Knowledge and perceptions of tuberculosis among patients in a pastoralist community in Kenya: a qualitative study

Gendered gaps to tuberculosis prevention and care in Kenya: a political economy analysis study

BACKGROUND

Tuberculosis (TB) remains a public health concern in Kenya despite the massive global efforts towards ending TB. The impediments to TB prevention and care efforts include poor health systems, resource limitations and other sociopolitical contexts that inform policy and implementation. Notably, TB cases are much higher in men than women. Therefore, the political economy analysis (PEA) study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection.

DESIGN

PEA adopts a qualitative, in-depth approach through key informant interviews (KII) and documentary analysis.

SETTING AND PARTICIPANTS

The KIIs were distributed among government entities, academia, non-state actors and community TB groups from Kenya.

RESULTS

The themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritisation for TB programmes, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programmes were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviours. The themes around the economic situation were poverty and unemployment, food insecurity and malnutrition. The political context centred around the systemic and governance gaps in the health system from the national and devolved health functions.

CONCLUSION

Broad contextual factors identified from the PEA widen the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is essential to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care.

Voices from the Patients: A Qualitative Study of the Integration of Tuberculosis, Human Immunodeficiency Virus and Primary Healthcare Services in O.R. Tambo District, Eastern Cape, South Africa

Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. Studies have observed that TB-HIV integration reduces mortality. The operational implementation of integrated services is still challenging. This study aimed to describe patients' perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities (study sites) in Oliver Reginald (O.R) Tambo Municipality, Eastern Cape province, South Africa. We purposely recruited twenty-nine (29) patients accessing TB and HIV services at the study sites. Data were analyzed using qualitative content analysis and presented as emerging themes. Barriers identified included a lack of health education about TB and HIV; an inadequate counselling for HIV and the antiretroviral drugs (ARVs); and poor quality of services provided by the healthcare facilities. These findings suggest that the O.R. Tambo district needs to strengthen its TB-HIV integration immediately.

Knowledge, Attitudes, and Perceptions of Tuberculosis in Indonesia: A Multi-Center Cross-Sectional Study

Introduction

Tuberculosis (TB) is still a persistent health challenge in Indonesia and ranks high on the list of factors causing morbidity and mortality. Improving knowledge, attitudes, and perceptions (KAP) of the general community about TB can help to control the disease.

Purpose

This study aimed to examine the KAP about TB in Indonesian society and investigate their sociodemographic determinants.

Participants and Methods

An online cross-sectional survey in 34 provinces in Indonesia was carried out in June 2022. The scores of KAP were classified as low, moderate, and high. Bivariate and multivariate ordinal logistic regression were applied to identify the potential sociodemographic determinants of KAP. Adjusted odds ratio and 95% confidence interval (CI) for each determinant were provided.

Results

Among the 3205 participants, 56.4%, 91%, and 38% had high scores on knowledge, attitude, and perception, respectively. Independent determinants of high knowledge were age (26-35 years; adjusted odds ratio: 1.53 [95% CI: 1.19-1.97]), marital status (married; adjusted odds ratio: 1.18 [95% CI: 1.00-1.39]), and salary (middle income; adjusted odds ratio: 0.76 [95% CI: 0.63-0.93]). Independent factors associated with high scores in attitude and perception were the residence location (village; adjusted odds ratio: 0.76 [95% CI: 0.59-0.98]) and the occupation type (civil servant; adjusted odds ratio: 1.53 [95% CI: 1.09-2.13]), respectively.

Conclusion

Most Indonesians have a high knowledge and good attitude, although they have a moderate perception toward TB. Improving public awareness and health education with the right strategies is critical to reducing the country's TB burden.

Rasch Modelling to Assess Psychometric Validation of the Knowledge about Tuberculosis Questionnaire (KATUB-Q) for the General Population in Indonesia

OBJECTIVE

This study aims to validate and evaluate the psychometric properties of the knowledge about tuberculosis questionnaire (KATUB-Q) for the general population in Indonesia.

METHODS

The KATUB-Q consists of three domains: general knowledge, transmission, and treatment, with 20 dichotomous items. Rasch analysis through WINSTEPS was used.

RESULTS

A total of 504 respondents from 34 provinces in Indonesia completed the survey. Based on the model fit statistics, 3 misfit items were deleted and 17 items were used. Item and person reliability, as well as Cronbach's Alpha values were 0.99, 0.63, and 0.73, respectively, which means they achieved the minimum acceptable limit of 0.6. Based on the results, Indonesia's Person ability analysis indicated a high level of knowledge. KATUB-Q has no significant bias item based on sex found in the differential item functioning analysis.

CONCLUSION

KATUB-Q has 17 items with a valid and reliable instrument; hence, it can be used to measure the knowledge about TB in the general population.

PRACTICE IMPLICATIONS

The unidimensional structure of the core items of the KATUB-Q provides empirical evidence for using the sum score of the items in practice to evaluate the effectiveness of TB education in the general population.

Cross-sectional community-based assessment of knowledge, attitude and practices on tuberculosis in Osun State, South-west, Nigeria

Tuberculosis (TB) has continued to be a global public health issue, especially in developing countries, where Nigeria accounts for 4% of the global TB burden. However, to achieve the Sustainable Development Goals targets for 2030, there is a need for adequate and robust awareness campaigns to ensure that individuals in the communities are aware of the total TB program package. This study assessed the knowledge, attitudes and practices (KAP) towards TB of the residents of two communities affected by the TB scourge in Osun State, Nigeria. An interviewer-administered, semi-structured questionnaire adapted from the WHO-KAP study guide was employed, and the data generated were analysed using the SPSS statistical package. A total of 280 respondents participated in the study comprising 162 (57.9%) males and 118 (42.1%) females, a large percentage of the respondents (273/97.5%) know about TB and know that anybody can be infected (63.6%). However, in this study, we obtained the following KAP scores: overall good knowledge of TB: 60% (Iwo- 54.7% and Ikire-65.2%), overall good attitude towards TB: 50% (Iwo- 53.3% and Ikire- 46.7%) and overall good TB preventive practices 65.2% (Iwo- 66.6% and Ikire- 63.8%). Ikire respondents were significantly more knowledgeable than Iwo respondents (p = .002), while Iwo respondents had better TB attitudes than Ikire respondents (p = .03). Predictors of good KAP scores were accommodation type, education, age and main source of income of respondents. This study assessed the level of community TB-KAP and reinforced the need for a more robust awareness campaign for better TB health service utilisation.

Knowledge and transmission risk awareness of tuberculosis among the pilgrims attending a religious mass gathering in India: a cross-sectional study

Background

Tuberculosis infection accounts for more annual deaths than any other single infectious disease, except the Corona Virus infection. It is a significant global issue and India is one of the most affected countries. Religious mass gatherings congregate millions of pilgrims at one place. Over-crowding is a high-risk factor for the transmission of tuberculosis. Knowledge and awareness of the disease are proven prerequisites for the spread-prevention and early diagnosis of tuberculosis. The present study was designed to explore the knowledge of tuberculosis and awareness of disease transmission risk among pilgrims attending a religious mass gathering, the Kumbh Mela (2016) in Ujjain, India.

Methods

Self-reported data on the pilgrims’ tuberculosis-knowledge were collected using a cross-sectional study design. A contextual, pre-tested questionnaire was used, using the convenience sampling method. In addition to the anonymous descriptive analyses, a composite knowledge-score was developed to enable comparisons between demographic groups.

Results

In total, 1665 pilgrims participated in the study with 38.8 years of mean age and 59% literacy rate. The most recognized symptoms of tuberculosis were “Cough for more than 15 days with sputum” (94%) and “Blood in sputum” (81%). Most participants knew that tuberculosis is an infectious disease (93%) and not hereditary (91%). Additionally, 84% considered it is a potentially lethal disease that requires extensive treatment. However, vaccine awareness was poor (4%). “Direct contact with tuberculosis patient” (78%) and “To be in a crowded area” (4%) were considered as the most important risk factors for tuberculosis transmission. For the composite knowledge-score, a significantly higher mean score was seen among those with at least ten years of schooling compared with illiterates (p <  0.001). Occupation and residency also affected the mean score.

Conclusion

Most pilgrims attending the Kumbh Mela had basic knowledge of the characteristics of tuberculosis, but some important knowledge gaps concerning the transmission risks associated with crowded situations existed. These gaps need to be addressed in future policies to enable safer mass gatherings and to end the TB epidemic, globally.

Knowledge, Beliefs, and Perceptions of TB and Its Treatment amongst TB Patients in the Limpopo Province, South Africa

Despite the implementation of global plans to end tuberculosis (TB), this disease remains a major cause of ill-health and is the second leading cause of death. In 2019, globally, an estimated 10.0 million people fell ill and about 1.4 million died of TB. During the same year, South Africa was among the eight countries with the highest tuberculosis burden, contributing to two-thirds of the world’s total. Due to the high burden of the human immunodeficiency virus (HIV) epidemic, TB in South Africa is a major public health problem. Limpopo is amongst the provinces that are hardest hit by TB and HIV in South Africa. Therefore, using a quantitative descriptive design, this study assessed the knowledge, beliefs, and perceptions of TB and TB treatment amongst TB patients in the Limpopo Province. A systematic random sampling method was used to sample 207 TB patients who agreed in writing to be part of the study. Data were collected using a self-administered questionnaire, however, about 3.9% of participants who could not read were assisted by the main researcher and health professional. About 33% of the participants with primary education were also assisted to clarify any questions that were not clear to them. Data were analyzed using the Statistical Package for Social Sciences^® version 26.0. Validity and reliability of the instrument was ensured, and ethical considerations were observed in this study. The research findings revealed that about 93.25% respondents only came to know they had TB after diagnosis. About 75% indicated that they had visited faith healers and only 2% acknowledged that they had visited traditional healers after diagnosis. A total of 76% of the respondents stated that they strongly believed in their culture and religion. These findings highlight the need for health education efforts to strengthen accurate information to improve TB knowledge and correct misconceptions about TB among patients within the community.

Assessment of delayed tuberculosis diagnosis preceding diagnostic confirmation among tuberculosis patients attending Isiolo County level four hospital, Kenya

INTRODUCTION

delayed diagnosis of Mycobacterium tuberculosis infection leads to accelerated individual to individual transmission. This study evaluated this aspect of delayed diagnosis among patients visiting Isiolo level four hospital in northern Kenya.

METHODS

this was a cross-sectional cohort study conducted during January, 2018-January, 2019 with systematically sampled 172 tuberculosis (TB) patients. Epidemiological and clinical characteristics were abstracted from records to serve as independent variables. Outcome variable was delayed diagnosis dichotomised into < 21 or > 21 days and treated as a binary outcome. Pre-tested interviewer-administered questionnaires, focused group discussions, and key informant interview guides were used to collect relevant information.

RESULTS

most (n=89, 57.8%) of the TB diagnosis fell in the category of > 21 day delay. Overall, among all patients, delay in days constituted a median of 27.6, a mean of 37.3 ± 57 days (range 0-414 days). Factors associated with delayed diagnosis (happening > 21 days) included (i) use of dispensary and private health facilities, (OR=4.3, 95% CI: 1.44,13.14; P=0.009) and (OR= 4.9, 95% CI: 1.64, 14.73; P=0.004), respectively (ii) Self-employed individuals (OR=21.7, 95% CI: 2.47,190.93; P=0.006) and employed individuals (OR=9.9, 95% CI: 1.14, 85.80; P=0.038) (iii) secondary-level education (OR=0.03, 95% CI: 0.01,0.21; P=0.000) and tertiary education (OR=0.033, 95% CI: 0.01, 0.23; P=0.001).

CONCLUSION

delayed diagnosis of TB was found to be associated with health-seeking behaviour of TB patients, proxied by diagnosis facility, occupation, and education levels in our study area. Curtailment of local transmission of M. tuberculosis needs intensified health promotion and education in affected communities complemented with active case findings.

Perceived stigma among patient with pulmonary tuberculosis at public health facilities in southwest Ethiopia: A cross-sectional study

OBJECTIVES

Although tuberculosis (TB) related stigma has a significant impact on the diagnosis, patient adherence with treatment, and recovery from the disease, there is limited evidence from Ethiopia regarding perceived stigma among patient with pulmonary tuberculosis (PTB).The purpose of this study was to assess perceived stigma and associated factors among patient with PTB on treatment in southwest Ethiopia.

METHODS

Institution-based cross-sectional study was conducted from April to May 2019 among 410 patient with PTB. Data were collected by using the perceived tuberculosis stigma scale. Epi data v3.1 and SPSSv23 were used for data entry and analysis. Multivariable logistic regression models were fitted to identify factors associated with perceived stigma. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

RESULT

Prevalence of perceived stigma among patient with Pulmonary tuberculosis was 57.1% (95% CI: 52.2, 61.7). Poor social support (AOR = 2.41; 95% CI: 1.06, 5.48), above a month duration of illness (AOR = 2.48; 95% CI: 1.33, 4.64), high perceived stress (AOR = 1.95; 95% CI:1.09, 3.49), current khat use (AOR = 1.88; 95% CI:1.05, 3.37), and presence of depression (AOR = 8.18; 95% CI:4.40, 15.22) were significantly associated with perceived stigma. Patient with HIV co-infection were 5.67 times (AOR = 5.67; 95% CI: 2.32, 13.87) more likely to have Perceived stigma than their counterparts.

CONCLUSION

TB related stigma was reported by more than half of the study participant. Stigma reduction measures are needed to lower TB related stigma perceived by the patient, the level of distress associated with it, and to promote the psychological wellbeing of patient with TB.

Burden of stigma among tuberculosis patients in a pastoralist community in Kenya: A mixed methods study

BACKGROUND

Tuberculosis (TB) stigma remains a barrier to early diagnosis and treatment completion. Increased understanding of stigma is necessary for improved interventions to minimise TB stigma and its effects. The purpose of this study is to quantitatively measure TB stigma and to explore qualitatively its manifestation among TB patients in a rural Kenyan community.

METHODS

This hospital based study using explanatory sequential mixed methods approach was conducted in 2016. In the quantitative part of the study, a questionnaire containing socio-demographic characteristics and scales measuring perceived TB stigma and experienced TB stigma, was administered to 208 adult pulmonary TB patients receiving treatment in West Pokot County. Respondents with high stigma were purposively selected to take part in in-depth interviews and focus group discussions. The qualitative data were collected through 15 in-depth interviews and 6 focus group discussions with TB patients. Descriptive and bivariate analysis was done for the quantitative data while the thematic analysis was done for qualitative data.

RESULTS

The internal consistency reliability coefficients were satisfactory with Cronbach alphas of 0.87 and 0.86 for the 11-item and 12-item stigma measurement scale. The investigation revealed that TB stigma was high. The key drivers of TB stigma were the association of TB with HIV/AIDS and the fear of TB transmission. TB stigma was exemplified through patients being isolated by others, self-isolation, fear to disclose TB diagnosis, association of TB with human immunodeficiency virus (HIV) and lack of social support. Being a woman was significantly associated with high levels of both experienced stigma (p = 0.007) and perceived stigma (p = 0.005) while age, marital status, occupation and the patient's religion were not.

CONCLUSION

There is a need to implement stigma reduction interventions in order to improve TB program outcomes.