Far from Home: Why Women in Enugu South Travel Miles to Hide Their TB Fears

At just 25, Sandra (not her real name) still remembers the shock of being told she had tuberculosis (TB). Like many people, she initially believed TB was almost a death sentence. “It was hard initially. In this country, when you’re diagnosed with tuberculosis, it’s like a death sentence, more like having HIV. It’s really disturbing,” she said.

Her symptoms had started like a normal cough, so she treated herself with antibiotics. “I thought it was a normal cough… but after two days it came back. It became persistent, so I went to the health facility,” she explained. The diagnosis changed everything, but counselling helped her shift her mindset. “I discovered it’s curable. Once you’re taking your medication and you’re constant with your drugs, you will recover in no time.”

The stigma she faced was more painful than the illness itself. Friends stopped visiting and kept their distance, afraid of infection. “It became clear to me they were not really my friends,” she said. “I really felt pained by their actions… this has taught me not to stigmatise people because of their TB status. I used to be like that until it happened to me.”
Today, Sandra travels monthly to the Enugu State Medical Centre, about 20 kilometres from her home, to receive medication. “I spend over one thousand naira on transport and also the time I have to spend going there,” she said.
Despite the long and costly journey, she feels safer getting care away from her community, where stigma still lingers.

TB, stigma and women
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. According to the World Health Organization (WHO), it most often affects the lungs but can also attack other parts of the body. It is spread through the air when a person with active TB of the lungs or throat coughs, sneezes, speaks or sings. Not everyone infected becomes sick: some people carry the bacteria without symptoms, while others develop active disease when the bacteria overcome the body’s defences.
Nigeria is among the top ten countries in the world with the highest number of TB cases, recording over 200,000 new infections each year, according to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Treatment coverage has improved in recent years, but many people with TB are still not diagnosed or enrolled in care.
Stigma around TB affects everyone, but it often hits women harder. In many communities, women are expected to keep their homes clean and families healthy. When a woman is diagnosed with TB, some people see her as “unclean” or as someone who has failed in her role. Others wrongly assume she must also have HIV. This perception makes women feel ashamed and afraid to speak up or seek help.
Because of this fear, many women delay going to the hospital when they start coughing or feeling weak. They hide their symptoms so that neighbours or relatives won’t suspect anything, or they travel long distances to access treatment where no one knows them. Health experts say this delay makes the illness worse and increases the risk of infection to others.
The National Tuberculosis and Leprosy Control Programme (NTBLCP) reports that stigma remains one of the biggest reasons people refuse to get tested or complete their treatment.
Stigma also brings social and emotional pain. Some women are avoided by friends and neighbours after their diagnosis. Others are abandoned by partners or lose their jobs. Women who depend on daily income may struggle to pay for transport to health facilities or to care for their children while undergoing treatment

“Nobody knows about my TB status”
Margret, a widow and petty trader, began experiencing serious leg pain that made it difficult to walk or carry out her daily activities. Her children had to assist her at home. At first, she thought she had been poisoned and started taking medication for poison, but the pain persisted. A neighbour whose brother worked in a health facility advised her to go to for further testing.
“I told him I didn’t have money, but he assured me not to worry, that it would be taken care of. When I got to the medical centre, a health worker asked me some questions before I did the tests. After the results came out, I was told I had TB” Margret said
Before the leg pain started, she had experienced a serious cough that later subsided. “When the leg pain began, I noticed the cough returned, though not as severe. I also had frequent fever alongside the leg pain,” she said. “I was given drugs to help me recover, and I was also given drugs for my two children, though they don’t know about my TB status.”
The distance from Margret’s house to the medical centre is about 50 kilometres. She travels there by public transport but insists that the distance is worth it for quality care and privacy.
“Nobody knows about my TB status, not even my children,” she said. “They only know I’m on medication. I refused to explain when they asked because I don’t want people to find out and start avoiding me or gossiping about me and my children” she said.

“I nearly died that day”
Ebube (not her real name), a trader in her early forties from Agbani, began experiencing a severe cough and body pains but had no idea it was TB.
“When it started disturbing me, I didn’t know it was TB,” she said. She visited several labs in Agbani, where she was repeatedly told it was “cold”.
“They prescribed some drugs for me…but I wasn’t getting better. It was really disturbing me, and every day I cried,” she recalled.
On 30 December 2024, her condition became critical. “I wasn’t myself at all. I nearly died that day,” she said. A friend called and, after hearing about her symptoms, offered to take her to a lab near Uwani, close to Eastern Nigeria Medical Center (ENMC). Her throat pain stopped after taking the prescribed medication, but “the cough continued,” prompting her to return with her friend.
“When we finally met the doctor, he said I had TB and referred me to Eastern Nigeria Medical Center (ENMC). He even called the doctor there to inform them I was coming,” she said. At ENMC, tests confirmed TB and she was placed on treatment. “I didn’t miss a single day because I knew what I had suffered. I was told I would take the drugs for six months and that I would recover.”
People in her neighbourhood supported her. “They saw the pain I went through…but they didn’t avoid me. Instead, they showed love, care, and concern,” she said. But she keeps her status secret at her business location. “I don’t want them to know. It might affect my business.”

Choosing distance, choosing trust
Another patient, Patricia Nathaniel (not her real name), travels from Akwuke to the Ikirike Health Centre, about 6.7 kilometres away, a 20-minute drive. Asked why she didn’t use the primary health centre closer to her home, she replied: “I want my friend Justina (the health worker) to treat me. I trust her and I don’t mind coming this distance.”
Agnes (not her real name), a 59-year-old fruit seller from Coal Camp, had a similar experience of travelling for care and keeping her diagnosis discreet.
“I discovered I had TB after experiencing symptoms like chest pain, persistent cough and irritation. At first, I thought it was malaria, but when I wasn’t getting better, I decided to come down to the medical centre,” she said. A TB focal person advised her to do a TB test “because the symptoms were suggestive of tuberculosis”.
“I went for a test…and the result came out positive. I immediately started taking the prescribed drugs,” she said. She was referred to a Directly Observed Therapy (DOT) centre for treatment, while her household members were screened. “Fortunately, their results came out negative, and they were given preventive drugs. I was taking TB treatment drugs, while they took preventive ones.”
Agnes chose not to seek help closer to home. “One can choose to go to any DOT facility or health centre they prefer. It doesn’t have to be the one close to your home. It’s all about finding a solution to your health problem,” she said. She also kept her diagnosis private. “I don’t think anyone apart from my family members knows I have TB. I didn’t tell anyone, and it’s not written on the forehead. Besides, I didn’t look critically ill.”

“A major public health problem”
The Programme Manager for TB, Leprosy and Buruli Ulcer Control in Enugu State, Dr Odo Chidebere, described TB as “a major public health problem” in the state and across Nigeria. She noted that TB is highly communicable and spreads through the air when an infected person is not on treatment.
“Nigeria happens to be the first in Africa and the sixth among countries with high TB cases,” she said, citing 2022 national data.
Dr Odo explained that the TB office collects data quarterly. “In the first quarter of 2025, we got 1,101 cases, while in the second quarter we got 1,144. So, in the first two quarters, we have gotten over two thousand cases.” These cases include both adults and children across all 17 local government areas. Some LGAs – Udenu, Igboeze North and Igbo-Etiti record the highest number of diagnosed cases.
She emphasized the need for active case search, because there are still people that have it but have not been found.
On gender, she said recorded cases appear higher in women, but this reflects health-seeking behaviour, not necessarily higher infection. “Women present themselves to health facilities more than men. Most men will say there’s no time… They will only visit the health facility if they notice that the drugs are not healing them.” As a result, advanced TB cases are more common among men.
Treatment, however, does not differ between men and women. “The treatment for men and women is the same. We only consider weight,” he said, adding that “women are more likely to complete their treatment” and urging men to adhere to the six-month schedule.
Stigmatization remains one of the biggest barriers. “People feel that just talking with someone with TB will infect them,” he said. He stressed that TB is not transmitted by “hugging, talking, kissing or shaking someone infected” and called for greater public understanding so that patients are encouraged, not isolated.
Because of stigma, many patients avoid local health centres and travel to distant locations to keep their diagnosis secret. This fear affects women particularly, leading to job loss and community isolation. “There have been cases of people losing their jobs. That’s why we let the public know that anyone who has TB and is on treatment cannot infect anyone. Hence, they shouldn’t be relieved from their jobs,” he said.
The Ministry of Health plays an active role in tackling TB, she added. “The Buruli Ulcer and TB Programme is under the Ministry of Health. Having this programme under the Ministry shows that they are really concerned about this communicable disease,” she said. The Ministry supports daily screening in public and private facilities, receives reports from TB activities, and drives awareness campaigns in communities, churches, markets and other public spaces.
Despite these efforts, stigma and misinformation persist. “The major gap that still exists in TB care and needs urgent attention is stigma,” she said. Many patients give wrong phone numbers or addresses to avoid follow-up, or deny their diagnosis and turn to traditional remedies. “Some will tell you it’s not their portion… they say it’s poison and choose to patronize traditional herbs. They only return when it gets worse, like vomiting blood or being unable to walk. But we try our best to treat them; we don’t reject anyone.”

Inside the health centres
At the Ikirike Health Centre, TB focal person and facility head, Justina Odoh, explained the first steps when a patient presents with symptoms.
“When people come to the health centre to complain, they are screened,” she said. “We ask if they have fever, night sweats, persistent cough or other signs of TB. If we suspect TB, we give them a sputum cup and send the sample to the lab at ENMC for a test. If it comes out positive, they are placed on medication.”
Speaking further on the challenges women with TB face, she noted that some leave the free public system because of fear of recognition, only to pay for services elsewhere. “Knowing fully well everything is free here, they choose to still go out where they are likely to meet people that will extort from them, people that are not sincere like us. They tend to pay for the drug, meanwhile it’s free.”
On approaches to make it easier for women to seek care, she stressed the importance of awareness. “The simple approach is enlightenment. By the time they are told that people have been coming and getting cured, we tell them when they hide their sickness, it becomes dangerous to their health. But once they are open about what is disturbing them, they get cured. There’s a need to create more awareness, like radio jingles, to tell people it’s not a death sentence; it’s curable.”
She acknowledged that TB drugs have side effects. “Some feel dizzy, some are affected under the sun, others have different reactions. These side effects often discourage patients, but they usually stop after the first two months,” she said.
“Poverty, shame and carelessness”
Another medical practitioner at ENMC, Dr Donald Aneke, offered further insight into how stigma affects individuals diagnosed with TB.
“Till today, TB is still associated with poverty, shame and carelessness in our communities, so you’d observe that patients are already labelled with those tags even before we have confirmed diagnosis,” he said.
“It takes several forms: social isolation, family members avoiding them, their plates, spoons, refusing to enter their rooms. There is also the blame game where they act like the patient must have been living dirty or brought it on themselves. There is also discrimination where schools and workplaces refuse to allow patients back even long after they are non-infectious.”
He said stigma is driven by TB’s perceived link with HIV, lack of information and class prejudice. “Some people still think it’s incurable. Some people also link it with poverty and wouldn’t want to be seen as poor.”
Stigma heavily influences patients’ willingness to seek care. “Many patients delay presentation and try several treatments before coming to the hospital because of fear of being labelled,” he said.
The mental and emotional consequences can be long-lasting. “Many have had to deal with anxiety and depression, even after they’ve been cured. They battle with confidence and self-esteem issues and all these are worsened by social withdrawal,” Dr Aneke added.
He believes education, confidentiality and patient voices are central to reducing stigma. “If people are aware that it is curable and patients are mostly not infectious after a few weeks of treatment, then the stigma would reduce,” he said. “When counselling patients, we should also counsel their family members. We should maintain patient confidentiality and be as discreet as possible. Healthcare workers should also be trained because sometimes, stigma starts with health workers. And I think we should empower cured patients as ambassadors, helping them share their powerful testimony with the world.”
Data Collection
Under Enugu-South Local Government Area in Enugu State, there are fourteen (14) public health facilities. I visited each facility to collect data on positive TB cases, including the number of male and female patients for each quarter from 2024 to the third quarter of 2025. The information was obtained using the Enugu State TB Case Finding Tool 2024/2025 to ensure a comprehensive and accurate dataset.
During the research, I observed that both health workers and TB patients frequently mentioned a private medical facility, Dr. Nlogha Okeke Memorial Medical Foundation (Eastern Nigerian Medical Center), which has a DOT health center equipped with a GeneXpert machine for TB testing.
Health workers highlighted that they send sputum samples of suspected cases there for testing, while patients indicated a preference for receiving treatment at this facility. Consequently, I visited the medical center to collect its data as well. Below are the compiled TB case data from each health facility.

Table

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