma associated with any infectious diseases. During any health crisis like the COVID-19 pandemic comprehensive support to the survivors both from the administrators and the society are important to provide a healthy environment to improve the mental health of the individuals.

Strengths

Selection of the sensitive topics like this and trying to find out the factors associated with such issues itself is strength of this study.

Limitations

As this information was collected by telephonic interview, there is a chance of recall bias. However, the sample size is too less to generalize the results which is the drawback of the present study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Centers for Disease Control and Prevention (CDC). Use of quarantine to prevent transmission of severe acute respiratory syndrome – Taiwan, 2003. MMWR Morb Mortal Wkly Rep 2003;52:680-3.  Back to cited text no. 3
    
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Jain S, Das AK, Talwar V, Kishore J, Heena P, Ganapathy U. Social stigma of COVID-19 experienced by frontline healthcare workers of department of Anaesthesia and critical care of a tertiary healthcare institution in Delhi. Indian J Crit Care Med 2021;25:1241-6.  Back to cited text no. 13
    
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Agence France-Presse. Bangladesh Virus Hospitals Accused of Rejecting Slum Dwellers. Hindustan Times; 22 April, 2020.  Back to cited text no. 14
    
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Mahmud A, Islam MR. Social stigma as a barrier to COVID-19 responses to community well-being in Bangladesh. Int J Community Wellbeing 2021;4:315-21.  Back to cited text no. 15
    
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Sahoo S, Mehra A, Suri V, Malhotra P, Yaddanapudi LN, Puri GD, et al. Lived experiences of COVID-19 Intensive Care Unit survivors. Indian J Psychol Med 2020;42:387-90.  Back to cited text no. 16
    
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Correspondence Address:
Pidakala Mary Moses,
Plot No: 84, Vasanth Nagar 4th Lane, KPHB, Hyderabad - 500 085, Telangana
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjhs.mjhs_51_22




 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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