Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

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Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

Tuberculosis is a problem of global importance among communicable diseases. It is second leading disease causing death worldwide killing nearly 2 million people each year in Nigeria. Non-compliance of patients on tuberculosis treatment in an irregular and unreliable way has greatly caused risk of treatment failure, relapse and the development of drug-resistance tuberculosis strains. There are varieties of reasons why patients fail to take their medications. The center for disease control (2008) states the following: The patient’s complaint is that medicines must be taken with empty stomach to facilitate absorption. This can be difficult for patients to follow especially waking up an hour earlier than usual everyday just to take medicine on empty stomach. Another complains is the size of tablet. Side-effect of the drugs can lead to patients not complying with their treatment. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects Issues on denial, stigmatization, emotional distress, cultural and life-style factors make patients not to take their treatment. Poverty, transportation, religion and attitude of health workers contribute to non-compliance of patients on tuberculosis treatment. Non-compliance of patient on tuberculosis treatment is a serious problem for national tuberculosis control programs in states that this case tens to have higher morbidity and mortality rate compared with those who are not cured also they remain infections for prolonged period of time, hence affected patient continues to transmit the disease in the community.

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1. The patient’s complaint is that medicines must be taken with empty stomach to facilitate absorption. This can be difficult for patients to follow especially waking up an hour earlier than usual everyday just to take medicine on empty stomach. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

Tuberculosis (TB) is one of the main causes of death among the infectious diseases worldwide. In 2012, about 8.6 million people developed TB and 1.3 million died of it. It is worth mentioning that 2 billion people are infected with Mycobacterium tuberculosis, which represents a substantial deposit of the pathogen, therefore it established some challenges to the sanitary authorities for eliminating TB until 20501.

Brazil is at the 16th position in number of cases and at the 109th position in the coefficient of incidence of TB infection. Since 1990, the number of TB cases has been decreasing in the country, and it may reach the Millennium Development Goals of reducing 50% of the disease incidence1.

Among the studies conducted in Brazil2 – 4, there is some evidence that the medical technological availability for diagnosis or treatment alone has not been improving in terms of access to health services.

Studies point out that cultural, environmental, and sociopolitical factors are determinant in this process5 – 7. According to the authors, the population’s knowledge about TB is an important factor to improve the disease control8 – 11. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

The World Health Organization (WHO) together with the Stop TB Strategy created the Advocacy, Communication and Social Mobilization (ACSM) in 200612, with the purpose of making the population aware of TB and stimulating community participation in health control. In countries like Pakistan13 and India11, promising results have been observed regarding the awareness of the population, the reduced waiting time to find services for diagnosis, the adhesion to treatment, and the decreasing social stigma.

In Brazil, this strategy was not formally and systematically introduced in health services, which prevents an evaluation addressed to the program.

It is worth mentioning that TB is a concept produced in the social imaginary of the population, therefore beliefs, values, and behaviors with regard to the disease may influence collective health projects designed to stop its aggravation. For the authors, knowledge about TB will encourage people to look for health care and quality of clinical/epidemiological results11.

However, studies about the theme in the country are rare; therefore, investigations on the possible factors associated with this event, being not explored and/or not well understood, are required14 – 16.

In the scope of public policies17, the improvement of new technologies is recommended with higher diagnostic sensitivity and therapies that reduce treatment time. However, some authors have reported that the awareness of a population about such an issue is what ends up defining the acceptance and the use of these technologies11. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

In a literature review, we can notice the non-satisfactory level of knowledge among patients with TB in the Brazilian prison system18, noncomprehension of the meaning of treatment adhesion by relatives in the Brazilian South14, and many discriminatory attitudes that come from the lack of knowledge of communities about TB13.

Studies in Pakistan show that education, income, and housing conditions seem to explain the phenomenon8. These factors were also identified by Ali et al.19 in families of patients with the disease. Therefore, a question is raised if such factors are applied to families in Brazil. Thus, we sought to investigate the knowledge of relatives about TB and the possible factors associated with this occurrence, and to conduct a comparative analysis of groups of relatives with knowledge or with little knowledge about their attitudes toward the patient with TB in Ribeirão Preto, São Paulo, Brazil.

METHODS

This is a cross-sectional study performed in the municipality of Ribeirão Preto, São Paulo, Brazil, which has about 604,682 thousand residents and is classified as pole city and a reference for the neighboring locations with regard to actions in health that require high technological density. Attention to TB in the municipality is centralized in five health district unities; each of them has a Reference Center that assists the patient with TB and his/her relatives.

The study population comprised relatives of patients diagnosed with pulmonary TB between January 1st, 2010 and July 31, 2011, aged more than 18 years old and under treatment for at least 1 month.

In the study period, 180 confirmed cases of TB were identified; among them 5 (2.7%) were excluded for being in a confinement situation and 32 (17.7%) for having the information of “zero communicators” in the record system (TB-WEB).

Finally, 153 cases were considered to be candidates for the investigation. We chose to work with a minimum and simple random sample without replacement. Considering a 95% confidence level (95%CI), 5% tolerable sample error, 10% loss, and 50% estimated proportion of the population (p = 0.5) with proper knowledge about about TB, the established final minimum sample for the investigation was of 110 observations.

In the study for each TB case, a relative was selected. Following the authors’ recommendations20, only relatives who were present at the time of interview were chosen or when there was more than a person, the first one who talked to the interviewer was selected. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

Twelve items of an instrument prepared by the authors were considered for the article based on the material published by WHO21. It is important to highlight that such material is part of the ACMS Program and aims at supporting researchers and managers in the development of instruments to assess knowledge, attitudes, and practices associated with TB12.

It is worth mentioning that the instrument was submitted to content validation, in which 10 experts appraised and gave suggestions with regard to structure and content. Later on, a pretest of the instrument was performed with 10 relatives of the patients with TB to measure their cultural sensitivity and certification of comprehensibility of the study population.

The instrument dimension associated with the knowledge about the disease comprised closed matters about the causal agent of TB, favorable factors, transmission mode, signals and symptoms, period of transmission, treatment duration, and if the families had read or heard anything about TB. The respondents had to choose the answers they thought to be correct.

With regard to attitudes, items were structured on the five-point Likert scale (1 = never; 2 = hardly ever; 3 = sometimes; 4 = almost always; and 5 = always), and the participants filled in the frequency with which they noticed the occurrence of an event.

The questionnaire also included questions about sociodemographic conditions, such as income (open question), information sources families use to consult, if teams of the directly observed treatment (TDO) were visited, or if the relative was in the treatment for latent TB. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

The team of interviewers visited the health services to present the study and update the participants’ addresses. Five interviewers took part in data collection, who had been previously trained and performed house interviews between July and August, 2011.

Data were analyzed through the software STATISTICA, version 9.0 of StatSoft(r) and SPSS for Mac. At first, the frequency of answers regarding knowledge was surveyed, therefore it was possible to observe the percentage of correct and incorrect answers. The criteria for the correction of responses were based on the Health Surveillance Guide, published by the Ministry of Health22.

Afterwards, a cutoff point for correct answers was defined considering the average percentage of right answers provided by the participants; 60% meant awareness, and lower percentages meant little awareness. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

A bivariate analysis was performed to test the association between knowledge by relatives (knowledge and little knowledge) and the dichotomized sociodemographic independent variables (age, income, schooling, unemployment, habit of reading newspapers, habit of watching television) and health services (being on TDO and TB latent treatments), then the χ2 test, χ2 test with Yates correction, or the Fisher’s exact test was applied. The considered association measure was odds ratio (OR) and its respective 95%CI.

The income variable was converted into minimum wages (MWs), and the average income of families was calculated; then, the variable was dichotomized as higher or lower than average.

Later, the multiple analyses with the binary logistic regression were carried out with the manual backward-forward stepwise strategy. In this stage, the most significant variables were chosen (p < 0.2) in the bivariate analysis. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

Authors ensured significance and quality of the model by using likelihood ratio and Hosmer-Lemeshow tests. The significance level established for the permanence of variables in the model was fixed as alpha lower than 5% (p < 0.05), as for the other statistic tests considered in the study.

To test the mean difference between attitudes of groups with knowledge and little knowledge regarding attitudes, the authors chose the Student’s t-test. We should mention that such a test was used when normality and homoscedasticity criteria of variance were met, which were respectively verified by the Shapiro-Wilk and the Levene tests. In case these criteria were not followed, the Mann-Whitney U-test was applied.

The mean score found in every item related to attitude of the instrument and per group was calculated through the sum of scores, dividing the number of subjects in each group. Scores higher than four were considered satisfactory; between three and four, regular; and lower than three, non-satisfactory.

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The project was approved by the Research Ethics Committee of the Nursing School in Ribeirão Preto, Universidade de São Paulo. All subjects who accepted participating in the study signed the free informed consent. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

· 1. The patient’s complaint is that medicines must be taken with empty stomach to facilitate absorption. This can be difficult for patients to follow especially waking up an hour earlier than usual everyday just to take medicine on empty stomach.

· 2 Another complains is the size of tablet

· 3 Side-effect of the drugs can lead to patients not complying with their treatment. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

Project Topics
· 4 Issues on denial, stigmatization, emotional distress, cultural and life-style factors make patients not to take their treatment.

· 5 Poverty, transportation, religion and attitude of health workers contribute to non-compliance of patients on tuberculosis treatment.

Non-compliance of patient on tuberculosis treatment is a serious problem for national tuberculosis control programs ()2007 states that this case tens to have higher morbidity and mortality rate compared with those who are not cured also they remain infections for prolonged period of time, hence affected patient continues to transmit the disease in the community.

2. Another complains is the size of tablet

3. Side-effect of the drugs can lead to patients not complying with their treatment.

4. Issues on denial, stigmatization, emotional distress, cultural and life-style factors make patients not to take their treatment.

5. Poverty, transportation, religion and attitude of health workers contribute to non-compliance of patients on tuberculosis treatment. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

Even though the incidence of tuberculosis (TB) has decreased worldwide, it remains a global
health challenge. An estimated 10.4 million people developed TB in the year 2015 of which
one-quarter was from Africa [1]. The disease is more prevalent in congregate settings such as
prisons [2]. Especially, it is much worse in sub-Saharan prisons due to the added problems of
human immunodeficiency virus (HIV) and poverty [3]. In Ethiopian prisons, a four to ninefold higher prevalence of TB has been reported compared to the general population [4,5].
The global focus of TB control programs is on early diagnosis and treatment of cases in
high TB and HIV-endemic areas [1]. However, the low TB case detection rate and the emergence of multi-drug-resistant strains have been a challenge [1,6]. Raising communities’ awareness contributes for early diagnosis of TB which is one of the pillars of the End TB Strategy [1]. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects
Studies documented a positive association between TB knowledge and care seeking and treatment adherence [7–9]. However, the level of knowledge should be known, also in relation to
previous reports, before informed decisions can be made when designing and implementing
appropriate educational interventions. In this regard, studies conducted in the general populations of sub-Saharan countries documented misconceptions ranging from 66.3% to 99.7% of
the population on the etiology (cause) of TB, 27.6% to 90.1% on the symptoms, 0.1% to 48.6%
on the transmission and 33.4% to 92.9% on prevention methods [10–16]. Stigma towards TB
patients has been reported in up to 58.3% of the respondents [10,14]. Literacy status, socio-cultural differences, gender, and spatial variations have been reported to be factors affecting TB
knowledge, attitude and practices (KAP) [11,13,16].
Baseline data regarding prisoners’ knowledge of TB and related factors are limited. Studies
conducted in prisons of Brazil [17] and Texas [18] reported gaps on some specific TB KAP variables. In a Brazilian prison, only 5.0% and 3.6% of the prisoners could mention the TB symptoms and prevention methods, respectively, and in a USA prison 43.0% of the prisoners had a
perceived stigma towards TB. To our knowledge, in sub-Saharan prisons, only one study
assessing prisoners knowledge was conducted six years ago in Eastern Ethiopian prisons [19].
This study reported a moderate level of knowledge about TB and revealed some misconceptions about its causes, control and prevention. This study was, however, limited in scope in
that it did not address the attitude, and was only conducted among presumptive TB cases.
Moreover, in culturally diversified countries like Ethiopia, TB knowledge-level has been
reported to show significant spatial variations [16]. In addition, through the Internet and
intensive educational campaigns, healthcare information can reach many people quickly and
increase the level of knowledge among people [20]. In a previous study among Ethiopian prisons we observed quite some TB cases with long-lasting symptoms without being diagnosed
[4], so we expect that KAP among Ethiopian prisoners is still very low. This study aimed at
assessing the level of knowledge, attitude, and practices of prisoners about TB and related
factors. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects
Tuberculosis knowledge, attitudes, and practices among prisoners
PLOS ONE | https://doi.org/10.1371/journal.pone.0174692 March 30, 2017 2 / 15
Methods
Study setting
This study was conducted in eight northern Ethiopian prisons located in the regions
Tigray (Mekelle, Abi Adi, Alamata, Humera, and Wukro) and Amhara (Dessie, Debre
Tabor, and Finote Selam) between March and May 2016. In 2015, Ethiopia ranked 10th
among the 22 high TB burden countries with an estimated TB incidence of 192 per 100,000
people [1]. The country had a registered prison population of 112,361 (136/100,000 persons) in 2010 [21], which is higher than the imprisonment rates observed in some sub-Saharan African countries such as in Kenya (121/100,000 persons), and Malawi (76/100,000
persons) [21].
Study design and sampling technique
This was a cross-sectional study, which was also part of a baseline measurement for an educational interventional study aimed to increase TB screening and case detection rate in
northern Ethiopian prisons. Larger prison centers located in the main cities of Amhara and
Tigray regions were considered as eligible while small jails were excluded (n = 22). Larger
prisons were defined as institutions that incarcerate people for longer periods of time, such
as many years, while small jails were institutions that confine people for shorter periods of
time. A multistage cluster sampling technique was employed to randomly select the study
prisons and the prisoners. Only prisoners who would stay imprisoned for a year or longer
from the date of the selection were included, since this baseline measurement was part of
an intervention study. Prisoners younger than 18 years of age and those mentally ill were
excluded. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects
Sample size determination
The sample size was determined using a single proportion formula, n1 = z
2
p (1-p)/d2
, where n1
was the initial sample size, considering a confidence level of 95%, an estimated overall proportion of good knowledge about TB of 52% [12], and a precision of 5%. After using a finite population correction, n2 = n1/(1+ (n1/N)), where N was the total number of the prisoners in the
study sites (N = 8,874), multiplying by 1.5 to account for the clustering effect, and adding a
15% non-response rate, we obtained a final sample size of 634. This figure was then proportionally allocated to each prison as per the total numbers of prisoners.
Questionnaire and interviewing
We used a semi-structured standardized KAP questionnaire to collect data. The questionnaire
was designed in English following the WHO guidelines [22] and was translated into the local
languages, Amharic and Tigrigna. The questionnaire consisted of 38 questions, divided into
two parts. Part one addressed the socio-demographic characteristics and prison history. The
second part addressed aspects related to TB knowledge, attitude, and practices. Briefly, questions regarding the etiology, transmission, prevention, and treatment of TB, beliefs, and feelings about TB and TB patients were included. The interviewing was done by trained data
collectors (prison nurses, or trained inmates). For sites with a shortage of prison health professionals, prisoners who were relatively educated (some with a diploma in clinical nursing) were
recruited and trained for two days on how to undertake the interview. The interviewing process was closely monitored by the investigators in which the first one-fourth of the interviews
were monitored by listening and observing the interviewing process. The investigators also
Tuberculosis knowledge, attitudes, and practices among prisoners
PLOS ONE | https://doi.org/10.1371/journal.pone.0174692 March 30, 2017 3 / 15
stayed close around the interviewing area to assist the interviewers on call for any ambiguity
for the rest of the interviews. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects
Statistical analysis
Data were entered in EpiData version 3.1 software and the analysis was performed using SPSS
version 20.0. Descriptive statistics was used to report frequencies and proportions. Bivariate
and multivariate logistic regression analysis was performed to examine the association of independent variables with our outcome variables. Our outcome variables of interest were knowledge about TB, attitude towards TB, and practice. We checked whether there was a clustering
effect at the prison level for the outcome variables following the mixed procedure for a possible
consideration of the multilevel logistic model. We found, however, that there was no statistically significant variability in the intercepts of the outcome variables across the prison sites; the
p values for the intercept estimates of knowledge, attitude, and practice were 0.14, 0.25, and
0.13, respectively.
Knowledge was assessed considering the following crucial elements: able to recognize
germ/bacteria as a cause of TB, able to recognize the airborne route of transmission, able to
recognize a cough of 2 weeks and longer as a symptom, able to realize covering mouth and
nose when coughing/sneezing as a prevention measure, and able to know the free TB treatment availability. Prisoners that mentioned all these five items were categorized as having a
‘good’ knowledge and those who missed one or more of these items were categorized as having
‘poor’ knowledge. Attitude was assessed using three questions: able to mention that TB is a
very serious disease, showing a favorable reaction if suspected having TB related symptoms
(i.e. seeking health care instead of being ashamed of or hopeless), and showing a compassion
and desire to help people with TB. Prisoners that mentioned these three items were categorized
as having a ‘favorable’ attitude and the others were categorized as having ‘unfavorable’ attitude. Analysing The Knowledge of People About Tuberculosis Cause And Its Effects
Similarly, practice was assessed using two questions: preference of modern health care for
treatment and the intention to visit the facility as soon as realizing having a TB related symptom. Prisoners who mentioned these two items were categorized as having a ’good’ practice
and the rest were categorized as having a ‘poor’ practice. All the potential predictor variables
were tested against the dichotomized knowledge, attitude, and practice. Multi-collinearity
among the independent variables was assessed considering the variance inflation factor of
greater than 10 (for our data, the maximum was 3.86). Covariates with p-values of 0.25 in
the bivariate analysis were considered for inclusion in the multivariate model. Accordingly,
the multivariate models for the level of knowledge, attitude, and practice consisted of five,
four, and six variables, respectively. Educational status and prison site were included in the
three models. In addition, age group and occupation were added to the final models of the
knowledge and practice level whereas residence was included in the knowledge and attitude
model. Duration of imprisonment was added to the attitude model and knowledge and attitude level to the practice model. Comparisons between subgroups with the outcomes were
expressed as odds ratios (OR) with a 95% confidence interval (CI). A p-value of 0.05 was
considered to declare a statistically significant association Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

Analysing The Knowledge of People About Tuberculosis Cause And Its Effects

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