Stigma, awareness, and access: Social determinants of tuberculosis management in Sokoto state, Nigeria

Tuberculosis (TB) remains a major public health challenge in Nigeria, with Sokoto State bearing a significant burden. Social determinants, including stigma, poor awareness, and geographic accessibility, influence TB management outcomes. This study assessed social determinants affecting TB management in Sokoto State from 2020 to 2024. A descriptive cross-sectional design was employed, combining quantitative and qualitative methods. The study involved 200 respondents comprising health workers (40.0%), TB patients (27.5%), and public health officers (32.5%). Data were collected using structured questionnaires, patient record reviews, and key informant interviews. The Health Belief Model and Andersen's Health Care Utilization Model served as theoretical frameworks. Stigma/discrimination (36.0%) was the most significant barrier, followed by poor awareness/health education (30.0%). Long distance to treatment centers (12.5%), poor patient follow-up (7.5%), and drug stock-outs (9.0%) were also identified. Most respondents were male (59.0%), with 32.5% having no formal education. Treatment success rate was 80.0%, below the 85% WHO target. Concurrent research documented a "perception gap" where only 22.7% of caregivers perceived malnutrition as a problem despite 83.3% underweight prevalence. Additionally, 73.3% of households consume ≤4 food groups daily, 75.3% of caregivers have secondary education or less, 45.3% live in extreme poverty, and 65.3% live >5 km from health facilities. Social determinants, particularly stigma and poor awareness, significantly impede TB control in Sokoto State. Addressing these barriers through multi-level interventions, community awareness campaigns, engagement of religious/traditional leaders, peer support programs, and integration of TB services into general health services is critical to improving TB outcomes.