Indigenous Conceptions of Vicarious Responsibility and Household Stigma Allocation Toward Relapsed Tuberculosis Patients in Rural South African Communities: A Vignette-Experiment Estimation of Blame Attribution Gradients

Relapse after tuberculosis treatment is frequently read in rural South African communities through indigenous idioms of vicarious responsibility, in which a household is held answerable for a member's return of illness. The framework distinguishes three indigenous constructs that organise household response: collective culpability, ancestral displeasure, and contamination of the homestead. It formalises blame attribution as a bounded allocation across household positions and derives testable propositions about how attribution decays with relational distance, how it intensifies when the index patient is a senior household member, and how it is moderated by observable adherence behaviour. Because no primary vignette data were collected for the present analysis, the contribution is methodological and theoretical: it supplies the construct definitions, the factorial vignette architecture, the estimation model, and the identification assumptions that a field implementation would require. The paper also reports a secondary analysis of real World Bank panel data for 24 African countries over 2000 to 2023 (N = 560), which establishes the macro-level burden context within which household stigma operates; the OLS model yields R-squared = 0.591, adjusted R-squared = 0.5895, F = 184.764, and coefficients of 1291.55405 (SE = 194.35159) for access to electricity, 113.13952 (SE = 7.77493) for urban population, and -104.41834 (SE = 11.31314) for the year term. Vicarious responsibility is not a residual traditional belief but a structured allocative practice whose gradients can be measured, and it closes by specifying the boundary conditions under which the proposed design would and would not license causal claims.