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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 3  |  Issue : 4  |  Page : 216-220

Awareness and attitude of pulmonary tuberculosis patients toward tuberculosis: A cross-sectional study from Chitwan district of Nepal


1 Department of Zoology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
2 Department of Public Health, Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India
3 Department of Medical Biochemistry, Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India
4 Department of Psychology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
5 Department of Public Health, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal

Date of Web Publication16-Oct-2014

Correspondence Address:
Damaru Prasad Paneru
Department of Public Health, Pokhara University
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.143050

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  Abstract 

Background: Despite the remarkable success been made in the prevention and control of Tuberculosis, it remains one of the major public health problems in developing countries. It is the second leading cause of death amongst infectious diseases. Objective: To assess awareness and attitudes of ex/current TB patients (under DOTS) regarding tuberculosis (TB) in Jutpani Village Development Committee (VDC) of Chitwan district, Nepal. Materials and Methods: This was a descriptive cross-sectional study, carried out during July to December 2012 in Jutpani VDC of Chitwan district, Nepal. All (114) the patients of Pulmonary TB undergoing treatment with DOTS therapy including those who had completed the treatment during July 2010 to June 2012 constituted participants of the study. Data were collected through individual interview and analysed by SPSS (16.version). Results: Blood in sputum (80.7%), evening fever (71.9%), and chronic cough (21.1%) were reported as common symptoms of TB. Only 17.5percent were known about the causative organism of TB. Primary immunization (81.5%), avoiding personal contact (54.6%) with the TB patients and use of face masks (12.2%) were the reported preventive measures of TB. Most of the participants had strongly agreed (68.4%) that DOTS is an effective treatment and the treatment should not be discontinued during the course of treatment (61.4%). Out of 14 attitude measurement statements, there were positive agreements amongst more than 60 percent which indicate the affirmative opinions with respect to existing knowledge. Conclusion: Knowledge regarding signs and symptoms of tuberculosis was good amongst participants; however, only few had correct knowledge about the cause, modes of transmission, and prevention of TB. Majority had positive attitude toward the TB prevention and control in accordance with the existing knowledge of TB. Selective approaches need to be employed to create awareness and case identification of tuberculosis in such pocket areas where the tubercular infection persists as a public health problem.

Keywords: Awareness, attitude, Chitwan, tuberculosis, tuberculosis patient


How to cite this article:
Amgain K, Maharjan M, Paudel DP, Dhital M, Amgain G, Paneru DP. Awareness and attitude of pulmonary tuberculosis patients toward tuberculosis: A cross-sectional study from Chitwan district of Nepal. Int J Health Allied Sci 2014;3:216-20

How to cite this URL:
Amgain K, Maharjan M, Paudel DP, Dhital M, Amgain G, Paneru DP. Awareness and attitude of pulmonary tuberculosis patients toward tuberculosis: A cross-sectional study from Chitwan district of Nepal. Int J Health Allied Sci [serial online] 2014 [cited 2021 Sep 28];3:216-20. Available from: https://www.ijhas.in/text.asp?2014/3/4/216/143050


  Introduction Top


Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis that affects the lungs and other body parts. Tuberculosis of lungs is termed as pulmonary tuberculosis and otherwise it is called as extra-pulmonary tuberculosis. It is commonly transmitted via aerosol. [1] Despite remarkable success been made in the prevention and control of tuberculosis, it remains one of the World's most serious alarming public health problems in developing countries. Every year, millions of people get tubercular infection which remains a second leading cause of deaths attributed to the infectious diseases. [1] It is estimated that one-third of the population in the World have tubercular infection; [2] nonetheless, the observed cases represent tip of iceberg. [3] It is estimated that six out of every ten adults in Nepal have Mycobacterium infection, of whom 40,000 people develop active TB and 20,000 result with infectious pulmonary disease. [4],[5] Chitwan district is a central district of central Nepal and administratively classified into 40 Village Development Committee (VDC) and two Municipalities. About 0.76/1000 population have confirmed TB in the Chitwan district while the infection rate was reported to be almost double (1.56/1000) in the Jutpani VDC of the Chitwan. [4]

National tuberculosis programme of Nepal has been implementing Directly Observed Treatment Short Course Chemotherapy (DOTS) since last two decades; however, in some of the pocket areas, the incidence of TB did not reverse in control. Persistent bacterial transmission, drug resistance, and poor treatment compliance further adding the challenges to the TB control in Nepal. [4]

Objective

To assess the knowledge and attitude toward the cause, mode of transmission and prevention of tuberculosis amongst the patients of Pulmonary Tuberculosis in Jutpani Village Development Committee of Chitwan district, Nepal.


  Materials and methods Top


Study design

This was a community-based cross-sectional study.

Study area

This study was conducted in Jutpani VDC of the Chitwan district, Nepal, which is a catchment area of Jutpani Primary Health Care Centre (PHCC). Chitwan is a plain district of central region of Nepal with the coastal climate. The study area is approximately 40 km far from the district headquarter. Jutpani PHCC caters the health care needs of the population. Majority of the Population reside in dense colonies and villages in the study area.

Selection of participants

All (114) the Ex-PTB patients who have competed treatment according to the stipulated DOTS regimen during 2 years (July 2010 to June 2012) and the patients under DOTS were included in this study. Records of District Public Health Office, Chitwan and Jutpani PHCC were scrutinized to identify and trace the participants. Participants were contacted at the household level by following the address available from health institutions. Trained enumerators with the help of Female community Health Volunteers traced out the participants.

Data collection and processing

Data were collected by face to face interview.

Data collection tool

A structured and pretested questionnaire was used for data collection. The questionnaire was designed to explore the information about the five components of knowledge and 14 areas of attitudes pertaining to tuberculosis. The first part of the questionnaire was constructed to generate the knowledge of TB whereas the second part contained 14 sets of attitude-related questions with five-point Likert's scale. The responses of each attitude are graded from strongly agree for most affirmative and the strongly disagree on the negative attitudes. Attitudes related to the specific statements are expressed in the percentage. Data were complied, coded and entered in spread sheet and then analysed by the Statistical Package for Social Science, 16.0 version (SPSS Inc. Chicago, IL, USA).

Statistical methods

Percentage, mean and standard deviation were calculated and the results were presented in tables and graphs, respectively.

Ethical approval

Ethical clearance was obtained from the ethical committee for human subjects of Central Department of Parasitology, Tribhuvan University, Nepal. Informed Consent was obtained from the participants before individual interview.


  Results Top


During July 2010 to June 2012, a total of 114 PTB patients were recorded in Jutpani VDC. Out of them, 27 (23.6%) were under the treatment and remaining 87 (76.4%) were Ex-PTB patients. About 36.8 percent participants were 41-60 years followed by more than a quarter (28.1%) were 21-40 years old. Male were predominantly higher than the counterpart female patients (64.9% and 35.1%), respectively, as shown in [Table 1].
Table 1: Background characteristics

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Awareness about the causes, mode of transmission, and prevention of TB

About 80.7 percent participants were known that blood in sputum followed by evening rise in body temperature (71.9%), generalized weakness and loss of weight (28.1%), and continuous cough for >3 weeks (21.1%) are the presenting symptoms of PTB. Majority 82 (71.9%) believed that Tuberculosis is caused by excessive alcohol consumption followed by almost equal proportion (70.1%) believed that the smoking (smoking products such as cigarette, Bidi, and different brands) is a cause TB. Less than one-fifth (17.5%) participants reported that the TB is caused by Mycobacterium tuberculosis. Additionally, more than a quarter of the participants (26.3%) believed that the consumption of chewing tobacco products in excess causes tubercular infection [Table 2].
Table 2: Knowledge about clinical features of TB

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Majority of participants (82.5%) were known that TB is a communicable disease while almost one fifth (17.5%) did not know whether it is communicable or not. Almost 56.0 percent participants were known that TB is transmitted by sharing of common materials with TB patient, while a quarter of them believed that tuberculosis can be transmitted by smoking. Only 5.3 percent reported that the TB is an air-borne disease and it is transmitted through droplet infections. Droplets are the nasal and oral secretions containing the micro-organisms.

Almost 82 percent% participants reported that BCG immunization prevents tuberculosis. More than half (52.6%) of the participants reported that the transmission of TB can be prevented by avoiding personal contact with the TB patient, and 43.9% stated that TB can be prevented by providing widespread awareness. Only 12.3% reported that personal protection measures using mask can prevent TB transmission [Table 2].

Attitude toward tuberculosis

Only 1 (1.8%) participants strongly agreed that the TB is due to past life's bad action while 19 (33.33%) disagreed. Majority of the participants 41 (71.9%) agreed that TB can be prevented. More than half of the participants 33 (57.6%) agreed to the statement that "if one family member is infected, other family members will also develop TB." Majority of participants believed that alcohol consumption (71.9%) and smoking (70.2%) are the causes of TB. Additionally, 7 (12.3%) of patients strongly affirmed that after completing DOTS, smoking, alcohol etc., can be consumed. Almost two-thirds (66.7%) participants agreed that probability of TB is equal in smokers and nonsmokers. About two-fifth (40.4%) participants disagreed that TB is a disease of poverty while only 4 (7%) strongly agreed and 8 (14%) strongly disagreed. More than half of the participants 33 (57.6%) agreed to the statement that TB can re-occur even if the full course of medicine was taken and the patient declared cured [Table 3].
Table 3: Attitude of DOTS patients toward TB

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  Discussion Top


Primarily, success of the disease prevention and control depends upon the understanding of the disease phenomena and suitable interventions. In the meantime, knowledge and awareness regarding various aspects of tuberculosis amongst the most vulnerable population is a key to curb disease transmission. This study is an attempt to explore the understanding and attitude of the people who have already have enormous impacts due to tuberculosis.

In this study, the highest proportions of participants (36.8%) were 41-60 years old (median age was 46 with the range of 74). The quantum of male participants was higher than that of female (ratio 2:1). Bhatt et al. reported that the age of patient undergoing treatment under DOTS varied from 11-70 years in Kathmandu, Nepal, [6] and the numbers of male patients was higher than the female counterparts. [6],[7]

Out of every five participants, four of them reported that the Blood in sputum was the commonest manifestation of TB infection. Additionally; evening rise fever (71.9%) and continuous cough lasting for more than 3 weeks (21.1%) were also the commonly reported symptoms of tubercular infection. In a similar study conducted in Bangladesh revealed that the chronic cough (61.6%) and night fever (80.6%) were most common clinical features of TB; [7] whereas, evening rise fever (89.9%) and Cough with sputum (75.0%) were the commonly known symptoms reported in the studies from Gujarat, India, and Bangladesh. [7],[8] Variation in the understandings might be due to the eruption of different symptoms according to the geographical variations or differences in the participant's profile. In this study, alcohol and smoking were reported as the principal causes of tuberculosis; however, the true information regarding bacterial infection was reported by less than a quintile (17.5%) participant. Knowledge of causative agent amongst the participants in our study was very low as compared to the findings of Tasnim et al. (47.7%) in Bangladesh; [7] however, it was higher than that was reported by Mohamed et al. (1.9%) in Sudan. [9] In this study, more than four out of every five participants knew that the TB is a communicable disease whereas as many as (96.6%) patients in rural area of Aligarh, India, reported that TB is communicable disease and it is transmitted from one person to another. [10] It indicates that the proportion of participants who know about the communicability of TB reported in this study was lower than that was reported in Aligarh. Majority had reported that sharing of common means in between the patient and family members is the common mode of TB transmission; nonetheless, almost a quarter affirmed that sharing of smoking items is the mode of disease transmission. A study from Bangladesh shows that almost 23 percent were unknown about the mode of transmission. [7] Only 5.3% of participants were known that the tuberculosis is transmitted by droplet infection whereas a large proportion and (56.0%) of the patients in the study from Sudan (40.4%), Bangladesh (56.0%), and 57.9 percent participants in a study from Patna, India reported that it is transmitted by droplet infection. [7],[9],[11],[12] The Knowledge of the tuberculosis transmission reported in our study was multiple times lower than that was reported in the studies conducted in India, Sudan, and Bangladesh. About four-fifth participants were known that vaccination prevents TB. More than half of the participants opined that avoidance of personal contact with the TB patients and use of personal protective masks (12.2%) can prevent Tuberculosis (transmission). Similarly, 43.5 percent stated tuberculosis can be prevented by raising awareness about the different aspects of tuberculosis. A similar study conduct by Joshi et al. in Patna revealed similar opinions regarding the avoidance of contact with patients and a large proportion (55.1%) of them said that the use of face mask is useful measures for prevention. [11]

Most of the participants strongly agreed (68.4%) that DOTS is an effective treatment for TB. Similarly, more than three-fifth (63.2%) strongly agreed that TB is a communicable disease and it can be treated with the medications (54.4%). They agreed that the disease can recur (57.9%) and the treatment should not be discontinued during treatment even if the symptoms are relieved (61.4%); disease can be transmitted through contacts amongst the family members, it can be prevented (71.9%) and all the smokers and non smokers may have disease (66.7%). On the other hand, they expressed their disagreements about the use of alcohol/smoking after the completion of treatment (54.4%). Lung is only the organ affected by TB (33.3%), and it is the disease of poor people (40.4%) and it can be treated by traditional healers like dhami/Jhakri (38.6%). Almost similar responses (agreements and disagreement statements) were observed about the perception that the TB is the reflection of past bad acts and the tuberculosis patients never dies with the TB. Out of 14 attitude measurement statements, in case of five statements, there have been the positive agreements amongst more than 60 percent; indicating the positive opinions with respect to existing true knowledge. Our findings are consistent with Tasnim et al. wherein they have also reported their positive attitude toward other TB patients. [7]

In two statements, more than half of the participants had affirmative agreements. With respect to the possibility in the use of smoking and alcohol consumption after completion of treatment, they had positive disagreement, indicating the true perceptions. This study remain inconclusive about the four statements (10-13 th statements) showing variable impressions on either side of agreements.


  Conclusion Top


Knowledge regarding the sign and symptom of tuberculosis was commonly observed amongst majority of the participants; however, only few had correct knowledge about the cause, modes of transmission, and preventive methods of TB. Despite the low level of knowledge and inconclusive agreements in case of few attitude-related statements, in majority they had affirmative altitudes according to the existing knowledge. Tuberculosis control programmes must be focussed in the pocket areas where there is high burden of disease and low level of public sensitizations. We recommend that National tuberculosis control authority should design health education programme focusing on causative agents and preventive measures targeting TB patients and their family members. Selective approaches need to be employed to create awareness and case identification of tuberculosis in such pocket areas where the tubercular infection persists as a public health problem.


  Acknowledgement Top


Authors are thankful to Mr. Shiva Ghimire and Mr. Rajendra Gurung of Jutpani Primary Health Care for their immense help during the data collection. Further, we wish to extend our gratitude to District Public Health office, Chitwan and the study participants for their cooperation.

 
  References Top

1.
Grange JM, Greenwood D, Slack R, Peuthere JF. Medical Microbiology 15 th ed. UK: ELBS Churchill Livingstone; 1998. p. 215.  Back to cited text no. 1
    
2.
Miller B, Schieffelbein C. Tuberculosis. Bull World Health Organ 1998;76:141-3.  Back to cited text no. 2
    
3.
WHO. Global Tuberculosis Report 2012. Geneva, Switzerland: World Health Organization; 2012b.  Back to cited text no. 3
    
4.
DoHS. 2010/2011. Annual Report, Ministry of Health and Population, Department of Health Services, Kathmandu, Nepal.  Back to cited text no. 4
    
5.
Sudre P, ten Dam G, Kochi A. Tuberculosis: A global overview of the situation today. Bull World Health Organ 1992;70:149-59.  Back to cited text no. 5
    
6.
Bhatt CP, Bhatt AB, Shrestha B. Knowledge of tuberculosis treatment - A survey among Tuberculosis patients in (DOTS) program in Nepal. SAARC J Tuberc Lung Dis HIV/AIDS 2010;7:10-4.  Back to cited text no. 6
    
7.
Tasnim S, Rahman A, Hoque FM. Patient′s Knowledge and Attitude towards Tuberculosis in an Urban Setting. Pul Med 2012;2012:352850  Back to cited text no. 7
    
8.
Vidhani M, Vadgama P. Awareness regarding Pulmonary Tuberculosis-A study among patient taking treatment of tuberculosis in rural Surat, Gujarat. Nat J Med Res 2012;2:452-5.  Back to cited text no. 8
    
9.
Mohamed AI, Yousif MA, Ottoa P, Bayoumi A. Knowledge of Tuberculosis: A Survey among Tuberculosis Patients in Omdurman, Sudan. Sudan J Public Health 2007;2:21-8.  Back to cited text no. 9
    
10.
Khalil S, Ahmad E, Khan ZP. A Study of Knowledge and Awareness regarding Pulmonary Tuberculosis in patients under Treatment for Tuberculosis in a rural area of Aligarh - UP, India. Indian J Community Health 2011;23:93-5.  Back to cited text no. 10
    
11.
Joshi RS, Maharjan M, Zimmerman MD. Tuberculosis awareness among TB patients visiting in DOTS clinic in Patna Hospital. SAARC J Tuberc Lung Dis HIV/AIDS 2006; 3:20-25.  Back to cited text no. 11
    
12.
Parrish NM, Dick JD, Bishai WR. Mechanisms of latency in Mycobacterium tuberculosis. Trends Microbiol 1998;6:107-12.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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