Knowledge, Attitude, and Practices Towards Tuberculosis Among Clients Visiting Tepi General Hospital Outpatient Departments, 2019

Knowledge of the Companions of Tuberculosis Patients Hospitalized in The Pneumology Department of The Hassan II Hospital Agadir About the Disease

Background

Tuberculosis is a major public health problem worldwide, and in Morocco, it is the leading cause of hospitalization in the Pneumology department. Hospitalized patients are often accompanied by family members who primarily act as caregivers. This study aimed to describe the knowledge related to the disease among the companions of tuberculosis patients hospitalized in the pneumology department of Hassan II Hospital in Agadir, Morocco.

Methodology

We conducted a cross-sectional observational study with the objective of evaluating the knowledge of the companions of tuberculosis patients.

Results

One hundred companions participated in this study, with an average age of 33.8 +/- 10.1. The male-to-female sex ratio was 1.5. More than half of our participants had a low socio-economic level, and over a third were illiterate. Knowledge was assessed through questions related to the disease. Results showed that 82.0% of participants declared that they were aware of the disease called "tuberculosis," and 46.0% knew about its infectious origin. Almost all of them were aware of the contagious nature of the disease and its airborne transmission. Schooling was found to be associated with knowledge of the disease, its infectious nature, contagiousness, and free treatment. The associations were statistically significant with p-values of <0.001, 0.004, <0.001, and 0.002, respectively.

Conclusion

The low level of schooling appears to be a hindrance to TB education. This observation could explain the very poor level of knowledge found in our study, despite the efforts made by various programs.

Assessing the knowledge, attitude, and practice measures against tuberculosis in patients in ambulatory department facilities in Pakistan: a cross-sectional analysis

Tuberculosis (TB), at present, is the leading infectious etiology of death globally. In Pakistan, there are approximately 510,000 new cases annually, with more than 15,000 of them developing into drug-resistant TB, making the nation the fifth-leading country in TB prevalence in the world. Due to the ongoing COVID-19 pandemic, the focus has drifted away from TB screening, diagnostic and health awareness campaigns, and therapeutic measures endangering knowledge, attitude, and practices (KAP) towards TB in our population. We conducted a cross-sectional descriptive study in Pakistan to assess the KAP of Pakistani residents attending the adult outpatient departments of public hospitals for any health-related concerns. Our sample size was 856 participants, with a median age of 22 years. Occupation-wise, those who were employed had better knowledge of TB than those who were unemployed [odds ratio (OR): 1.011; 95% confidence interval (CI): 1.005-1.8005]. No differences were observed in TB knowledge between those adherents to common preventive practices versus those not adherent (OR: 0.875; 95% CI: 0.757-1.403). More than 90% of participants agreed that TB is dangerous for the community, and the majority opted against stigmatizing TB patients (79.1%). People who could read and write were 3.5 times more likely to have a good attitude towards TB compared to those who could not (OR: 3.596; 95% CI: 1.821-70.230; p=0.037). Similarly, employed subjects had better attitudes compared to unemployed ones (OR: 1.125; 95% CI: 0.498-1.852; p=0.024) and those with better knowledge of TB had a better attitude grade (OR: 1.749; 95% CI: 0.832-12.350; p=0.020). Age, occupation, and educational status were statistically significant among the two groups (p=0.038, p=0.023, p=0.000). Literate subjects had three times better practice towards TB than illiterate subjects (OR: 3.081; 95% CI: 1.869-4.164; p=0.000). Future education and awareness programs should target specific groups, such as the unemployed and illiterate, with practice-focused approaches. Our study outcomes can enable the concerned officials and authorities to take appropriate evidence-based steps to direct the efforts efficiently to curtail the burden of TB in Pakistan and to limit its progression, which could potentially lead our nation to become a multi drug-resistant TB endemic territory.

Risk factors and perceptions about coronavirus disease among tuberculosis patients in Delhi, India: A cross-sectional study

BACKGROUND

Tuberculosis (TB) and Coronavirus disease (COVID-19) co-infection can increase the severity among affected patients. This study was conducted to study the burden, risk factors and perceptions of COVID-19 among TB patients.

METHODS

This was a cross-sectional study conducted among TB patients at one of the Directly Observed Treatment Short Course (DOTS) centre of Urban Primary Health Centre (UPHC) of Delhi, India. Information regarding socio-demographic profile, TB disease profile, history of COVID-19 and perceptions about TB and COVID-19 co-infection was collected. Descriptive analysis was performed.

RESULTS

A total of 107 study participants were enrolled. Twenty-two TB patients (20.6%) never got tested for COVID-19. Two TB patients out of 107 study participants had COVID-19 in past. Both were males in age group of 30-44 years, had drug sensitive TB and were having pre-existing co-morbidities. Transmission routes of TB and COVID-19 were not known to about half of the study participants. Approximately 42.1% study participants perceived TB patients to be at higher risk of COVID-19 and majority study participants agreed that they should follow COVID-19 appropriate behaviour. However, helpline numbers for COVID-19 were not known to most of the study participants.

CONCLUSION

One-fifth of TB patients were never tested for COVID-19 inspite of the bi-directional screening guidelines for TB patients. Guidelines need to be practised stringently to find out true burden of co-infection. As the two TB patients who had COVID-19 in past already had other pre-existing co-morbidities as risk factors, whether TB enhances the risk for coronavirus infection independently needs further research.

Knowledge, Attitude, and Practices Toward Tuberculosis Among Hospital Outpatients in Kabul, Afghanistan

Background

Tuberculosis (TB) is a high-burden respiratory infectious disease. There was a sharp decline in the number of confirmed TB cases during the pandemic; this is likely to be influenced by the COVID-19 pandemic response, with under-reporting due to resource diversion. There are typically 13,000 tuberculosis-associated deaths in Afghanistan annually, with significant problems posed by drug-resistant TB.

Method

A cross-sectional descriptive study was conducted in Afghanistan on Kabul residents who visited the adult outpatient departments of public hospitals for any health-related reason from 1st January to 20th March 2022. The study scored their knowledge, attitude, and practices (KAP) toward tuberculosis. The sample size was calculated using Epi-Info, and the minimum sample size was 385. The sampling method is chosen the non-probability convenient sampling for data gathering. Data were analyzed using SPSS version 28, and we used the Mann-Whitney test, Chi-square or fisher extract test, spearman correlations, and binary logistic regression model.

Results

Of 829 participants, 450 (54.3%) were males and 379 (45.7) females. The median age was 28 years, and 63.3% were married. Most participants were unemployed (75.5%), but 54% had a monthly income >3,000 Afghanis, indicating the reliance on family. By TB knowledge score, 727 (87.7%) participants had good knowledge, and 800 (96.5%) participants had a positive attitude toward treatment and control. Only 2 participants reported poor practices regarding prevention. Regarding the binary logistic regression, young age, being a male, belonging to the “1,000–3,000” Afghani monthly income category, and having a positive attitude were significant predictors of good TB knowledge (P-value = 0.009, 0.000, 0.003, and 0.009), respectively. A positive attitude was expected to have good knowledge 6.035 times more than a negative attitude (95% CI: 1.572–23.167).

Conclusion

The study findings highlighted that outpatients in Kabul had good knowledge, attitude, and practice toward TB. More studies are needed to highlight KAP in different Afghan populations, including in other parts of the country.

Knowledge, Attitudes, and Stigma: The Perceptions of Tuberculosis in Equatorial Guinea

Tuberculosis remains one of the major causes of morbidity and mortality in Equatorial Guinea, with an estimated incidence of 280 per 100,000 inhabitants, an estimated mortality rate of 96 per 100,000 inhabitants, and a treatment non-adherence rate of 21.4%. This study aimed to identify the factors associated to TB-related knowledge, attitudes, and stigma in order to design community intervention strategies that could improve TB diagnostic and treatment adherence in Equatorial Guinea. A nationwide cross-sectional survey of 770 household caregivers was conducted in Equatorial Guinea about TB knowledge, attitudes, and practices. Knowledge, attitude, and stigma scores were calculated through correct answers and the median was used as cut-off. Associated factors were analyzed calculating prevalence ratio (PR) and a 95% confidence interval (95% CI) through Poisson regression with robust variance. The percentage of women was 53.0% and median age was 46 years (IQR: 33–60). The percentage of caregivers with high TB related knowledge was 34.9%, with a bad attitude (52.5%) and low stigma (40.4%). A greater probability of having good knowledge was observed in those 45 years old or less (PR: 1.3, 95% CI: 1.1–1.6), those with higher education level (PR: 1.4, 95% CI: 1.1–1.8) and higher wealth (PR: 1.4, 95% CI: 1.0–2.0), while sex (PR = 0.8, 95% CI: 0.6–0.9), religion (PR = 1.4, 95% CI: 1.0–1.8), and good knowledge (PR = 1.4, 95% CI: 1.2–1.7) were associated with good attitudes. Wage employment (PR = 95% CI: 1.2–1.4), feeling well informed (PR = 0.7, 95% CI: 0.6–0.8), having good TB knowledge (PR = 1.3, 95% CI: 1.1–1.7), and some sources of information were associated with having lower TB-related stigma. This study found that a high percentage of caregivers in Equatorial Guinea lack important knowledge about TB disease and have bad attitudes and high TB-related stigma. Given the epidemiological situation of TB in the country, it is urgent to improve TB knowledge and awareness among Equatorial Guinea’s general population.

Study on the Influencing Factors of Knowledge, Attitudes and Practice About Tuberculosis Among Freshmen in Jiangsu, China: A Cross-Sectional Study

Background

Adolescents aged from 19 to 22 are the main high-risk population of pulmonary tuberculosis (PTB). This study aimed to understand the current status of knowledge, attitudes and practices (KAP) about TB among freshmen from Jiangsu colleges and universities. Analyze its influencing factors and explore the interrelationships of KAP. This provides a basis for building a reversing mechanism for health education on tuberculosis prevention and treatment in middle and high schools.

Methods

A multistage randomly was used to select freshmen to conduct this online survey. The χ ² test was used to compare the rates. Construct linear regression model, logistic regression model, decision tree model and random forest model, use grid search to adjust the parameters of the model, and use multiple models to explore the influencing factors of the overall awareness rate of students' core knowledge of tuberculosis.

Results

A total of 6980 freshmen in colleges and universities were investigated. The total awareness rate was 89.02%, and the awareness rate of all core knowledge about TB was 58.94%. It is characterized by general demographic data, and all core knowledge is known as a label to establish a model, based on the f1- of the four models The score believes that the random forest model has the best fitting effect, and the ranking of the influencing factors included in the model is school type (0.72) >father's education (0.15) >family monthly income (0.03) >mother's education, gender, region (0.02); a structural equation model is established, and the modified knowledge and attitude path coefficient is 0.29 (P<0.05); the attitude and behavior path coefficient is 0.64 (P<0.05).

Conclusion

The total awareness rate of core knowledge of Jiangsu college freshmen reaches the national requirements, but the overall awareness rate is low. It is necessary to strengthen the health education of tuberculosis for those with identified risk factors.

Cut-off Points of Treatment Delay to Predict Poor Outcomes Among New Pulmonary Tuberculosis Cases in Dalian, China: A Cohort Study

Purpose

Despite increasing literature on the association between treatment delay and outcomes, cut-off point (1 month or median) selection in almost all studies for treatment delay is too subjective. This study explored more scientific cut-off points of treatment delay for poor treatment outcomes and death at the clinical level.

Patients and Methods

A total of 18,100 newly confirmed pulmonary tuberculosis (TB) cases in Dalian, China were used in the final analysis. A 3-knotted restricted cubic spline (RCS) fitted for Cox proportional hazard regression models is used to analyse the effects of cut-off points of treatment delay on incident poor treatment outcomes. To explore the moderating effects of age, gender and diabetes, we added the interaction terms of these moderating variables and treatment delay to Cox proportional hazard regression models.

Results

The median time of treatment initiation was 30 days (IQR: 14–59 days). The risk of incident poor treatment outcomes increased when the time was greater than cut-off point 1 (53 days; adjusted HR: 1.26; 95% CI: 1.00–1.60) of treatment delay, and the risk of incident death events increased when the time was greater than cut-off point 2 (103 days; adjusted HR: 1.56; 95% CI: 1.00–2.44) of delay. In addition, treatment delay was associated with an increased risk of incident poor treatment outcomes and death, and older age, male sex, and diabetes may increase the risk of treatment delay for poor outcomes.

Conclusion

This study is the first to identify scientific cut-off points of treatment delay for poor treatment outcomes and death, and this method of exploration should be popularized. In addition, the knowledge of tuberculosis must be spread to every adult. Moreover, the tuberculosis diagnosis level of community level health workers should be enhanced.