1
|
Imam F, Sharma M, Obaid Al-Harbi N, Rashid Khan M, Qamar W, Iqbal M, Daud Ali M, Ali N, Khalid Anwar M. The possible impact of socioeconomic, income, and educational status on adverse effects of drug and their therapeutic episodes in patients targeted with a combination of tuberculosis interventions. Saudi J Biol Sci 2021; 28:2041-2048. [PMID: 33911919 PMCID: PMC8071916 DOI: 10.1016/j.sjbs.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022] Open
Abstract
Socio-economic status is very important in patient receiving DOT therapy. Income influences disease occurrence as well as adverse events. Occupation increases the risk of diseases and results increase risk of adverse events. Low income results mal nutrition and increased risk of drug intolerance or adverse events. DOTS is an effective treatment strategy for MTB patients.
First-line antituberculosis (anti-TB) compounds have been considered as proven components of the Directly Observed Treatment-Short course (DOTS). Drug therapy against tuberculosis has been categorized as I, II, or III following the Revised National Tuberculosis Control Program guidelines. Anti-TB are drugs are quite common and show limited adverse effects. However, first-line anti-TB compounds mediated DOTS therapy and were found with several complications. Thus, those drugs have been discontinued. Therefore, the present study was designed to find out the possible impact of socioeconomic, income, and educational status on the adverse effects of drugs and their therapeutic episodes in patients targeted with a combination of tuberculosis intervention. This study found that an increased incidence of tuberculosis was found in patients who have finished high school, contributing to a high percentage of adverse effects. Notably, adverse events were shown maximally in poor patients compared with rich- or high-income patients. On the contrary, a high prevalence of adverse events was shown to be increased in partially skilled workers compared with full-skilled workers. Consequently, adversely considerable events were implicated to be raised in patients associated with minimal socioeconomic class. Such interesting factors would help in monitoring such events in experimental patients.
Collapse
Affiliation(s)
- Faisal Imam
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Corresponding author at: Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Post Box 2455, Riyadh 11451, Saudi Arabia.
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Hamdard University, New Delhi 110062, India
| | - Naif Obaid Al-Harbi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammad Rashid Khan
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Wajhul Qamar
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Central Laboratory, Research Center, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Muzaffar Iqbal
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammad Daud Ali
- Mohammed Al-Mana College for Medical Sciences, Abdulrazaq Bin Hammam Street, As Safa, Dammam 34222, Saudi Arabia
| | - Nemat Ali
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Md. Khalid Anwar
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
| |
Collapse
|
2
|
Dorji T, Tshering T, Wangdi K. Assessment of knowledge, attitude and practice on tuberculosis among teacher trainees of Samtse College of Education, Bhutan. PLoS One 2020; 15:e0241923. [PMID: 33156845 PMCID: PMC7647099 DOI: 10.1371/journal.pone.0241923] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023] Open
Abstract
Background Tuberculosis (TB) is a major public health problem in Bhutan despite the implementation of directly observed treatment short-course since 1997. This study aimed to assess the knowledge, attitude and practice on TB among the teacher trainees of Samtse College of Education. Methodology A cross-sectional study was conducted among the teacher trainees of Samtse College of Education. A standardized pretested questionnaire was distributed and self-administered. The participants were selected randomly using randomization. The data was entered in Epi-data 4.4.2.1 and analysed using STATA version 13. A score of 1 point for a correct answer and 0 for wrong/don’t know answer was given. The knowledge, attitude and practice score were divided into good and poor based on 50% cut off. Logistic regression was used for the analysis to identify the significant covariates. Results A total of 420 trainees responded to the survey questionnaire. The average knowledge score on TB was 10.7 (Range = 0–21). Two hundred and forty respondents (58.6%) had low knowledge (mean score 7.8±2.5) on TB. Cough, chest pain and weight loss were correctly reported as the symptoms of TB by 306 (72.9%), 187(44.5%) and 187 (44.5%) participants. Eighty-nine-point five percent (376) of participants reported coughing as the main route of TB transmission and 85% (357) of the participants said that it could be prevented by covering the mouth while coughing. In multivariable analysis; the trainees in the junior years of college had good knowledge of TB compared with the senior years (adjusted odds ratio [AOR] 2.02; 95% confidence interval [CI] 1.18–3.5; p-value 0.011). Respondents previously treated for TB were more likely to have good knowledge on TB compared to those who never had TB in the past (AOR 2.39; 95% CI 1.07–5.31; p-value 0.033). The majority (93%) of respondents had a good attitude towards TB cases. Female trainees were 2.4 (95% CI 1.02–5.62; p-value 0.045) times more likely than male trainees to have a positive attitude towards TB. Eighty-eight percent of the respondents reported that they would visit the hospital if they had TB symptoms. The mean score for the practice on TB was 1.33±0.59 (Range:0–2). Conclusion In this study, the majority of the trainees had poor knowledge on TB, especially among the trainees in senior years of college and those who had never suffered from TB. The attitude towards TB was good especially among the female trainees. However, the overall practice was poor among the participants. Therefore, the Ministry of Health should collaborate with relevant stakeholders especially the Ministry of Education to incorporate topics on TB in the syllabus of students and colleges to create awareness on it.
Collapse
Affiliation(s)
| | | | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Acton, Canberra, ACT, Australia
| |
Collapse
|
3
|
Mbuthia GW, Nyamogoba HDN, Chiang SS, McGarvey ST. Burden of stigma among tuberculosis patients in a pastoralist community in Kenya: A mixed methods study. PLoS One 2020; 15:e0240457. [PMID: 33057420 PMCID: PMC7561176 DOI: 10.1371/journal.pone.0240457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- * E-mail:
| | | | - Silvia S. Chiang
- Department of Pediatrics, Alpert Medical School, Brown University, Providence, RI, United States of America
- Center for International Health Research, Rhode Island Hospital, Providence, RI, United States of America
| | - Stephen T. McGarvey
- International Health Institute, and Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States of America
| |
Collapse
|
4
|
Imam F, Sharma M, Khayyam KU, Al-Harbi NO, Rashid MK, Ali MD, Ahmad A, Qamar W. Adverse drug reaction prevalence and mechanisms of action of first-line anti-tubercular drugs. Saudi Pharm J 2020; 28:316-324. [PMID: 32194333 PMCID: PMC7078525 DOI: 10.1016/j.jsps.2020.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/27/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Understanding the appearance of anti-tubercular drug-related adverse drug reactions (ADRs) in patients receiving tuberculosis (TB) treatment is important, and may be related to morbidity and mortality if not recognized early. Here, we aimed to characterize the mechanisms underlying adverse drug reactions due to combination anti-tuberculosis therapy of the Revised National Tuberculosis Control Program (RNTCP). METHODS This was a prospective observational study conducted in 9 DOTS centers of New Delhi, India. All enrolled TB patients receiving first-line tuberculosis treatment as per RNTCP guidelines were monitored for ADRs. All ADRs that appeared during the treatment were recorded and analyzed. RESULTS The study included 1011 TB patients on anti-TB treatment under DOTS. According to Naranjo's probability scale, of a total 351 (34.72%) reported adverse events, 102 (10.09%) were definite, 59 (5.83%) probable, 123 (12.17%) possible, and 67 (6.63%) doubtful. On the Hartwig severity scale, of the 351 adverse drug events, 225 (22.26%) were mild, 105 (10.38%) were moderate, and 21 (2.08%) were severe. Out of 102 reported adverse drug reactions, 81 (79.41%) were moderate and 21 (20.59%), while 65.28% did not experience any ADRs. CONCLUSIONS Directly Observed Treatment (DOT) is effective and safe compared to daily treatment regimens. Patients receiving DOTS therapy needed close monitoring for adverse events. Therefore, a pharmacovigilance program should be added at the National level to accesses the adverse event incidence.
Collapse
Affiliation(s)
- Faisal Imam
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Hamdard University, New Delhi 110062, India
| | - Khalid Umer Khayyam
- Department of Epidemiology & Public Health, National Institute of Tuberculosis & Respiratory Diseases, New Delhi 110030, India
| | - Naif O. Al-Harbi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
| | - Mohd. Khan Rashid
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
| | - Mohammad Daud Ali
- Mohammed Al-Mana College for Medical Sciences, Abdulrazaq Bin Hammam Street, As Safa, Dammam 34222, Saudi Arabia
| | - Ayaz Ahmad
- Mohammed Al-Mana College for Medical Sciences, Abdulrazaq Bin Hammam Street, As Safa, Dammam 34222, Saudi Arabia
| | - Wajhul Qamar
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
- Central Laboratory, Research Center, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| |
Collapse
|
5
|
Nautiyal RG, Mittal S, Awasthi S, Singh RK. Knowledge about tuberculosis among pulmonary tuberculosis patients: A cross-sectional study from Uttarakhand. J Family Med Prim Care 2019; 8:1735-1740. [PMID: 31198746 PMCID: PMC6559062 DOI: 10.4103/jfmpc.jfmpc_51_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major health problem in India. The Revised National TB Control Programme (RNTCP) is working towards elimination of TB in the country by 2025. As the RNTCP relies on passive case finding, it is crucial for the success of the RNTCP that TB patients have knowledge about their disease. The present study aimed to assess the knowledge of TB among pulmonary TB (PTB) patients. MATERIALS AND METHODS A cross-sectional questionnaire based study using a pretested semi-structured questionnaire among new and previously treated PTB patients at Haldwani Block of Nainital District of Uttarakhand State of North India. Data was analyzed using the software Epi Info version 7.2.0.1. RESULTS A total of 111 PTB patients with mean age of 36.3 years were included for final analysis. Only 43.2% PTB patients were aware that TB is caused by germs, 48.6% knew that it is not a hereditary disease. Only 13.5% PTB patients knew that vaccine is available and majority (68.5%) were aware of covering mouth and nose while coughing and sneezing for prevention of the disease. Overall, only two-third (65%) patients had good knowledge about TB. CONCLUSIONS About one-third of PTB patients had poor knowledge about TB. This highlights that to achieve elimination of TB, RNTCP needs to change the present information, education, and communication (IEC) system which is based on a bio-medical framework, and to design a culturally sensitive health education system. Alternatively, the Programme needs to shift from passive case finding to active case finding strategy.
Collapse
Affiliation(s)
- Ram G. Nautiyal
- Department of Respiratory Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Sneha Mittal
- Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Sadhana Awasthi
- Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Rajesh K. Singh
- Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| |
Collapse
|
6
|
Patient Health Seeking and Diagnostic Delay in Extrapulmonary Tuberculosis: A Hospital Based Study from Central India. Tuberc Res Treat 2019; 2019:4840561. [PMID: 30854235 PMCID: PMC6378024 DOI: 10.1155/2019/4840561] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/12/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022] Open
Abstract
Objective We aimed to investigate the awareness, health care seeking behavior, and diagnostic delay in extrapulmonary tuberculosis (EPTB) in a resource-constrained setting from Central India. Setting and Method Questionnaire based interview of 1220 EPTB patients ≥14 years of age was conducted between July 2004 and August 2012 at Ujjain charitable Hospital, Ujjain, India. Results Only 15% of patients had ever heard about EPTB and 2-4% knew about its prevention or treatment. Only 12% patients first sought medical advice while 49% patients practiced self-medication, 28% consulted traditional healers and 11% drug store/pharmacy. The median patient delay was 8 weeks (4.6-21.4 weeks). Majority (78%) of patients visited ≥3 health centers. Thirty-eight percent patients first visited any government health facility. Majority (97%) who first visited district and primary public health center were referred to private sector for investigations and 82% patients changed the consultation to private doctor after initial visit to public hospital. The median health system delay was 7 weeks (0.6-16.4 weeks). Conclusion Patients had very poor awareness of EPTB. Patients were referred from public to private sector in search of diagnostic facilities. Improvement of public awareness about EPTB and better public-private partnership may contribute towards reduction in diagnostic delay.
Collapse
|
7
|
Méda ZC, Somé T, Sombié I, Maré D, Morisky DE, Chen YMA. Patients infected by tuberculosis and human immunodeficiency virus facing their disease, their reactions to disease diagnosis and its implication about their families and communities, in Burkina Faso: a mixed focus group and cross sectional study. BMC Res Notes 2016; 9:373. [PMID: 27473578 PMCID: PMC4965888 DOI: 10.1186/s13104-016-2183-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 07/23/2016] [Indexed: 12/02/2022] Open
Abstract
Background Patients facing tuberculosis (TB) and human immunodeficiency virus (HIV) infection receive particular care. Despite efforts in the care, misconceptions about TB and HIV still heavily impact patients, their families and communities. This situation severely limits achievement of TB and HIV programs goals. This study reports current situation of TB patients and patients living with HIV/AIDS (PLWHA) facing their disease and its implications, by comparing results from both qualitative and quantitative study design. Methods Cross sectional study using mixed methods was used and excluded patients co-infected by TB and HIV. Focus group included 96 patients (6 patients per group) stratified by setting, disease profile and gender; from rural (Orodara Health District) and urban (Bobo Dioulasso) areas, all from Hauts-Bassins region in Burkina Faso. Quantitative study included 862 patients (309 TB patients and 553 PLWHA) attending TB and HIV care facilities in two main regions (Hauts-Bassins and Centre) of Burkina Faso. Results A content analysis of reports found TB patients and PLWHA felt discriminated and stigmatized because of misconceptions with its aftermaths (rejection, emotional and financial problems), mainly among PLWHA and women patients. PLWHA go to healers when facing limited solutions in health system. There are fewer associations for TB patients, and less education and sensitization sessions to give them opportunity for sharing disease status and learning from other TB patients. TB patients and PLWHA still need to better understand their disease and its implication. Access to care (diagnosis and treatment) remains one of the key issues in health system, especially for PLWHA. Individual counseling is centered among PLWHA but not for TB patients. With research progress and experiences sharing, TB patients and PLWHA have some hope to implement their life project, and to receive psychosocial and nutritional support. Conclusion Despite international aid, TB patients and PLWHA are facing misconceptions effects. There is a need to reinforce health education towards patients and healers, inside community, health centers and associations, and for specific settings. International aid must be adapted to specific targets and strategies implementing programs. Maintaining psychosocial and nutritional support is crucial for better outcomes of medication adherence. Individual counseling has to be centered among TB patients and PLWHA.
Collapse
Affiliation(s)
- Ziemlé Clément Méda
- Ministry of Health, Ouagadougou, Burkina Faso.,International Health Program, Institute of Public Health, Bobo Dioulasso, Burkina Faso
| | | | - Issiaka Sombié
- Research Office of West African Health Organization (WAHO), Bobo Dioulasso, Burkina Faso.,National Institute of Health Sciences, Polytechnic University, Bobo Dioulasso, Burkina Faso
| | - Daouda Maré
- Association Responsabilité-Espoir-Vie-Solidarité (REVS+), Bobo Dioulasso, Burkina Faso
| | - Donald E Morisky
- Department of Community Health Sciences, University of California Los Angeles (UCLA), School of Public Health, Los Angeles, USA
| | - Yi-Ming Arthur Chen
- Department of Microbiology and Institute of Medical Research, Kaohsiung Medical University, Kaohsiung City, Taiwan. .,Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, Kaohsiung City, Taiwan.
| |
Collapse
|
8
|
Narula P, Azad S, Lio P. Bayesian Melding Approach to Estimate the Reproduction Number for Tuberculosis Transmission in Indian States and Union Territories. Asia Pac J Public Health 2015; 27:723-32. [PMID: 26182939 DOI: 10.1177/1010539515595068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tuberculosis (TB) is one of the most common infectious diseases and a leading cause of death in the world. Despite the full implementation of Revised National Tuberculosis Control Programme, the disease continues to be a leading cause of morality and economic burden in India. The basic reproduction is a fundamental key parameter that quantifies the spread of a disease. In this article, we present a Bayesian melding approach to estimate the basic reproduction number using a deterministic model of TB. We present a point estimate of the basic reproduction number of 35 states and union territories of India during 2006 to 2011. The basic reproduction number of TB for India is computed to be 0.92, which indicates the slow elimination of TB in India during 2006 to 2011.
Collapse
Affiliation(s)
| | - Sarita Azad
- Indian Institute of Technology Mandi, Mandi, India
| | | |
Collapse
|
9
|
Arend SM, van Soolingen D. Editorial Commentary:Genotyping ofMycobacterium tuberculosisin China and Missing Links in the Chain of Ongoing Transmission of Tuberculosis: Figure 1. Clin Infect Dis 2015; 61:228-32. [DOI: 10.1093/cid/civ259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 11/12/2022] Open
|
10
|
Barriers and delays in tuberculosis diagnosis and treatment services: does gender matter? Tuberc Res Treat 2014; 2014:461935. [PMID: 24876956 PMCID: PMC4020203 DOI: 10.1155/2014/461935] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Tuberculosis (TB) remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men.
Collapse
|
11
|
Sreeramareddy CT, Harsha Kumar HN, Arokiasamy JT. Prevalence of self-reported tuberculosis, knowledge about tuberculosis transmission and its determinants among adults in India: results from a nation-wide cross-sectional household survey. BMC Infect Dis 2013; 13:16. [PMID: 23324535 PMCID: PMC3551631 DOI: 10.1186/1471-2334-13-16] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 01/14/2013] [Indexed: 12/05/2022] Open
Abstract
Background Knowledge about symptoms and transmission of tuberculosis determines health seeking behavior and helps in prevention of tuberculosis transmission in the community. Such data is useful for policy makers to formulate information, education and communication strategies for tuberculosis control. Methods A secondary data analysis of India demographic and health survey, 2005/6 was carried out. Questions about self-reported tuberculosis, transmission and curability of tuberculosis were analysed. Correct knowledge (without misconceptions) about tuberculosis transmission was used as a dependant variable and the explanatory variables tested were: demographic data, education, wealth quintiles, frequency of exposure to media and the curability of tuberculosis. Determinants of correct knowledge without misconceptions were tested by univariate and multivariate analyses using national weighting factor to adjust for complex sampling design. Results A total of 109,070 households (response rate of 93.5%) and 198,718 participants (response rate of 91.6%) completed the survey. The samples of men and women interviewed were 74,360 and 124,358 respectively. Prevalence rate of self-reported tuberculosis was 445 per 100,000 usual household residents and 4.60 per 1,000 participants. The number of respondents who had “heard of an illness called tuberculosis” was 177,423 (89.3%). Of these 47,487 (26.8%) participants did not know and 55.5% knew about the correct mode of tuberculosis transmission i.e. “Through the air when coughing or sneezing”. The common misconceptions about transmission were “Through food” (32.4%), “Sharing utensils” (18.2%), and “Touching a person with tuberculosis” (12.3%). Only 52,617 (29.7%) participants had correct knowledge without misconceptions. Being male (aOR 1.17, 95% CIs 1.14, 1.21), being a Hindu (aOR 1.20, 95% CIs 1.14, 1.26) or Muslim (aOR 1.26, 95% CIs 1.18, 1.34), listening to radio (aOR 1.08, 95% CIs 1.04, 1.13) and “Tuberculosis can be cured” (aOR 1.47, 95% CIs 1.41, 1.53) were associated with correct knowledge without misconceptions. Conclusions Knowledge about tuberculosis transmission is very poor and misconceptions still exist. Among the traditional mass media, the frequency of listening to radio was associated with correct knowledge about tuberculosis transmission. Strategies to deliver information, education and communication campaigns could be improved.
Collapse
Affiliation(s)
- Chandrashekhar T Sreeramareddy
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Sungai Long, Malaysia.
| | | | | |
Collapse
|
12
|
Awareness of the Warning Signs, Risk Factors, and Treatment for Tuberculosis among Urban Nigerians. Tuberc Res Treat 2013; 2013:369717. [PMID: 23401764 PMCID: PMC3557638 DOI: 10.1155/2013/369717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/07/2012] [Accepted: 12/21/2012] [Indexed: 11/17/2022] Open
Abstract
Objectives. To determine the awareness of the warning signs, risk factors, and treatment of tuberculosis among urban Nigerians. Methods. This was a cross-sectional survey among 574 adults in Ilorin, Nigeria. Semistructured questionnaire was administered by trained interviewers to obtain information about awareness of tuberculosis warning signs, risk factors, and treatment. Results. Majority of the subjects (71.4%) were aware of at least one warning sign of tuberculosis. Cough (66.2%), weight loss (38.0%), and haemoptysis (30.7%) were the most identified warning signs. The predictors of awareness of warning sign were increasing age (r + 0.12), higher family income (r + 0.10), higher level of education (r + 0.10), and belonging to Christian faith (r + 0.11). Awareness of risk factors for tuberculosis was higher for tobacco smokers (77.0%) and history of contact with a case of TB (76.0%). Less than half were aware of HIV infection (49.8%), alcohol consumption (42.5%), chronic kidney disease (40.4%), extremes of ages (39.4%), cancers (36.9%), and diabetes mellitus (27.5%) as risk factors for TB. Tuberculosis was reported to be curable by 74.6% of the subjects and 67.9% knew that there are medications for treatment of tuberculosis, while 11.5% knew the duration of treatment. Conclusion. This study has revealed that the awareness of HIV and noncommunicable diseases as risk factors for TB is poor. This study has therefore demonstrated the need for health education programs that will emphasize recognition, identification, and modification of risk factor for TB.
Collapse
|
13
|
Das P, Basu M, Dutta S, Das D. Perception of tuberculosis among general patients of tertiary care hospitals of Bengal. Lung India 2012; 29:319-24. [PMID: 23243343 PMCID: PMC3519015 DOI: 10.4103/0970-2113.102799] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Tuberculosis is a public health problem in India. The patients of Tuberculosis hide their disease from family, relatives, and community due to the presence of stigma. This study was conducted to assess the knowledge, awareness, and perception regarding social variables of tuberculosis among patients and to associate the awareness with their literacy status. MATERIALS AND METHODS Type of study was observational, descriptive, and epidemiological. Study design was cross-sectional. Study setting was general out-patient department of tertiary care hospitals of West Bengal. Sample size was 464 (Four hundred sixty four) patients. The collected data were tabulated, analyzed, and interpreted by proper statistical methods (by percentage and Z test). RESULTS 60.34% of study population was male. More than one third was illiterate (37.93%). Majority (91.38%) had heard about tuberculosis (TB). Correct answer on cause (infection) was responded by 16.81% patients. About 72.41% had heard about TB from an informal contact. The correct response on mode of spread of TB was told by 31.47% patients. About 62.07% correctly answered that cough was the commonest symptom. 82.76% knew about curability of the disease. Isolation of patient (08.62%) and avoidance of sharing of food (06.03%) were reported as preventive measures. The literacy status had a significant influence on awareness about TB. CONCLUSION An attempt could be made in future to improve awareness among illiterates to remove myths and misconceptions, to allay the social stigma attached with it, to decrease TB transmission.
Collapse
Affiliation(s)
- Palash Das
- Department of Community Medicine, Midnapore Medical College, Paschim Medinipur, West Bengal, India
| | - Mausumi Basu
- Department of Community Medicine, IPGME & R, Kolkata, India
| | - Sinjita Dutta
- Department of Community Medicine, IPGME & R, Kolkata, India
| | - Debasis Das
- Department of Community Medicine, College of Medicine, Maldah, West Bengal, India
| |
Collapse
|
14
|
Atre S, Kudale A, Morankar S, Gosoniu D, Weiss MG. Gender and community views of stigma and tuberculosis in rural Maharashtra, India. Glob Public Health 2011; 6:56-71. [PMID: 21509994 DOI: 10.1080/17441690903334240] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Stigma associated with tuberculosis (TB) is often regarded as a barrier to health seeking and a cause of social suffering. Stigma studies are typically patient-centred, and less is known about the views of communities where patients reside. This study examined community perceptions of TB-related stigma. A total of 160 respondents (80 men and 80 women) without TB in the general population of Western Maharashtra, India, were interviewed using Explanatory Model Interview Catalogue interviews with same-sex and cross-sex vignettes depicting a person with typical features of TB. The study clarified features of TB-related stigma. Concealment of disease was explained as fear of losing social status, marital problems and hurtful behaviour by the community. For the female vignette, heredity was perceived as a cause for stigmatising behaviour. Marital problems were anticipated more for the male vignette. Anticipation of spouse support, however, was more definite for men and conditional for women, indicating the vulnerability of women. Community views acknowledged that both men and women with TB share a psychological burden of unfulfilled social responsibilities. The distinction between public health risks of infection and unjustified social isolation (stigma) was ambiguous. Such a distinction is important for effective community-based interventions for early diagnosis of TB and successful treatment.
Collapse
Affiliation(s)
- S Atre
- Foundation for Research in Community Health, Pune, India.
| | | | | | | | | |
Collapse
|
15
|
Viney K, O'Connor J, Wiegandt A. The epidemiology of tuberculosis in Pacific Island countries and territories: 2000-2007. Asia Pac J Public Health 2011; 23:86-99. [PMID: 21169602 DOI: 10.1177/1010539510390671] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a descriptive study of routinely collected tuberculosis (TB) surveillance data from 19 Pacific Island countries and territories. The objectives of the study are to describe (a) the epidemiology of TB during the period 2000-2007 (with a focus on 2007), (b) progress against World Health Organization (WHO) targets, and (c) how TB control can be enhanced in the region. In 2007, there were 1544 cases of TB notified in the Pacific (excluding Papua New Guinea). The case notification rate was 52 per 100 000 population. The case detection rate for sputum smear positive cases in 2007 was 66%, slightly below the WHO target of 70%. The treatment success rate for new sputum smear positive cases in 2006 was 89%, above the WHO target of 85%. It is likely that the regional prevalence and mortality targets will be narrowly missed in 2010. There has been good progress in TB control in the Pacific region, but intensified efforts are needed to further reduce the burden of TB.
Collapse
Affiliation(s)
- Kerr Viney
- Secretariat of the Pacific Community, Noumea Cedex, New Caledonia.
| | | | | |
Collapse
|
16
|
Abebe G, Deribew A, Apers L, Woldemichael K, Shiffa J, Tesfaye M, Abdissa A, Deribie F, Jira C, Bezabih M, Aseffa A, Duchateau L, Colebunders R. Knowledge, health seeking behavior and perceived stigma towards tuberculosis among tuberculosis suspects in a rural community in southwest Ethiopia. PLoS One 2010; 5:e13339. [PMID: 20948963 PMCID: PMC2952624 DOI: 10.1371/journal.pone.0013339] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 09/16/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Perceived stigma and lack of awareness could contribute to the late presentation and low detection rate of tuberculosis (TB). We conducted a study in rural southwest Ethiopia among TB suspects to assess knowledge about and stigma towards TB and their health seeking behavior. METHODS A community based cross sectional survey was conducted from February to March 2009 in the Gilgel Gibe field research area. Any person 15 years and above with cough for at least 2 weeks was considered a TB suspect and included in the study. Data were collected by trained personnel using a pretested structured questionnaire. Logistic regression analysis was done using SPSS 15.0 statistical software. RESULTS Of the 476 pulmonary TB suspects, 395 (83.0%) had ever heard of TB; "evil eye" (50.4%) was the commonly mentioned cause of TB. Individuals who could read and write were more likely to be aware about TB [(crude OR = 2.98, (95%CI: 1.25, 7.08)] and more likely to know that TB is caused by a microorganism [(adjusted OR = 3.16, (95%CI: 1.77, 5.65)] than non-educated individuals. Males were more likely to know the cause of TB [(adjusted OR = 1.92, (95%CI: 1.22, 3.03)] than females. 51.3% of TB suspects perceived that other people would consider them inferior if they had TB. High stigma towards TB was reported by 199(51.2%). 220 (46.2%) did not seek help for their illness. Individuals who had previous anti-TB treatment were more likely to have appropriate health seeking behavior [(adjusted OR = 3.65, (95%CI: 1.89, 7.06)] than those who had not. CONCLUSION There was little knowledge about TB in the Gilgel Gibe field research area. We observed inappropriate health seeking behavior and stigma towards TB. TB control programs in Ethiopia should educate rural communities, particularly females and non-educated individuals, about the cause and the importance of early diagnosis and treatment of TB.
Collapse
Affiliation(s)
- Gemeda Abebe
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep 2010; 125 Suppl 4:34-42. [PMID: 20626191 DOI: 10.1177/00333549101250s407] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The institutional and community norms that lead to the stigmatization of tuberculosis (TB) are thought to hinder TB control. We performed a systematic review of the literature on TB stigma to identify the causes and evaluate the impact of stigma on TB diagnosis and treatment. Several themes emerged: fear of infection is the most common cause of TB stigma; TB stigma has serious socioeconomic consequences, particularly for women; qualitative approaches to measuring TB stigma are more commonly utilized than quantitative surveys; TB stigma is perceived to increase TB diagnostic delay and treatment noncompliance, although attempts to quantify its impact have produced mixed results; and interventions exist that may reduce TB stigma. Future research should continue to characterize TB stigma in different populations; use validated survey instruments to quantify the impact of TB stigma on TB diagnostic delay, treatment compliance, and morbidity and mortality; and develop additional TB stigma-reduction strategies.
Collapse
Affiliation(s)
- Andrew Courtwright
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Yawkey 4B, Ste. 4700, Boston, MA 02114, USA.
| | | |
Collapse
|
18
|
Deribew A, Abebe G, Apers L, Jira C, Tesfaye M, Shifa J, Abdisa A, Woldemichael K, Deribie F, Bezabih M, Aseffa A, Colebunders R. Prejudice and misconceptions about tuberculosis and HIV in rural and urban communities in Ethiopia: a challenge for the TB/HIV control program. BMC Public Health 2010; 10:400. [PMID: 20604951 PMCID: PMC2909168 DOI: 10.1186/1471-2458-10-400] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 07/06/2010] [Indexed: 12/02/2022] Open
Abstract
Background In Ethiopia, where HIV and tuberculosis (TB) are very common, little is known about the prejudice and misconceptions of rural communities towards People living with HIV/AIDS (PLHA) and TB. Methods We conducted a cross sectional study in Gilgel Gibe Field Research area (GGFRA) in southwest Ethiopia to assess the prejudice and misconceptions of rural and urban communities towards PLHA and TB. The study population consisted of 862 randomly selected adults in GGFRA. Data were collected by trained personnel using a pretested structured questionnaire. To triangulate the findings, 8 focus group discussions among women and men were done. Results Of the 862 selected study participants, 750(87%) accepted to be interviewed. The mean age of the respondents was 31.2 (SD ± 11.0). Of the total interviewed individuals, 58% of them were females. More than half of the respondents did not know the possibility of transmission of HIV from a mother to a child or by breast feeding. For fear of contagion of HIV, most people do not want to eat, drink, and share utensils or clothes with a person living with HIV/AIDS. A higher proportion of females [OR = 1.5, (95% CI: 1.0, 2.2)], non-literate individuals [OR = 2.3, (95%CI: 1.4, 3.6)], rural residents [OR = 3.8, (95%CI: 2.2, 6.6)], and individuals who had poor knowledge of HIV/AIDS [OR = 2.8, (95%CI: 1.8, 2.2)] were more likely to have high prejudice towards PLHA than respectively males, literates, urban residents and individuals with good knowledge. Exposure to cold air was implicated as a major cause of TB. Literates had a much better knowledge about the cause and methods of transmission and prevention of TB than non-literates. More than half of the individuals (56%) had high prejudice towards a patient with TB. A larger proportion of females [OR = 1.3, (95% CI: 1.0, 1.9)] and non-literate individuals [OR = 1.4, (95% CI: 1.1, 2.0)] had high prejudice towards patients with TB than males and literate individuals. Conclusion TB/HIV control programs in collaboration with other partners should invest more in social mobilization and education of the communities to rectify the widespread prejudice and misconceptions.
Collapse
Affiliation(s)
- Amare Deribew
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Roy A, Abubakar I, Yates S, Chapman A, Lipman M, Monk P, Catchpole M. Evaluating knowledge gain from TB leaflets for prison and homeless sector staff: the National Knowledge Service TB pilot. Eur J Public Health 2008; 18:600-3. [DOI: 10.1093/eurpub/ckn096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|