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Give C, Morris C, Murray J, José B, Machava R, Wayal S. Sociocultural understanding of Tuberculosis and implications for care-seeking among adults in the province of Zambezia, Mozambique: Qualitative research. PLoS One 2024; 19:e0289928. [PMID: 38236935 PMCID: PMC10795997 DOI: 10.1371/journal.pone.0289928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/29/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Mozambique has a high burden of Tuberculosis (TB) with an incidence of 368 per 100,000 population in 2020, coupled with a low all-form TB detection rate. The COVID-19 pandemic has exacerbated delays in timely diagnosis and treatment of new TB cases. Promoting active TB case finding is a national priority in Mozambique. We conducted qualitative research to explore factors influencing TB testing in Zambezia province in Mozambique. MATERIALS AND METHODS One-to-one, semi-structured, audio-recorded telephone interviews were conducted to explore TB-related knowledge, and barriers and facilitators to TB testing. A sample of two TB Program staff, two community providers of TB services, and 19 community members (10 women and 9 men) was recruited, with support from provincial government TB staff, from four districts in Zambezia with a high TB burden. Interviews were transcribed verbatim, and thematic analysis was conducted. The Mozambican National Bioethics Committee for Health approved the study protocol. RESULTS Our study highlights that knowledge about TB symptoms and its causes is low, which could delay timely TB testing. Sociocultural beliefs often implicate certain types of sexual activity and women as causes of TB symptoms; for example, having sex with a widow who has not been traditionally purified, or with a woman who has had an abortion. Therefore, people usually tend to first seek care from traditional healers instead of going to a health facility. Additionally, stigma associated with HIV and TB also delays care seeking. Gender-related disparities in TB care seeking were also evident. CONCLUSIONS This study provides valuable insights into how healthcare seeking for TB is influenced by sociocultural understanding of symptoms and gender dynamics. Therefore, interventions to promote timely and appropriate care seeking for TB should be contextually tailored, culturally appropriate, and gender sensitive.
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Affiliation(s)
- Celso Give
- Development Media International, Maputo, Mozambique
| | | | - Joanna Murray
- Development Media International, London, United Kingdom
| | - Benedita José
- National Tuberculosis Control Programme, Ministry of Health, Maputo, Mozambique
| | - Raimundo Machava
- National Tuberculosis Control Programme, Ministry of Health, Maputo, Mozambique
| | - Sonali Wayal
- Development Media International, London, United Kingdom
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Madebo M, Balta B, Daka D. Knowledge, attitude and practice on prevention and control of pulmonary tuberculosis index cases family in Shebedino District, Sidama Region, Ethiopia. Heliyon 2023; 9:e20565. [PMID: 37818014 PMCID: PMC10560778 DOI: 10.1016/j.heliyon.2023.e20565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Tuberculosis is a leading cause of death, despite being a largely curable and preventable disease. The goals of TB control are to reduce infection transmission, morbidity, and mortality until TB cannot be a threat to public health any longer while preventing drug resistance. Assessing KAP on TB control and prevention among family members is more essential, and taking action based on the result can break the transmission of TB infection. Methods From August to September 2022, a community-based cross-sectional study method was used. A total of 422 participants were selected from a list of sample frames who were family members of PTB patients who had used anti-TB medication in the previous 12 months prior to the study period using a systematic random sampling method. SPSS version 25 software was used to analyze the data. Bivariate and multivariate analyses were used to determine variables related to KAP on TB prevention and control. A variable with p-values less than 0.25 was included in the multivariable logistic regression model to find independent determinant factors. In the multivariate logistic regression, variables with p-values ≤0.05 were identified as statistically significant. Result A total of 414 family members responded to the survey questionnaire. The average knowledge score on TB was 17.11 ± 6.34. The majority (51.9%) of respondents had a good knowledge of TB cases. One-third of those polled had an unfavorable attitude towards PTB prevention, with a mean score of 3.16 ± 1.78 and 55.1% had good practice in preventing tuberculosis. Marital status (AOR = 1.7, 95% CI: 1.5-2.5) was an independent predictor of knowledge. Practice level is independently affected by occupation (AOR = 3.9; 95% CI = (1.7-8.7)) and health education on PTB (AOR = 2.4; 95% CI = (1.6-3.9). Conclusion Knowledge, attitudes, and preventive practices about tuberculosis were not satisfactory when compared to several national and international studies. It is necessary to strengthen the program for health education and awareness-building on PTB.
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Affiliation(s)
| | - Bargude Balta
- Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
| | - Deresse Daka
- Hawassa University College of Medicine and Health Science, Hawassa, Ethiopia
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Craciun OM, Torres MDR, Llanes AB, Romay-Barja M. Tuberculosis Knowledge, Attitudes, and Practice in Middle- and Low-Income Countries: A Systematic Review. J Trop Med 2023; 2023:1014666. [PMID: 37398546 PMCID: PMC10314818 DOI: 10.1155/2023/1014666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
Tuberculosis (TB) is the leading cause of death from an infectious agent in the world. Most tuberculosis cases are concentrated in low- and middle-income countries. The aim of this study is to better understand tuberculosis-related knowledge about TB disease, prevention, treatment and sources of information, attitudes towards TB patients and their stigmatization and prevention, diagnosis and treatment practices in the general population of middle- and low-income countries, with a high tuberculosis burden, and provide evidence for policy development and decision-making. A systematic review of 30 studies was performed. Studies reporting on knowledge, attitudes, and practices surveys were selected for systematic review through database searching. Population knowledge about TB signs and symptoms, prevention practices, and treatment means was found inadequate. Stigmatization is frequent, and the reactions to possible diagnoses are negative. Access to health services is limited due to difficulties in transportation, distance, and economic cost. Deficiencies in knowledge and TB health-seeking practices were present regardless of the living area, gender, or country; however, it seems that there is a frequent association between less knowledge about TB and a lower socioeconomic and educational level. This study revealed gaps in knowledge, attitude, and practices in focused in middle- and low-income countries. Policymakers could take into account the evidence provided by the KAP surveys and adapt their strategies based on the identified gaps, promoting innovative approaches and empowering the communities as key stakeholders. It is necessary to develop education programs on symptoms, preventive practices, and treatment for TB, to reduce transmission and stigmatization. It becomes also necessary to provide communities with innovative healthcare solutions to reduce their barriers to access to diagnosis and treatment.
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Affiliation(s)
| | - Malen del Rosario Torres
- National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- Andrés Isola Hospital, Puerto Madryn, Chubut, Argentina
| | - Agustín Benito Llanes
- National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María Romay-Barja
- National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Vargese SS, Kurian N, Mathew E, Raju AS, Khader J, Pillai RS. Short Comprehensive Multimodal Behavioural Intervention for Tuberculosis-Can It Be Effectively Incorporated in Tribal Health? J Racial Ethn Health Disparities 2023; 10:542-552. [PMID: 35106742 DOI: 10.1007/s40615-022-01244-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tuberculosis management in tribal areas is a major challenge to the National Tuberculosis Elimination Program in India. There is need for culturally appropriate interventions for bridging the gaps existing in the current system. There is paucity of research in this vulnerable group; hence, a study was undertaken to determine the effect of a Short Comprehensive Multimodal Behavioural Intervention in tribal colonies of Kerala. METHODS The study used before-after design to assess the effectiveness of a Short Comprehensive Multimodal Behavioural Intervention for tuberculosis knowledge and voluntary reporting among residents of tribal colonies. The intervention included individual, small group, and large group education, with verbal, printed, and performance methods. Public-private partnership with community participation was emphasized to encourage the residents to approach public health system for managing tuberculosis. RESULTS Ten tribal colonies from two districts were included with 104 participants. There was significant improvement in the proportion of participants with knowledge regarding different aspects of tuberculosis such as aetiology, symptoms, transmission, and treatment. The overall knowledge score had a significant improvement [median (range) 3.0 (0-9) to 7.0 (0-11), p < 0.001] when assessed one month consequent to the intense period of group education. CONCLUSION Short-term health behavioural intervention package appropriate for the target group, implemented with public-private partnership and community participation of trained local volunteers, proved effective in improving the knowledge regarding tuberculosis and thereby health-seeking behaviour in detection. This can be tested for scaling up, and replication in other tribal health issues.
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Affiliation(s)
- Saritha Susan Vargese
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India.
| | - Nisha Kurian
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Elsheba Mathew
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Aarya Serin Raju
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Jithin Khader
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Rahul S Pillai
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
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Kaaffah S, Kusuma IY, Renaldi FS, Lestari YE, Pratiwi ADE, Bahar MA. Knowledge, Attitudes, and Perceptions of Tuberculosis in Indonesia: A Multi-Center Cross-Sectional Study. Infect Drug Resist 2023; 16:1787-1800. [PMID: 37013169 PMCID: PMC10066633 DOI: 10.2147/idr.s404171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Tuberculosis (TB) is still a persistent health challenge in Indonesia and ranks high on the list of factors causing morbidity and mortality. Improving knowledge, attitudes, and perceptions (KAP) of the general community about TB can help to control the disease. Purpose This study aimed to examine the KAP about TB in Indonesian society and investigate their sociodemographic determinants. Participants and Methods An online cross-sectional survey in 34 provinces in Indonesia was carried out in June 2022. The scores of KAP were classified as low, moderate, and high. Bivariate and multivariate ordinal logistic regression were applied to identify the potential sociodemographic determinants of KAP. Adjusted odds ratio and 95% confidence interval (CI) for each determinant were provided. Results Among the 3205 participants, 56.4%, 91%, and 38% had high scores on knowledge, attitude, and perception, respectively. Independent determinants of high knowledge were age (26-35 years; adjusted odds ratio: 1.53 [95% CI: 1.19-1.97]), marital status (married; adjusted odds ratio: 1.18 [95% CI: 1.00-1.39]), and salary (middle income; adjusted odds ratio: 0.76 [95% CI: 0.63-0.93]). Independent factors associated with high scores in attitude and perception were the residence location (village; adjusted odds ratio: 0.76 [95% CI: 0.59-0.98]) and the occupation type (civil servant; adjusted odds ratio: 1.53 [95% CI: 1.09-2.13]), respectively. Conclusion Most Indonesians have a high knowledge and good attitude, although they have a moderate perception toward TB. Improving public awareness and health education with the right strategies is critical to reducing the country's TB burden.
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Affiliation(s)
- Silma Kaaffah
- Department of Pharmacy, Faculty of Health, Universitas Harapan Bangsa, Purwokerto, Indonesia
| | - Ikhwan Yuda Kusuma
- Department of Pharmacy, Faculty of Health, Universitas Harapan Bangsa, Purwokerto, Indonesia
- Departement of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | | | - Yovita Endah Lestari
- Department of Pharmacy, Faculty of Health Science, Universitas Malahayati, Lampung, Indonesia
| | | | - Muh Akbar Bahar
- Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
- Correspondence: Muh Akbar Bahar, Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, 90245, Indonesia, Tel +62 819-4422-8642, Fax +62 411 590663, Email
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Mohammedhussein M, Dule A, Tessema W, Mamaru A, Alenko A. Perceived stress and its psychosocial and clinical correlates among patients with pulmonary tuberculosis: A cross-sectional study. Indian J Psychiatry 2023; 65:103-106. [PMID: 36874521 PMCID: PMC9983448 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1356_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/01/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although various psychosocial consequences of pulmonary tuberculosis (PTB) have been thoroughly evaluated, perceived stress has not been well studied. AIM This study assessed perceived stress and its psychosocial and clinical correlates. METHODS An institution-based cross-sectional study was conducted among 410 PTB patients. Data were analyzed by Statistical Package for the Social Sciences (SPSS) v23. Independent sample t-test and Pearson correlation were used to test the association between perceived stress and other variables. Assumptions of linear regression were checked. Multiple regression analysis was done to identify statistically significant association at P < 0.05. RESULTS Anxiety, perceived social support, and stigma were found to have significant association with perceived stress in multiple regression analysis. Perceived social support and duration of treatment were negatively significantly associated with perceived stress. Patients with PTB had high perceived stress, and moderate to strong significant correlation was observed among variables. CONCLUSION Interventions tailored at addressing various psychosocial aspects of tuberculosis (TB) are needed.
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Affiliation(s)
- Mustefa Mohammedhussein
- Department of Psychiatry, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Aman Dule
- Department of Psychiatry, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Worknesh Tessema
- Department of Psychiatry, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Almaz Mamaru
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Arefayne Alenko
- Department of Psychiatry, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Sociodemographic Determinants of Knowledge towards Tuberculosis Transmission among Women of 15–49 Years of Age in India. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/2141777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background. India is one of the countries in the world most heavily impacted by tuberculosis (TB). In 2015, TB was a leading cause of death, killing 1.4 million people worldwide. The aim of the study was to assess the knowledge and associated factors regarding the transmission of TB among women in India. Method. We used publicly available datasets collected as part of the NFHS during 2015–16 in India. Data related to sociodemographic factors and knowledge about the transmission of TB among women (N = 699,686) were extracted using STATA. Multiple logistic regression analyses were used to determine factors associated with the knowledge of TB transmission among women. Results. Among 699,686 women, 88.36% knew about TB, 59.81% recognized that tuberculosis spreads by air through coughing or sneezing, and 78.55% understood that tuberculosis is a curable disease indicating correct knowledge about TB. 70.74% of the women were from rural areas with 59.29% having a secondary or higher level of education and 40.41% living in poverty. Multivariable analysis indicated that the probability of having good knowledge of TB was consistently significant among women with higher education [aOR: 2.502; 95% CI: 2.454–2.551]; women living in rich households (highest wealth quintile) [aOR: 1.590; 95% CI: 1.556–1.625]; and women residing in urban areas [aOR: 1.191; 95% CI: 1.166–1.215] than their rural counterparts. Conclusion. The findings of this study showed that women in India have moderately good knowledge and a correct attitude towards tuberculosis. However, the level of information varies with the various sociodemographic factors such as age group, place of residence, education, wealth index, religion, and caste/tribe bearing a positive causal relationship between the knowledge and TB transmission and hence the resulting attitude.
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Fuady A, Fitriangga A, Sugiharto A, Arifin B, Yunita F, Yani FF, Nasution HS, Putra IWGAE, Rauf S, Mansyur M, Wingfield T. Characterising and Addressing the Psychosocial Impact of Tuberculosis in Indonesia (CAPITA): A study protocol. Wellcome Open Res 2022; 7:42. [PMID: 36874576 PMCID: PMC9975400 DOI: 10.12688/wellcomeopenres.17645.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Tuberculosis (TB)-related stigma remains a key barrier for people with TB to access and engage with TB services and can contribute to the development of mental illnesses. This study aims to characterise stigmatisation towards people with TB and its psychosocial impact in Indonesia. Methods: This study will apply a sequential mixed method in two main settings: TB services-based population (setting 1) and workplace-based population (setting 2). In setting 1, we will interview 770 adults with TB who undergo sensitive-drug TB treatment in seven provinces of Indonesia. The interview will use the validated TB Stigma Scale questionnaire, Patient Health Questionnaire-9, and EQ-5D-5L to assess stigma, mental illness, and quality of life. In Setting 2, we will deploy an online questionnaire to 640 adult employees in 12 public and private companies. The quantitative data will be followed by in-depth interview to TB-related stakeholders. Results: CAPITA will not only characterise the enacted stigma which are directly experienced by people with TB, but also self-stigma felt by people with TB, secondary stigma faced by their family members, and structural stigma related to the law and policy. The qualitative analyses will strengthen the quantitative findings to formulate the potential policy direction for zero TB stigma in health service facilities and workplaces. Involving all stakeholders, i.e., people with TB, healthcare workers, National Tuberculosis Program officers, The Ministry of Health Workforce, company managers, and employees, will enhance the policy formulation. The validated tool to measure TB-related stigma will also be promoted for scaling up to be implemented at the national level. Conclusions: To improve patient-centered TB control strategy policy, it is essential to characterise and address TB-related stigma and mental illness and explore the needs for psychosocial support for an effective intervention to mitigate the psychosocial impact of TB.
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Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16 Jakarta, 10310, Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, 78124, Indonesia
| | - Agus Sugiharto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16 Jakarta, 10310, Indonesia
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, 90245, Indonesia
| | - Ferdiana Yunita
- Department of Community Medicine, Faculty of Medicine, Universitas Gunadarma, Depok, 16451, Indonesia
| | - Finny Fitry Yani
- Faculty of Medicine, Department of Child Health, M. Djamil Hospital, Universitas Andalas, Padang, 25129, Indonesia
| | | | | | - Saidah Rauf
- Politeknik Kesehatan Kemenkes Maluku, Maluku, 97711, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16 Jakarta, 10310, Indonesia
- South East Asian Ministers of Education Organization Regional Center for Food and Nutrition, Jakarta, 13120, Indonesia
| | - Tom Wingfield
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, 171 76, Sweden
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L7 8XP, UK
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Yohannes K, Ayano G, Toitole KK, Teferi HM, Mokona H. Harmful Alcohol Use Among Patients with Tuberculosis in Gedeo Zone, Southern Ethiopia. Subst Abuse Rehabil 2022; 13:117-125. [DOI: 10.2147/sar.s384921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
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Almalki ME, Almuqati FS, Alasmari R, Enani MJ, Bahwirith AA, Alloqmani AA, Alqurashi A, Hassan-Hussein A. A Cross-Sectional Study of Tuberculosis Knowledge, Attitude, and Practice Among the General Population in the Western Region of Saudi Arabia. Cureus 2022; 14:e29987. [PMID: 36381904 PMCID: PMC9642831 DOI: 10.7759/cureus.29987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/16/2023] Open
Abstract
Background Religious gatherings like the Hajj, an Islamic pilgrimage, attract millions of people to one place during the same time frame. Due to crowding, infectious diseases, specifically tuberculosis (TB), are very common during such events. This study investigates the knowledge, attitudes, and practices of the public in the western region of Saudi Arabia related to TB to better understand the situation. Methodology An observational, questionnaire-based, cross-sectional study was conducted over two months between January and March 2022. A survey of 29 questions was used to collect data from the general population. The study included any person who was a resident of Makkah. Individuals under 18 years of age and health workers were excluded. We used OpenEpi, version 3.0, for sample size calculation, which gave a result of 604 participants, and SPSS version 25.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results A total of 604 participants were included in this study; 64.7% of respondents showed poor overall knowledge, and 14.1% had good knowledge of TB. Concerning attitude, 89.9% of the respondents showed poor attitude, and only 2.3% had a good attitude. As for practice, 59.4% of respondents had poor knowledge of proper practices, and only 10.4% knew the right practices regarding TB. Upon further analysis of our results, women exhibited better knowledge of TB than men (0.62, 95% confidence interval (CI), 0.44-0.87). Participants over 50 years old had the lowest knowledge about TB compared with participants aged 18 to 28 years old (7.61, 95% CI, 4.35-13.32). Non-Saudi residents had less knowledge compared with Saudi residents (45.849, 95% CI, 18.475-113.78). Level of education also played a substantial role; university graduates had the most knowledge about TB compared with participants with below university or no formal education (0.052, 95% CI, 0.01-0.40). Conclusions Participants with lower educational backgrounds were the most lacking in knowledge, attitude, and practice regarding TB. This lack of knowledge was more common among non-Saudi men over 50 years old. Information campaigns are needed to help reduce the prevalence of TB.
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Assessment of knowledge, attitude, and practices of tuberculosis patients towards DOTs regimen in Jimma health center, Jimma zone, southwest Ethiopia. J Clin Tuberc Other Mycobact Dis 2022; 28:100329. [PMID: 35958355 PMCID: PMC9361319 DOI: 10.1016/j.jctube.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of conducting this study was to assess the knowledge, attitude, and practices of tuberculosis patients towards dots regimen in Jimma health Center. In addition, assessing the attitude of tuberculosis towards factors, modern, and traditional medicine was another aim of this study. Methods A cross-sectional study was conducted based on patient card and registration book at TB follow-up clinic at Jimma health center, southwest Ethiopia. The study population comprises 150 participants, who were selected from the patient registration book by interviewing and questionnaires. Additionally, cross-tabulation and OR with 95% confidence interval were computed. Results In this study, only 103 (68.7%) and 47 (31.3%) patients scored higher and lower knowledge status respectively. Of the total enrolled governmental employee, 25 (16.7 %) patients had an overall high knowledge status. On the other hand, 101 (67.3%) and 49 (32.7 %) patients scored high and low overall attitude respectively. Conclusions In this study, the knowledge and attitude of patients about TB and its treatment were found within a low level of perception. Therefore, implementation of health education and awareness creation through different mobilization mechanisms are required to avoid the problem for patients.
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Fuady A, Fitriangga A, Sugiharto A, Arifin B, Yunita F, Yani FF, Nasution HS, Putra IWGAE, Rauf S, Mansyur M, Wingfield T. Characterising and Addressing the Psychosocial Impact of Tuberculosis in Indonesia (CAPITA): A study protocol. Wellcome Open Res 2022; 7:42. [PMID: 36874576 PMCID: PMC9975400 DOI: 10.12688/wellcomeopenres.17645.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Tuberculosis (TB)-related stigma remains a key barrier for people with TB to access and engage with TB services and can contribute to the development of mental illnesses. This study aims to characterise stigmatisation towards people with TB and its psychosocial impact in Indonesia. Methods: This study will apply a sequential mixed method in two main settings: TB services-based population (setting 1) and workplace-based population (setting 2). In setting 1, we will interview 770 adults with TB who undergo sensitive-drug TB treatment in seven provinces of Indonesia. The interview will use the validated TB Stigma Scale questionnaire, Patient Health Questionnaire-9, and EQ-5D-5L to assess stigma, mental illness, and quality of life. In Setting 2, we will deploy an online questionnaire to 640 adult employees in 12 public and private companies. The quantitative data will be followed by in-depth interview to TB-related stakeholders. Results: CAPITA will not only characterise the enacted stigma which are directly experienced by people with TB, but also self-stigma felt by people with TB, secondary stigma faced by their family members, and structural stigma related to the law and policy. The qualitative analyses will strengthen the quantitative findings to formulate the potential policy direction for zero TB stigma in health service facilities and workplaces. Involving all stakeholders, i.e., people with TB, healthcare workers, National Tuberculosis Program officers, The Ministry of Health Workforce, company managers, and employees, will enhance the policy formulation. The validated tool to measure TB-related stigma will also be promoted for scaling up to be implemented at the national level. Conclusions: To improve patient-centered TB control strategy policy, it is essential to characterise and address TB-related stigma and mental illness and explore the needs for psychosocial support for an effective intervention to mitigate the psychosocial impact of TB.
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Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16 Jakarta, 10310, Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, 78124, Indonesia
| | - Agus Sugiharto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16 Jakarta, 10310, Indonesia
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, 90245, Indonesia
| | - Ferdiana Yunita
- Department of Community Medicine, Faculty of Medicine, Universitas Gunadarma, Depok, 16451, Indonesia
| | - Finny Fitry Yani
- Faculty of Medicine, Department of Child Health, M. Djamil Hospital, Universitas Andalas, Padang, 25129, Indonesia
| | | | | | - Saidah Rauf
- Politeknik Kesehatan Kemenkes Maluku, Maluku, 97711, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16 Jakarta, 10310, Indonesia
- South East Asian Ministers of Education Organization Regional Center for Food and Nutrition, Jakarta, 13120, Indonesia
| | - Tom Wingfield
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, 171 76, Sweden
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L7 8XP, UK
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13
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Alemu WG, Tilahun SY, Bekele E, Eshitu B, Kerebih H. Prevalence and associated factors of perceived stigma among medically ill patients on follow-up screened positive for depression in Ethiopia: facility-based cross-sectional study. BMJ Open 2022; 12:e056665. [PMID: 35105651 PMCID: PMC8804654 DOI: 10.1136/bmjopen-2021-056665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Many people are familiar with the issues of stigma in mental health or HIV, but feeling stigma as an underlying factor for many medically ill-health conditions has not been examined. METHODS Institution-based cross-sectional study was conducted on patients followed for medical illnesses and having depression. We recruited 384 participants and who were interviewed by nurses using face-to-face interviews and a systematic random sampling technique applied. We used a perceived devaluation and discrimination, a 12-item tool that is used to measure outcome perceived stigma. Variables were coded and entered Epi Info V.3.5.3 and exported to SPSS V.20 for analysis. Statistical analysis parameters, such as descriptive and multivariate logistic regression, were used for data analysis. Adjusted ORs (AORs) with a 95% CI and p value <0.05 were declared significance. RESULT The prevalence of perceived stigma on a patient who followed for medical illness screened positive for depression was found to be around 66.3%. In the multivariate logistic regression, patients with hypertension 61% less likely ((AOR=0.39, 95% CI (0.17 to 0.89)) to have perceived stigma than with asthma and cardiac patients, patients completed higher education 2.15 times ((AOR=2.15; 95% CI 1.05 to 4.40)) more likely to have perceived stigma than which cannot read and write. Patients who had the previous admission with medical illness 1-2 times were 3.52 more likely (AOR=3.52, 95% CI (2.14 to 5.78)) perceived stigma than those who had no hospital admission. Patients who had the previous admission three times with medical illness were 6.1 more likely (AOR=6.1, 95% CI (2.32 to 16.07)) to have perceived stigma than those who had no previous hospital admission. CONCLUSION The prevalence of perceived stigma among patients who had on follow-up for medical illnesses was high. Educational status, history of previous hospital admission were considerably associated with higher perceived stigma.
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Affiliation(s)
- Wondale Getinet Alemu
- Department of Psychiatry, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | - Sewbesew Yitayih Tilahun
- Department of Psychiatry, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | | | | | - Habtamu Kerebih
- Department of Psychiatry, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
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14
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Akpobolokemi T, Martinez-Nunez RT, Raimi-Abraham BT. Tackling the global impact of substandard and falsified and unregistered/unlicensed anti-tuberculosis medicines. MEDICINE ACCESS @ POINT OF CARE 2022; 6:23992026211070406. [PMID: 36204519 PMCID: PMC9413333 DOI: 10.1177/23992026211070406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Substandard and falsified (SF) medicines are a global health challenge with the
World Health Organization (WHO) estimating that 1 in 10 of medicines in low- and
middle-income countries (LMICs) are SF. Antimicrobials (i.e. antimalarials,
antibiotics) are the most commonly reported SF medicines. SF medicines
contribute significantly to the global burden of infectious diseases and
antimicrobial resistance (AMR). This article discusses the challenges associated
with the global impact of SF and unregistered/unlicensed antimicrobials with a
focus on anti-TB medicines. Tuberculosis (TB) is the 13th leading cause of death
worldwide, and is currently the second leading cause of death from a single
infectious agent, ranking after COVID-19 and above HIV/AIDS. Specifically in the
case of TB, poor quality of anti-TB medicines is among the drivers of the
emergence of drug-resistant TB pathogens. In this article, we highlight and
discuss challenges including the emergence of SF associated AMR, patient
mistrust and lack of relevant data. We also present study reports to inform
meaningful change. Recommended solutions involve the adaptation of interventions
from high-income countries (HICs) to LMICS, the need for improvement in the
uptake of medication authentication tools in LMICs, increased stewardship, and
the need for global and regional multidisciplinary legal and policy cooperation,
resulting in improved legal sanctions.
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Affiliation(s)
- Tamara Akpobolokemi
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rocio Teresa Martinez-Nunez
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, Guy’s Hospital, London, UK
| | - Bahijja Tolulope Raimi-Abraham
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
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15
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Cvetković VM, Nikolić N, Ocal A, Martinović J, Dragašević A. A Predictive Model of Pandemic Disaster Fear Caused by Coronavirus (COVID-19): Implications for Decision-Makers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:652. [PMID: 35055474 PMCID: PMC8775677 DOI: 10.3390/ijerph19020652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/14/2022]
Abstract
This paper presents quantitative research results regarding a predictive model of pandemic disaster fear caused by the coronavirus disease (COVİD-19). The aim of this paper was to establish the level and impact of certain demographic and socioeconomic characteristics on pandemic disaster fear caused by the coronavirus (COVID-19). The research was conducted using a questionnaire that was provided and then collected online for 1226 respondents during May 2021. A closed, five-point Likert scale was used to create the structured questionnaire. The first section of the questionnaire included research questions about the participants' socioeconomic and demographic characteristics, while the second section included issue questions about fear caused by COVID-19. The results of multivariate regression analyses showed the most important predictor for fear of COVID-19 to be gender, followed by age and education level. Furthermore, the results of t-tests showed statistically significant differences between men and women in terms of different aspects of pandemic disaster fear caused by the coronavirus disease. Our results have several significant public health implications. Women who were more educated and knowledgeable, married, and older, reported a greater fear of the outbreak at various levels. Decision-makers can use these findings to identify better strategic opportunities for pandemic disaster risk management.
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Affiliation(s)
- Vladimir M. Cvetković
- Faculty of Security Studies, University of Belgrade, Gospodara Vučića 50, 11040 Belgrade, Serbia
- Scientific-Professional Society for Disaster Risk Management, Dimitrija Tucovića 121, 11040 Belgrade, Serbia;
- International Institute for Disaster Research, Dimitrija Tucović 121, 11056 Belgrade, Serbia
| | - Neda Nikolić
- Faculty of Technical Sciences, University of Kragujevac, 32102 Cacak, Serbia; (N.N.); (A.D.)
| | - Adem Ocal
- Independent Researcher, Ankara 06500, Turkey;
| | - Jovana Martinović
- Scientific-Professional Society for Disaster Risk Management, Dimitrija Tucovića 121, 11040 Belgrade, Serbia;
- International Institute for Disaster Research, Dimitrija Tucović 121, 11056 Belgrade, Serbia
| | - Aleksandar Dragašević
- Faculty of Technical Sciences, University of Kragujevac, 32102 Cacak, Serbia; (N.N.); (A.D.)
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Das A, Lakhan T, Unisa S. Tuberculosis prevalence, knowledge of transmission and its association with vaccination of children. J Infect Prev 2021; 22:259-268. [PMID: 34880948 DOI: 10.1177/17571774211012777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Understanding the perceptions of patients regarding tuberculosis (TB) will enable better design of a comprehensive, client-oriented program for the disease. Methods This study was conducted district-wise across India in 2015-2016 as part of the National Family Health Surveys (NFHS). Results We discovered that the prevalence of TB remains significantly high, with quite a high percentage of people being unaware of the exact cause of disease proliferation. The majority of people believed that touching or sharing utensils can be a source of TB. This perception affected the participants' responses about seeking diagnosis and treatment. However, it is a good sign that most people knew that TB is a curable disease that can be prevented to some extent if immunization with the Bacillus Calmette-Guérin (BCG) vaccine is done at the correct stage. So, a large section of the population had their children vaccinated. In addition, they would go for diagnosis if they had symptoms suggestive of the disease. Conclusion Findings from this study are indicative of the fact that a large population is aware that health facilities can make a significant contribution to the treatment of tuberculosis. There is a need to further investigate how this information could potentially be used to enhance early seeking of appropriate services among TB patients.
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Affiliation(s)
- Anisha Das
- Department of Statistics and Biostatistics, Florida State University, USA
| | - Tejal Lakhan
- Department of Bio-statistics and Demography, International Institute for Population Sciences, Mumbai, India
| | - Sayeed Unisa
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
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17
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Makgopa S, Madiba S. Tuberculosis Knowledge and Delayed Health Care Seeking Among New Diagnosed Tuberculosis Patients in Primary Health Facilities in an Urban District, South Africa. Health Serv Insights 2021; 14:11786329211054035. [PMID: 34720588 PMCID: PMC8554548 DOI: 10.1177/11786329211054035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Patients’ delay in seeking health care is a major problem in the control of tuberculosis (TB) and increases the risk of TB transmission. This study determined health-seeking practices and delays that occurred from the onset of TB symptoms until diagnosis and assessed the patients’ TB-related knowledge. This was a cross-sectional study involving 391 new TB patients recruited from health facilities at an urban sub-district in South Africa from December 2016 to March 2017. Descriptive statistics and logistic regression analyses were performed using Stata 14. Over half (56.3%) of the patients delayed seeking health care for more than 30 days after the onset of their symptoms, 32% sought treatment from informal providers, and 13.3% self-medicated. Lack of suspicion of a TB diagnosis, which was prevalent in 45% of respondents, was statistically associated with delay in seeking healthcare (AOR = 0.53, CI: 0.32-1.87). Overall TB knowledge was high, correct knowledge about TB transmission was 92.6%. TB knowledge was significantly associated with educational status (AOR = 3.96, CI: 1.69-9.28) and seeking treatment from informal sectors (AOR = 0.17, CI: 0.03-0.95). High overall TB knowledge was not statistically associated with seeking health care for TB diagnosis and treatment. We found a substantial delay between the onset of TB symptoms and seeking healthcare from a public health facility providing TB screening services. Promoting early screening and diagnosis through increasing awareness of TB is key in the elimination of TB in communities with a high TB burden
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Affiliation(s)
- Sylvia Makgopa
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sphiwe Madiba
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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18
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Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 2021; 22:251. [PMID: 34556113 PMCID: PMC8459488 DOI: 10.1186/s12931-021-01841-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world's TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. METHODS We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. RESULTS This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were-patient delay (LIC/LMIC: 28 (95% CI 20-30); UMIC: 10 (95% CI 10-20), health system delay (LIC/LMIC: 14 (95% CI 2-28); UMIC: 4 (95% CI 2-4), and treatment delay (LIC/LMIC: 14 (95% CI 3-84); UMIC: 0 (95% CI 0-1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. CONCLUSIONS This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
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19
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Boah M, Kpordoxah MR, Adokiya MN. Self-reported gender differentials in the knowledge of tuberculosis transmission and curative possibility using national representative data in Ghana. PLoS One 2021; 16:e0254499. [PMID: 34252131 PMCID: PMC8274842 DOI: 10.1371/journal.pone.0254499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Health-seeking behaviour, stigma, and discrimination towards people affected by tuberculosis (TB) are influenced by awareness of the disease. Gender differentials in the diagnosis and treatment of TB have been reported in other settings of the world. However, little is known about the gender differences in the knowledge of TB transmission and curative possibility in Ghana. Methods The analysed data were a weighted sample of 9,396 women aged 15–49 years and 4,388 men aged 15–59 years, obtained from the 2014 Ghana Demographic and Health Survey. The dependent variable, correct knowledge regarding TB transmission and cure was derived from questions on the transmission of the disease and the possibility of a cure. A design-based multivariate logistic regression model in Stata 13.0/SE was used to identify the correlates of reporting correct knowledge. Results Overall, the mean knowledge score was 6.1±0.9 (maximum = 7). Of the 13,784 respondents, 45.7% (95% CI: 44.0–47.3) reported correct knowledge regarding TB transmission and cure. Men had significantly higher knowledge than women (50.9% versus 43.2%). Misconceptions, including TB transmitted through sharing utensils (13.3%), food (6.9%), touching a person with TB (4.5%), sexual contact (4.1%), and mosquito bites (0.4%) were noted. About 30% (33% women and 25% men) of the total sample would keep the information secret when a household member is affected with TB. In the adjusted analysis, age, gender, education, region, place of residence, wealth quintile, frequency of reading newspaper/magazine, listening to the radio, and watching television were significantly associated with reporting correct knowledge. Conclusions There was low knowledge regarding TB transmission and cure. Misconceptions regarding the transmission of TB prevailed among the participants. Gender differential in knowledge was observed. Comparatively, females were less likely to be aware of TB and report correct knowledge regarding TB transmission but were more likely to conceal information when a household member was affected by the disease.
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Affiliation(s)
- Michael Boah
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
- * E-mail:
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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20
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Mercaldo R, Whalen C, Kakaire R, Nakkonde D, Handel A, Sekandi JN. Community drivers of tuberculosis diagnostic delay in Kampala, Uganda: a retrospective cohort study. BMC Infect Dis 2021; 21:641. [PMID: 34217245 PMCID: PMC8255016 DOI: 10.1186/s12879-021-06352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent approaches to TB control have focused on identifying and treating active cases to halt further transmission. Patients with TB symptoms often delay to seek care, get appropriate diagnosis, and initiate effective treatment. These delays are partly influenced by whom the patients contact within their community network. We aimed to evaluate the community drivers of diagnostic delay in an urban setting in Uganda. METHODS In this study we analyze data from a retrospective cohort of 194 TB patients in Kampala, Uganda. We characterized the patterns of contacts made by patients seeking care for TB symptoms. The main outcome of interest was total community contact delay, defined as the time patients spent seeking care before visiting a provider capable of diagnosing TB. RESULTS Visits to health providers without access to appropriate diagnostic services accounted for 56% of contacts made by cohort members, and were significantly associated with community contact delay, as were symptoms common to other prevalent illnesses, such as bone and joint pain. CONCLUSIONS Education programs aimed at primary care providers, as well as other community members, may benefit case identification, by informing them of rarer symptoms of TB, potential for co-infections of TB and other prevalent diseases, and the availability of diagnostic services.
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Affiliation(s)
- Rachel Mercaldo
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA.
| | - Christopher Whalen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
- Global Health Institute, University of Georgia, Athens, GA, USA
| | - Robert Kakaire
- Global Health Institute, University of Georgia, Athens, GA, USA
| | | | - Andreas Handel
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
- Health Informatics Institute, University of Athens, Kampala, GA, USA
| | - Juliet N Sekandi
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
- Global Health Institute, University of Georgia, Athens, GA, USA
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21
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Getnet F, Demissie M, Worku A, Gobena T, Tschopp R, Farah AM, Seyoum B. Challenges in delivery of tuberculosis Services in Ethiopian Pastoralist Settings: clues for reforming service models and organizational structures. BMC Health Serv Res 2021; 21:627. [PMID: 34193133 PMCID: PMC8246683 DOI: 10.1186/s12913-021-06662-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The End-TB strategy aims to see a world free of tuberculosis (TB) by the coming decade through detecting and treating all cases irrespective of socioeconomic inequalities. However, case detections and treatment outcomes have not been as they should be in Somali pastoral settings of Ethiopia. Hence, this study aimed to explore the challenges that hinder the delivery and utilization of TB services in pastoral areas. Methods A qualitative study was conducted between December 2017 and October 2018 among pastoralist patients with delay of ≥2 months in seeking healthcare, healthcare providers and programme managers. Data were collected from different sources using 41 in-depth interviews, observations of facilities and a review meeting of providers from 50 health facilities. The data were transcribed, coded and analyzed to identify pre-defined and emerging sub-themes. ATLAS.ti version 7.0 was used for coding data, categorizing codes, and visualizing networks. Results Poor knowledge of TB and its services, limited accessibility (unreachability, unavailability and unacceptability), pastoralism, and initial healthcare-seeking at informal drug vendors that provide improper medications were the key barriers hindering the uptake of TB medical services. Inadequate infrastructure, shortage of trained and enthused providers, interruptions of drugs and laboratory supplies, scarce equipment, programme management gaps, lack of tailored approach, low private engagement, and cross-border movement were the major challenges affecting the provision of TB services for pastoral communities. The root factors were limited potential healthcare coverage, lack of zonal and district TB units, mobility and drought, strategy and funding gaps, and poor development infrastructure. Conclusion In pastoral settings of Ethiopia, the major challenges of TB services are limited access, illicit medication practices, inadequate resources, structural deficits, and lack of tailored approaches. Hence, for the pastoral TB control to be successful, mobile screening and treatment modalities and engaging rural drug vendors will be instrumental in enhancing case findings and treatment compliance; whereas, service expansion and management decentralization will be essential to create responsive structures for overcoming challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06662-3.
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Affiliation(s)
- Fentabil Getnet
- School of Public Health, Jigjiga University, Jigjiga, Ethiopia. .,School of Public Health, Haramaya University, Dire Dawa, Ethiopia.
| | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- School of Public Health, Haramaya University, Dire Dawa, Ethiopia
| | - Rea Tschopp
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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22
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Pampalia N, Waluyo A, Yona S. Knowledge, stigma and health-seeking behavior of patients co-infected with HIV and tuberculosis in Jakarta. ENFERMERIA CLINICA 2021. [PMID: 33849184 DOI: 10.1016/j.enfcli.2020.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose was to identify knowledge and TB stigma, as well as its relationship with health-seeking behavior in HIV and TB co-infection patients. A cross-sectional study was conducted with 115 HIV and TB co-infection patients who visited the VCT Polyclinic in five hospitals in Jakarta. This study was using instruments: Brief HIV-Knowledge Questionnaire (HIV-KQ-18), Knowledge TB survey Questionnaire, Berger HIV stigma Scale, Tuberculosis-Related Stigma Scale. This study showed that respondents had good knowledge of TB (69.6%) and had a low stigma of TB (55.7%), and had a health-seeking behavior that did not delay consultation (55.7%). There was a significant relationship between TB knowledge (p-value: 0.042) and TB stigma (p-value: 0.026) with health-seeking behavior. The results of this study can be used as guidelines to improve education and counseling about TB knowledge and TB stigma in HIV and TB co-infection patients.
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Affiliation(s)
- Novi Pampalia
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia; Mohammad Hoesin Cental General Hospital, South Sumatera, Indonesia
| | - Agung Waluyo
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia.
| | - Sri Yona
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia
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Mehta SN, Murrill M, Suryavanshi N, Bhosale R, Naik S, Patil N, Gupta A, Mathad J, Shivakoti R, Alexander M. TB-related knowledge and stigma among pregnant women in low-resource settings. Int J Tuberc Lung Dis 2021; 25:148-150. [PMID: 33656428 DOI: 10.5588/ijtld.20.0241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S N Mehta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Murrill
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Suryavanshi
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Bhosale
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - S Naik
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - N Patil
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - J Mathad
- Weill Cornell Medical College, New York, NY
| | - R Shivakoti
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - M Alexander
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
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Bihon A, Zinabu S, Muktar Y, Assefa A. Human and bovine tuberculosis knowledge, attitude and practice (KAP) among cattle owners in Ethiopia. Heliyon 2021; 7:e06325. [PMID: 33748453 PMCID: PMC7969333 DOI: 10.1016/j.heliyon.2021.e06325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/02/2021] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) is a re-emerging disease occurring worldwide, resulting in multi-billion-dollar loss and human death annually. The situation is worse in developing countries like Ethiopia, where lower knowledge, attitude, and practice (KAP) of the people is poor about the disease. A questionnaire-based cross-sectional study was conducted to assess livestock owners' KAP level towards human and bovine Tuberculosis in Gondar, Ethiopia. A total of 349 study participants were addressed through a face-to-face interview. Descriptive statistics and Pearson's chi-squares analysis were used to analyze the data and observe the association between outcome (KAP level) and predictor variables (sociodemographic characteristics). Out of the 349 respondents, 223 (63.9%) were males, while 126 (36.1%) were females. The KAP measuring interview indicated that 97.4% of the participants are aware of human tuberculosis, while only 84 (24.1%) know about bovine tuberculosis cause and mode of transmission. Inhalation was reported as the main route of transmission for human TB (41.1%) whereas, 50% of the respondent mentioned inhalation, contact, and ingestion of raw animal products as the main route of TB transmission from animal to human. Among those who have heard of bovine tuberculosis, only 56 (66.7%) of respondents consider bovine tuberculosis as a significant threat to public health. The study showed there is a lower KAP on bovine TB among cattle owners in the study area. Therefore, community health education about the impact of the disease, transmission, control, and prevention should be integrated with one health-oriented education and research to eradicate the disease from the country.
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Affiliation(s)
- Amare Bihon
- Woldia University, College of Agriculture, Department of Veterinary Medicine, Mersa, Ethiopia
| | - Solomon Zinabu
- Samara University, College of Veterinary Medicine, Samara, Ethiopia
| | - Yimer Muktar
- Woldia University, College of Agriculture, Department of Veterinary Medicine, Mersa, Ethiopia
| | - Ayalew Assefa
- Woldia University, College of Agriculture, Department of Veterinary Medicine, Mersa, Ethiopia
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Ruan Y, Zhuang C, Chen W, Xie J, Zhao Y, Zhang L, Lin H. Limited knowledge and distrust are important social factors of out-patient' s 'inappropriate diagnosed seeking behaviour': a qualitative research in Shanghai. Int J Health Plann Manage 2021; 36:847-865. [PMID: 33615549 DOI: 10.1002/hpm.3134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/05/2021] [Accepted: 01/29/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS This study is designed to present out-patient's 'inappropriate diagnosed seeking behaviour' in tertiary hospitals and interpret its association with some potential social factors. METHODS A qualitative study based on grounded theory was designed in this paper. The participates were recruited by a two-stage process. The field observation and in-depth interview were adopted for data collection. Multi-round (five rounds) sampling and continuing data analysis were adopted as well. RESULTS Totally 26 out-patients from three tertiary hospitals in Shanghai were involved. Four focused codes, including 'limited policy-related knowledge', 'limited health-related knowledge', 'distrust on related policy' and 'distrust on medical networks', were identified. Then, a theoretical model about the association of out-patient's 'limited knowledge' with 'distrust' and its relationship with 'inappropriate first-diagnosed seeking behaviour' in tertiary hospitals was developed. CONCLUSION 'Inappropriate first-diagnosed seeking behaviour' of the out-patients in tertiary hospitals is closely associated with their limited knowledge and related distrust. Great effort on improving publics' knowledge and rebuilding a benign trust relationship with out-patients and the medical networks is found to be essential for guiding publics' appropriate first-diagnosed health behaviour in various levels of medical institutions.
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Affiliation(s)
- Yuhui Ruan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Chenyang Zhuang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weisin Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinyu Xie
- Huashan Hospital, Affiliated to Shanghai Fudan University, Shanghai, China
| | - Yaodong Zhao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lufa Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Institute of Medical Science Popularization, Fudan University, Shanghai, China
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Chen X, Du L, Wu R, Xu J, Ji H, Zhang Y, Zhu X, Zhou L. Tuberculosis-related stigma and its determinants in Dalian, Northeast China: a cross-sectional study. BMC Public Health 2021; 21:6. [PMID: 33397334 PMCID: PMC7780403 DOI: 10.1186/s12889-020-10055-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022] Open
Abstract
Background The stigma of tuberculosis (TB) poses a significant challenge to TB control because it leads to delayed diagnosis and non-adherence. However, few studies on TB-related stigma have been completed in China. The aim of the current study was to explore the status of TB-related stigma and its associated predictive factors among TB patients in Dalian, Northeast China. Methods An institution-based, cross-sectional survey was conducted among outpatients at Dalian Tuberculosis Hospital in Liaoning Province, Northeast China. Data were collected by using a questionnaire that measured TB-related stigma, treatment status, anxiety, social support, doctor-patient communication and so on. A multiple linear regression model was used to determine the predictors of TB-related stigma. Results A total of 601 eligible participants were recruited. The mean score for TB-related stigma was 9.07, and the median score was 10. The average scores for anxiety, social support and doctor-patient communication were 4.03, 25.41 and 17.17, respectively. Multiple linear regression analysis revealed that patients who were female (β = 1.19, 95% CI: 0.38–2.01, P < 0.05), had self-assessed moderate or severe disease (β = 1.08, 95% CI: 0.12–2.03 and β = 1.36, 95% CI: 0.03–2.70, respectively, P < 0.05), and had anxiety (β = 0.38, 95% CI: 0.30–0.46, P < 0.001) were more likely to have a greater level of TB-related stigma than their counterparts. However, a significantly lower level of TB-related stigma was observed in patients with good social support (β = − 0.25, 95% CI: − 0.33--0.17, P < 0.001) and doctor-patient communication (β = − 0.14, 95% CI: − 0.29--0.00, P < 0.05). Conclusions This study showed that stigma among TB patients was high. Targeted attention should be paid to female patients and patients with moderate or severe disease in TB stigma-related interventions. Moreover, the important role of social support and doctor-patient communication in reducing TB-related stigma should also be emphasized. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10055-2.
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Affiliation(s)
- Xu Chen
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Liang Du
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Jia Xu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Yu Zhang
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Xuexue Zhu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Ling Zhou
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044.
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A Comparative Study of Knowledge, Attitude, and Determinants of Tuberculosis-Associated Stigma in Rural and Urban Communities of Lagos State, Nigeria. Tuberc Res Treat 2020; 2020:1964759. [PMID: 33343936 PMCID: PMC7728486 DOI: 10.1155/2020/1964759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/15/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis (TB) is an important public health concern in Nigeria. TB-associated stigma could lead to delayed diagnosis and care, treatment default, and multidrug resistance. Understanding of TB-associated stigma is therefore important for TB control. The study is aimed at determining and comparing the knowledge, attitude, and determinants of TB-associated stigma. Methodology. This was a comparative cross-sectional study among adults in urban and rural areas of Lagos State, Nigeria. Respondents were selected through a multistage sampling technique and interviewed using a semistructured questionnaire, which contained the Explanatory Model Interviewed Catalogue (EMIC) stigma scale. IBM SPSS Statistics Software package version 20 was used for analysis. Results A total of 790 respondents were interviewed. High proportions of respondents in rural and urban areas were aware of TB (97.5% and 99.2%, respectively). Respondents in the urban areas had overall better knowledge of TB compared to the rural areas (59.4% vs. 23%; p < 0.001), while respondents in the rural areas had a better attitude to TB (60.5% vs. 49.9%; p = 0.002). The majority of respondents in rural and urban areas had TB-associated stigma (93% and 95.7%, respectively). The mean stigma score was higher in the urban compared to rural areas (17.43 ± 6.012 and 16.54 ± 6.324, respectively, p = 0.046). Marital status and ethnicity were the predictors of TB-associated stigma in the rural communities (AOR-0.257; CI-0.086-0.761; p = 0.014 and AOR–3.09; CI-1.087-8.812; p = 0.034, respectively), while average monthly income and age of respondents were the predictors of TB-associated stigma in urban areas (AOR–0.274; CI–0.009-0.807; p = 0.019 and AOR-0.212; CI–0.057-0.788; p = 0.021, respectively). Conclusion TB-associated stigma is prevalent in both rural and urban areas in this study. There is therefore a need to disseminate health appropriate information through the involvement of the community. Also, innovative stigma reduction activities are urgently needed.
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Angelo AT, Geltore TE, Asega T. Knowledge, Attitude, and Practices Towards Tuberculosis Among Clients Visiting Tepi General Hospital Outpatient Departments, 2019. Infect Drug Resist 2020; 13:4559-4568. [PMID: 33376362 PMCID: PMC7762442 DOI: 10.2147/idr.s287288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis, which is an infectious disease, is one of the leading causes of morbidity and mortality in developing countries. Ethiopia is facing high tuberculosis burdens. Even if it is preventable and curable, individuals' KAP towards the disease is one of the bottlenecks in decreasing the disease burdens. TGH, located in the Sheka zone, is one of the remote areas and the KAP towards TB is unknown. Therefore, the current study was undertaken in TGH to assess the KAP towards TB. Materials and Methods A cross-sectional study was conducted among 415 randomly selected participants. A structured questionnaire was used to collect the data by a face-to-face interview from May 23 to June 23/2019. Data were entered into Epidata 3.1 and exported to SPSS version 21 for descriptive analysis. Results A total of 345 (83%) respondents have heard about TB, while 76 (18%) respondents said persistence productive cough as symptoms of tuberculosis. Only 9.9% of participants mentioned bacteria as the cause of the diseases and 170 (41%) considered that the transmission is via air droplets. The majority (70%) of participants responded that its transmission is not preventable and overall 236 (56.9%) had high overall knowledge about TB. Thirty percent of the respondents considered that TB is serious to the area while 29% considered TB is not very serious for them. Fifty-three percent of the participants were having a favorable attitude towards tuberculosis. The majority (85%) did not cover their mouth while coughing, while 79.5% did not screen for tuberculosis and 82% of participants have not received any health education about TB. Overall, 44.6% practiced TB prevention. Conclusion The majority of the study participants had high overall knowledge and positive attitude towards tuberculosis prevention, which are not seen in the practice of tuberculosis. Effective educational programs should be implemented to overcome the problem.
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Affiliation(s)
| | | | - Tagay Asega
- Nursing Department, Tepi General Hospital, Tepi, Ethiopia
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Mohammedhussein M, Hajure M, Shifa JE, Hassen TA. Perceived stigma among patient with pulmonary tuberculosis at public health facilities in southwest Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0243433. [PMID: 33290413 PMCID: PMC7731994 DOI: 10.1371/journal.pone.0243433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Although tuberculosis (TB) related stigma has a significant impact on the diagnosis, patient adherence with treatment, and recovery from the disease, there is limited evidence from Ethiopia regarding perceived stigma among patient with pulmonary tuberculosis (PTB).The purpose of this study was to assess perceived stigma and associated factors among patient with PTB on treatment in southwest Ethiopia. METHODS Institution-based cross-sectional study was conducted from April to May 2019 among 410 patient with PTB. Data were collected by using the perceived tuberculosis stigma scale. Epi data v3.1 and SPSSv23 were used for data entry and analysis. Multivariable logistic regression models were fitted to identify factors associated with perceived stigma. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULT Prevalence of perceived stigma among patient with Pulmonary tuberculosis was 57.1% (95% CI: 52.2, 61.7). Poor social support (AOR = 2.41; 95% CI: 1.06, 5.48), above a month duration of illness (AOR = 2.48; 95% CI: 1.33, 4.64), high perceived stress (AOR = 1.95; 95% CI:1.09, 3.49), current khat use (AOR = 1.88; 95% CI:1.05, 3.37), and presence of depression (AOR = 8.18; 95% CI:4.40, 15.22) were significantly associated with perceived stigma. Patient with HIV co-infection were 5.67 times (AOR = 5.67; 95% CI: 2.32, 13.87) more likely to have Perceived stigma than their counterparts. CONCLUSION TB related stigma was reported by more than half of the study participant. Stigma reduction measures are needed to lower TB related stigma perceived by the patient, the level of distress associated with it, and to promote the psychological wellbeing of patient with TB.
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Affiliation(s)
- Mustefa Mohammedhussein
- Department of Psychiatry, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, Ethiopia
| | - Mohammedamin Hajure
- Department of Psychiatry, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, Ethiopia
| | - Jemal Ebrahim Shifa
- Department of Psychiatry, School of Health Sciences, Mada Walabu University, Shashemene campus, Shashemene, Ethiopia
| | - Tahir Ahmed Hassen
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Bresenham D, Kipp AM, Medina-Marino A. Quantification and correlates of tuberculosis stigma along the tuberculosis testing and treatment cascades in South Africa: a cross-sectional study. Infect Dis Poverty 2020; 9:145. [PMID: 33092636 PMCID: PMC7579945 DOI: 10.1186/s40249-020-00762-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/12/2020] [Indexed: 11/14/2022] Open
Abstract
Background South Africa has one of the world’s worst tuberculosis (TB) (520 per 100 000 population) and TB-human immunodeficiency virus (HIV) epidemics (~ 56% TB/HIV co-infected). While individual- and system-level factors influencing progression along the TB cascade have been identified, the impact of stigma is underexplored and underappreciated. We conducted an exploratory study to 1) describe differences in perceived community-level TB stigma among community members, TB presumptives, and TB patients, and 2) identify factors associated with TB stigma levels among these groups. Methods A cross sectional study was conducted in November 2017 at public health care facilities in Buffalo City Metro (BCM) and Zululand health districts, South Africa. Community members, TB presumptives, and TB patients were recruited. Data were collected on sociodemographic characteristics, TB knowledge, health and clinical history, social support, and both HIV and TB stigma. A validated scale assessing perceived community TB stigma was used. Univariate and multivariate linear regression models were used to describe differences in perceived community TB stigma by participant type and to identify factors associated with TB stigma. Results We enrolled 397 participants. On a scale of zero to 24, the mean stigma score for TB presumptives (14.7 ± 4.4) was statistically higher than community members (13.6 ± 4.8) and TB patients (13.3 ± 5.1). Community members from Zululand (β = 5.73; 95% CI 2.19, 9.72) had higher TB stigma compared to those from BCM. Previously having TB (β = − 2.19; 95% CI − 4.37, 0.0064) was associated with reduced TB stigma among community members. Understanding the relationship between HIV and TB disease (β = 2.48; 95% CI 0.020, 4.94), and having low social support (β = − 0.077; 95% CI − 0.14, 0.010) were associated with increased TB stigma among TB presumptives. Among TB Patients, identifying as Black African (β = − 2.90; 95% CI − 4.74, − 1.04) and knowing the correct causes of TB (β = − 2.93; 95% CI − 4.92, − 0.94) were associated with decreased TB stigma, while understanding the relationship between HIV and TB disease (β = 2.48; 95% CI 1.05, 3.90) and higher HIV stigma (β = 0.32; 95% CI 0.21, 0.42) were associated with increased TB stigma. Conclusions TB stigma interventions should be developed for TB presumptives, as stigma may increase initial-loss-to-follow up. Given that stigma may be driven by numerous factors throughout the TB cascade, adaptive stigma reduction interventions may be required.
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Affiliation(s)
- Dana Bresenham
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, South Africa
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA. .,Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Public Health, East Carolina University, 115 Heart Drive, Ste #2219, Greenville, NC, 27858-4353, USA.
| | - Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, South Africa. .,Desmond Tutu HIV Centre, Men's Health Division, University of Cape Town, Cape Town, South Africa.
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Bashorun AO, Linda C, Omoleke S, Kendall L, Donkor SD, Kinteh MA, Danso B, Leigh L, Kandeh S, D'Alessandro U, Adetifa IMO. Knowledge, attitude and practice towards tuberculosis in Gambia: a nation-wide cross-sectional survey. BMC Public Health 2020; 20:1566. [PMID: 33069220 PMCID: PMC7568354 DOI: 10.1186/s12889-020-09685-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022] Open
Abstract
Background Early diagnosis and treatment of tuberculosis (TB) are the mainstay of global and national TB control efforts. However, the gap between expected and reported cases persists for various reasons attributable to the TB services and care-seeking sides of the TB care cascade. Understanding individual and collective perspectives of knowledge, attitudes, beliefs and other social circumstances around TB can inform an evidence-based approach in engaging communities and enhance their participation in TB case detection and treatment. Methods The study was conducted during the Gambian survey of TB prevalence. This was a nationwide cross-sectional multistage cluster survey with 43,100 participants aged ≥15 years in 80 clusters. The study sample, a random selection of 10% of the survey population within each cluster responded to a semi-structured questionnaire administered by trained fieldworkers to assess the knowledge, attitudes and practice of the participants towards TB. Overall knowledge, attitude and practice scores were dichotomised using the computed mean scores and analysed using descriptive, univariable and multivariable logistic regression. Results All targeted participants (4309) were interviewed. Majority were females 2553 (59.2%), married 2614 (60.7%), had some form of education 2457 (57%), and were unemployed 2368 (55%). Although 3617 (83.9%) of the participants had heard about TB, only 2883 (66.9%) were considered to have good knowledge of TB. Overall 3320 (77%) had unfavourable attitudes towards TB, including 1896 (44%) who indicated a preference for staying away from persons with TB rather than helping them. However, 3607(83.7%) appeared to have the appropriate health-seeking behaviours with regard to TB as 4157 (96.5%) of them were willing to go to the health facility if they had symptoms suggestive of TB. Conclusions About 3 in 10 Gambians had poor knowledge on TB, and significant stigma towards TB and persons with TB persists. Interventions to improve TB knowledge and address stigma are required as part of efforts to reduce the burden of undiagnosed TB in the country. Supplementary information Supplementary information accompanies this paper at 10.1186/s12889-020-09685-3.
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Affiliation(s)
- Adedapo Olufemi Bashorun
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia.
| | - Christopher Linda
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Semeeh Omoleke
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Lindsay Kendall
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Simon D Donkor
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Ma-Ansu Kinteh
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Baba Danso
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Lamin Leigh
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Sheriff Kandeh
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Ifedayo Morayo O Adetifa
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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van Gurp M, Rood E, Fatima R, Joshi P, Verma SC, Khan AH, Blok L, Mergenthaler C, Bakker MI. Finding gaps in TB notifications: spatial analysis of geographical patterns of TB notifications, associations with TB program efforts and social determinants of TB risk in Bangladesh, Nepal and Pakistan. BMC Infect Dis 2020; 20:490. [PMID: 32650738 PMCID: PMC7350590 DOI: 10.1186/s12879-020-05207-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In order to effectively combat Tuberculosis, resources to diagnose and treat TB should be allocated effectively to the areas and population that need them. Although a wealth of subnational data on TB is routinely collected to support local planning, it is often underutilized. Therefore, this study uses spatial analytical techniques and profiling to understand and identify factors underlying spatial variation in TB case notification rates (CNR) in Bangladesh, Nepal and Pakistan for better TB program planning. METHODS Spatial analytical techniques and profiling was used to identify subnational patterns of TB CNRs at the district level in Bangladesh (N = 64, 2015), Nepal (N = 75, 2014) and Pakistan (N = 142, 2015). A multivariable linear regression analysis was performed to assess the association between subnational CNR and demographic and health indicators associated with TB burden and indicators of TB programme efforts. To correct for spatial dependencies of the observations, the residuals of the multivariable models were tested for unexplained spatial autocorrelation. Spatial autocorrelation among the residuals was adjusted for by fitting a simultaneous autoregressive model (SAR). RESULTS Spatial clustering of TB CNRs was observed in all three countries. In Bangladesh, TB CNR were found significantly associated with testing rate (0.06%, p < 0.001), test positivity rate (14.44%, p < 0.001), proportion of bacteriologically confirmed cases (- 1.33%, p < 0.001) and population density (4.5*10-3%, p < 0.01). In Nepal, TB CNR were associated with population sex ratio (1.54%, p < 0.01), facility density (- 0.19%, p < 0.05) and treatment success rate (- 3.68%, p < 0.001). Finally, TB CNR in Pakistan were found significantly associated with testing rate (0.08%, p < 0.001), positivity rate (4.29, p < 0.001), proportion of bacteriologically confirmed cases (- 1.45, p < 0.001), vaccination coverage (1.17%, p < 0.001) and facility density (20.41%, p < 0.001). CONCLUSION Subnational TB CNRs are more likely reflective of TB programme efforts and access to healthcare than TB burden. TB CNRs are better used for monitoring and evaluation of TB control efforts than the TB epidemic. Using spatial analytical techniques and profiling can help identify areas where TB is underreported. Applying these techniques routinely in the surveillance facilitates the use of TB CNRs in program planning.
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Affiliation(s)
| | - Ente Rood
- KIT Royal Tropical Instituter, Amsterdam, Netherlands
| | - Razia Fatima
- National TB Control Program, Islamabad, Pakistan
| | | | | | | | - Lucie Blok
- KIT Royal Tropical Instituter, Amsterdam, Netherlands
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Cvetković VM, Nikolić N, Radovanović Nenadić U, Öcal A, K. Noji E, Zečević M. Preparedness and Preventive Behaviors for a Pandemic Disaster Caused by COVID-19 in Serbia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4124. [PMID: 32527056 PMCID: PMC7313005 DOI: 10.3390/ijerph17114124] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 12/31/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. The disease was first detected in Wuhan, the capital of China's Hubei province, in December 2019 and has since spread globally, especially to Europe and North America, resulting in the ongoing global coronavirus pandemic disaster of 2019-2020. Although most cases have mild symptoms, there is some progression to viral pneumonia and multi-organ failure and death. More than 4.6 million cases have been registered across 216 countries and territories as of 19 April 2020, resulting in more than 311,000 deaths. Risk to communities with continued widespread disease transmission depends on characteristics of the virus, including how well it spreads between people; the severity of resulting illness; and the medical or other measures available to control the impact of the virus (for example, vaccines or medications that can treat the illness) and the relative success of these. In the absence of vaccines or medications, non-pharmaceutical interventions were the most important response strategy based on community interventions such as person-to-person distancing, mask-wearing, isolation and good personal hygiene (hand-washing)-all of which have been demonstrated can reduce the impact of this seemingly unstoppable globally spreading natural disaster. This paper presents the results of quantitative research regarding the level of citizen preparedness for disasters caused by coronavirus disease (COVID-19) in Serbia. The survey was conducted using a questionnaire that was requested and then collected online among 975 respondents during disaster in April 2020. The questionnaire examined citizens' basic socio-economic and demographic characteristics, their knowledge, preparedness, risk perception and preventive measures taken individually and as a community to prevent the death and widespread transmission of novel coronavirus disease 2019 in the Republic of Serbia. Based on the findings that there are major differences in the public's perception of risks posed by communicable disease threats such as presented by COVID-19, emergency management agencies should use these differences to develop targeted strategies to enhance community and national preparedness by promoting behavioral change and improving risk management decision-making.
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Affiliation(s)
- Vladimir M. Cvetković
- Faculty of Security Studies, University of Belgrade, Gospodara Vučića 50, 11040 Belgrade, Serbia
| | - Neda Nikolić
- Faculty of Tehnical Science in Čačak, University of Kragujevac, 32000 Čačak, Serbia;
| | - Una Radovanović Nenadić
- Scientific-Professional Society for Disaster Risk Management, Dimitrija Tucovića 121, 11040 Belgrade, Serbia;
| | - Adem Öcal
- Independent Researcher, Ankara 06500, Turkey;
| | - Eric K. Noji
- King Saud University Hospitals and College of Medicine, Riyadh 11564, Saudi Arabia;
| | - Miodrag Zečević
- Faculty of International Engineering Management Belgrade, European University, 11000 Belgrade, Serbia;
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Assessment of Knowledge and Attitude of Tuberculosis Patients in Direct Observation Therapy Program towards Multidrug-Resistant Tuberculosis in Addis Ababa, Ethiopia: A Cross-Sectional Study. Tuberc Res Treat 2020; 2020:6475286. [PMID: 32566290 PMCID: PMC7298339 DOI: 10.1155/2020/6475286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/20/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) is becoming a major challenge of tuberculosis (TB) control program globally but more serious in developing countries like Ethiopia. In 2013, a survey result showed that in Ethiopia, tuberculosis patients from new cases and retreatment cases had resistance to at least isoniazid and rifampicin with a significant increase over time. Inadequate knowledge and wrong perception about MDR-TB by patients were detrimental to TB control programs. The study aimed at assessing the knowledge and attitude of TB patients of direct observation therapy program towards multidrug-resistant tuberculosis in health centres of Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted in 10 health centres of Addis Ababa which were selected by simple random sampling technique. A total of 422 TB patients were included in the study, and participants from each health centres were taken proportional to the number of clients in each health centres. Data was entered and analyzed using SPSS version 20. Association between outcome and independent variables was explored using logistic regression. Results The level of knowledge of TB patients about MDR-TB was poor and only 55.0% of TB patients attained good overall knowledge. A significant association was found between good knowledge and attending tertiary level of education (AOR = 4.3, 95%CI = 1.9, 9.8), gender (AOR = 1.62, 95%CI = 1.1, 2.4), income of respondents' family (OR = 0.4, 95%CI = 0.2, 0.9), and sleeping practice (AOR = 8.0, 95%CI = 4.0, 15.7). Nearly three-fourths (73.5%) of TB patients had a favourable attitude towards MDR-TB. Occupational status (AOR = 4.4, 95%CI = 2.5, 7.6) and sleeping practices (AOR = 2.4, 95%CI = 1.2, 5.0) were significantly associated with the attitude of the TB patients. Conclusions Knowledge of TB patients toward MDR-TB was poor. Although a large proportion of patients had a favourable attitude, it still needs to be improved. Hence, efforts should be made to implementing health education to improve awareness of TB patients about MDR-TB.
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Gamtesa DF, Tola HH, Mehamed Z, Tesfaye E, Alemu A. Health care seeking behavior among presumptive tuberculosis patients in Ethiopia: a systematic review and meta-analysis. BMC Health Serv Res 2020; 20:445. [PMID: 32429988 PMCID: PMC7238571 DOI: 10.1186/s12913-020-05284-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health seeking behavior is one of the challenges affecting tuberculosis (TB) control program because of its high risk to prolonged diseases transmission and poor treatment outcome. Although there are few primary studies that reported diversified magnitudes of health seeking behavior among presumptive TB patients in Ethiopia, there is no review study that attempted to summarize the available evidence. Thus, this review was aimed to estimate the proportion of health care seeking behavior from health facility and to summarize the reasons why individuals with presumptive TB are not seeking health care in Ethiopia. METHOD A systematic review and meta-analysis study was conducted on primary studies that reported proportion of health seeking behavior among presumptive TB patients. Electronic databases: PubMed, Google Scholar and Science Direct were searched to retrieve studies published in English language from Ethiopia without restricting publication year. In addition, bibliographies of included studies were also screened to retrieve potential studies. The keywords "health seeking", "health seeking behavior", "TB suspects" and "presumptive TB" were used both in Medical Subject Heading (MeSH) and free text. Random effects meta-analysis model was used to estimate the pooled proportions of health care seeking and not seeking behaviors. Stata version 14 was used for data analysis. RESULT Five studies which involved 3230 patients with presumptive TB were included into this review. The pooled estimated proportion of health care seeking behavior among presumptive TB patients from health facilities was 65% (95% CI, 54-76%), while the pooled proportion of not seeking health care from any sources was 17% (95% CI;6-27%). In addition, 18% (95% CI; 5-30%) of presumptive TB patients were seeking health care from inappropriate sources. Being female, younger age, low income status, absence of previous TB treatment history, low education status were the risk factors that associated with low health care seeking behavior. CONCLUSION Considerable proportion of patients with presumptive TB were not seeking health care from health facilities or seeks care from inappropriate sources in Ethiopia. Implementing efforts that could improve health care seeking behavior is vital to prevent prolonged disease transmission through immediate treatment commencement.
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Affiliation(s)
- Dinka Fikadu Gamtesa
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, PO Box 1242, Addis Ababa, Ethiopia.
| | - Habteyes Hailu Tola
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, PO Box 1242, Addis Ababa, Ethiopia
| | - Zemedu Mehamed
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, PO Box 1242, Addis Ababa, Ethiopia
| | - Ephrem Tesfaye
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, PO Box 1242, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, PO Box 1242, Addis Ababa, Ethiopia
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Mohammedhussein M, Alenko A, Tessema W, Mamaru A. Prevalence and Associated Factors of Depression and Anxiety Among Patients with Pulmonary Tuberculosis Attending Treatment at Public Health Facilities in Southwest Ethiopia. Neuropsychiatr Dis Treat 2020; 16:1095-1104. [PMID: 32636628 PMCID: PMC7326627 DOI: 10.2147/ndt.s249431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/10/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Depression and anxiety are the most commonly occurring psychiatric comorbidities among patients with pulmonary tuberculosis (PTB). Co-occurring anxiety and depression in PTB patients result in poor adherence to anti-tuberculosis medication. This in turn results in lower success rate of treatment and an upsurge in morbidity and mortality. Despite this problem existing globally, little has been explored in southwest Ethiopia. OBJECTIVE The aim of this study was to assess the prevalence and associated factors of depression and anxiety among patients with pulmonary tuberculosis receiving treatment at public health facilities in southwest Ethiopia. MATERIALS AND METHODS A facility-based cross-sectional study was conducted from April to May 2019. Data were collected from 410 PTB patients using hospital anxiety and depression scale (HADS). Epi data version 3.1 and SPSS version 23 were used to enter and analyze data respectively. Multiple logistic regressions were fitted to identify the strength of association between outcome and explanatory variables. P <0.05 was considered statistically significant. RESULTS Prevalence of depression and anxiety among PTB patients were 229 (55.9 %) and 224 (54.6%), respectively. High perceived stress [AOR=3.61 (1.99, 6.53)], perceived stigma [AOR=10.13 (5.52, 18.63)], being in an intensive phase of treatment [AOR= 3.33 (1.83, 6.07)], and low body mass index [AOR=2.07 (1.13, 3.80)] were significantly associated with depression. Being female [AOR=2.42 (1.39, 4.22)], perceived stigma [AOR=3.58 (1.99, 6.42)], high perceived stress [AOR=4.40 (2.52, 7.69)], and family history of mental illness [AOR=2.66 (1.19, 5.94)] had significant association with anxiety. CONCLUSION More than half of the study participants were found to have probable depression and anxiety. This indicates the need to pay attention to the mental health condition of patients with PTB, particularly to those with identified risk factors.
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Affiliation(s)
- Mustefa Mohammedhussein
- Department of Psychiatry, Faculty of Public Health and Medical Science, Mettu University, Mettu, Ethiopia
| | - Arefayne Alenko
- Department of Psychiatry, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Worknesh Tessema
- Department of Psychiatry, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Almaz Mamaru
- Department of Psychiatry, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
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Khan A, Shaikh BT, Baig MA. Knowledge, Awareness, and Health-Seeking Behaviour regarding Tuberculosis in a Rural District of Khyber Pakhtunkhwa, Pakistan. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1850541. [PMID: 32382530 PMCID: PMC7193271 DOI: 10.1155/2020/1850541] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/25/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pakistan is a country with one of the highest burden of tuberculosis (TB) in the world, and therefore, it is imperative to revisit the design of behaviour change interventions in the program. This study was designed to understand and assess the knowledge, awareness, perceptions, and health-seeking behaviour of general and specifically TB-affected population and to determine the presence and level of stigma and discrimination toward TB patients. METHODS A mixed-method study was conducted in district Haripur of the Khyber Pakhtunkhwa province, comprising a household survey, whereby 526 individuals were interviewed, and five focus group discussions with various subgroups including TB patients and health workers and authorities. Study sought an ethical approval, and data of all respondents was kept confidential. RESULTS Quantitative results show that women were more knowledgeable on symptomatology and spread of TB, and with rising education, awareness on TB improves. The majority of our respondents had the understanding that it is a curable disease, yet some would avoid TB patients. Most of the respondents (both men and women) knew that one must go to a government facility for treatment. Only one-third would speak to doctor first, if they suspect TB-like symptoms. Television was a popular source of information on TB. Qualitative results captured people's perceptions that TB was related with poverty and was still considered a stigma in the community; hence, patients afflicted feared disclosing the disease. CONCLUSION With contextual understanding of communities' knowledge, attitudes, health-seeking behaviour, and care-seeking patterns, it can be concluded that there is a need to increase the awareness about TB symptoms, mode of transmission, prevention, diagnosis and treatment, and destigmatization of the disease through health education.
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Affiliation(s)
- Adeela Khan
- Rights & Health Alliance for Integrated Development, Islamabad, Pakistan
| | | | - Mirza Amir Baig
- Field Epidemiology & Laboratory Training Program, National Institute of Health, Islamabad, Pakistan
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Der JB, Grint D, Narh CT, Bonsu F, Grant AD. Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana. PLoS One 2020; 15:e0230604. [PMID: 32191768 PMCID: PMC7081980 DOI: 10.1371/journal.pone.0230604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Ghana’s national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment. Methods A prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression. Results A total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84–42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87–23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05–0.33). Conclusion The majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.
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Affiliation(s)
- Joyce B. Der
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- * E-mail:
| | - Daniel Grint
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clement T. Narh
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg – University Mainz, Mainz, Germany
| | - Frank Bonsu
- Department of Disease Control and Prevention, National TB Control Program, Ghana Health Service, Accra, Ghana
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Baniqued MG, Ballecer BAP, Ballesteros BDC, Balmonte JRR, Bancud EMF, Rebueno MCDR, Macindo JRB. Social support from nurses and non-adherence with directly observed therapy (DOTS) maintenance phase among patients with tuberculosis in Metro Manila, Philippines. Public Health Nurs 2020; 37:339-346. [PMID: 32077135 DOI: 10.1111/phn.12714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the influence of community health nurses' social support on non-adherence with the maintenance phase of directly observed therapy (DOTS) among patients with tuberculosis (TB). DESIGN Prospective-cohort. SAMPLE One hundred purposively selected patients with TB starting with DOTS maintenance phase. MEASUREMENTS Participants answered the robotfoto and Berlin Social Support Scale (BSSS) to assess demographics and social support provided by nurses. Non-adherence was measured using the attendance record and documented in an abstraction form. Cox proportion-hazards regression determined the influence of social support provided by nurses to non-adherence. RESULTS With a median adherence of 3 weeks, 15% of the sample was non-adherent. The hazard of non-adherence was lower with high perceived emotional support (HR = 0.25, p = .046), perceived instrumental support (HR = 0.20, p = .044), perceived support seeking (HR = 0.27, p = .045), and received emotional support (HR = 0.45, p = .045). High received emotional support increased non-adherence (HR = 2.65, p = .039). CONCLUSION Social support from nurses influenced DOTS non-adherence among patients with TB, a critical issue in the development of drug-resistance. Perceived emotional, instrumental, support seeking and received emotional support decreased the hazard of non-adherence, while received emotional support increased non-adherence. This study highlights the need to promote positive perception of instrumental support needs. Appropriate interventions should be provided to promote support-seeking skills.
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Affiliation(s)
- Mikee G Baniqued
- College of Nursing, University of Santo Tomas, Manila, Philippines
| | | | | | | | | | | | - John Rey B Macindo
- Faculty of Management and Development Studies, University of the Philippines - Open University, Laguna, Philippines.,Nursing Service Division, AMOSUP Seamen's Hospital, Manila, Philippines
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Datiko DG, Jerene D, Suarez P. Stigma matters in ending tuberculosis: Nationwide survey of stigma in Ethiopia. BMC Public Health 2020; 20:190. [PMID: 32028914 PMCID: PMC7006204 DOI: 10.1186/s12889-019-7915-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/07/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) affects, and claims the lives of, millions every year. Despite efforts to find and treat TB, about four million cases were missed globally in 2017. Barriers to accessing health care, inadequate health-seeking behavior of the community, poor socioeconomic conditions, and stigma are major determinants of this gap. Unfortunately, TB-related stigma remains unexplored in Ethiopia. METHODS This mixed methods survey was conducted using multistage cluster sampling to identify 32 districts and 8 sub-cities, from which 40 health centers were randomly selected. Twenty-one TB patients and 21 family members were enrolled from each health center, and 11 household members from each community in the catchment population. RESULTS A total of 3463 participants (844 TB patients, 836 from their families, and 1783 from the general population) were enrolled for the study. The mean age and standard deviation were 34.3 ± 12.9 years for both sexes (34.9 ± 13.2 for men and 33.8 ± 12.5 for women). Fifty percent of the study participants were women; 32.1% were illiterate; and 19.8% came from the lowest wealth quintile. The mean stigma score was 18.6 for the general population, 20.5 for families, and 21.3 for TB patients. The general population of Addis Ababa (AOR: 0.1 [95% CI: 0.06-0.17]), those educated above secondary school (AOR: 0.58 [95% CI: 0.39-0.87]), and those with a high score for knowledge about TB (AOR: 0.62 [95% CI: 0.49-0.78]) had low stigma scores. Families of TB patients who attended above secondary school (AOR: 0.37 [95% CI: 0.23-0.61]) had low stigma scores. TB patients educated above secondary school (AOR: 0.61 [95% CI: 0.38-0.97]) had lower stigma scores, while those in the first (AOR: 1.93: 95% CI 1.05-3.57) and third quintiles (AOR: 1.81: 95% CI: 1.08-3.05) had stigma scores twice as high as those in the highest quintile. Fear of job loss (32.5%), isolation (15.3%), and feeling avoided (9.3%) affected disclosure about TB. CONCLUSIONS More than a third of Ethiopians have high scores for TB-related stigma, which were associated with educational status, poverty, and lack of awareness about TB. Stigma matters in TB prevention, care, and treatment and warrants stigma reduction interventions.
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Affiliation(s)
- Daniel G Datiko
- Challenge TB/Ethiopia and Management Sciences for Health/Ethiopia, P.O. Box 1157, Code 1250, Addis Ababa, Ethiopia.
| | - Degu Jerene
- Challenge TB/Ethiopia and Management Sciences for Health/Ethiopia, P.O. Box 1157, Code 1250, Addis Ababa, Ethiopia
| | - Pedro Suarez
- Management Sciences for Health, Senior Director Infectious Diseases Cluster, Arlington, USA
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Asemahagn MA, Alene GD, Yimer SA. Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design. Res Rep Trop Med 2020; 11:3-16. [PMID: 32099509 PMCID: PMC7007782 DOI: 10.2147/rrtm.s233052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Tuberculosis (TB) remains a foremost global public health threat. Active TB control needs geographically accessible health facilities that have quality diagnostics, equipment, supplies, medicines, and staff. Objective This study aimed at assessing the geographic distribution, physical accessibility, readiness and barriers of health facilities for TB services in East Gojjam zone, Ethiopia. Methods A convergent parallel design was applied using health facility and geographic data. Data on facility attributes, service availability and readiness were collected by inteviewing TB officers, laboratory heads and onsite facility visits. Coordinates of health facilities and kebele centroids were collected by GPS. We used ArcGIS 10.6 to measure Euclidean distance from each kebele centroids to the nearest health facility. Descriptive statistics were computed by using SPSS version 25. Barriers to TB service readiness were explored by in-depth interviews. NVivo12 was used to thematically analyze the qualitative data. Results The overall TB health service coverage (THSC) was 23% (ranging: 10–85%). The mean distance from the nearest health facility was 8km (ranging: 0.5–16km). About 132 (32%) kebeles had poor geographic accessibility to TB services (over 10km distance from the nearest health facility) and had poor facility readiness. Although 114 (95%) health facilities offered at least one TB service, 44 (38.6%) of them had no sputum smear microscopy. The overall TB readiness index was 63.5%: first-line anti-TB drugs (97%), diagnostics (63%), trained staffs, diagnostic and treatment guidelines (53%) and laboratory supplies (41%). Lack of health workers (laboratory personnel), inadequate budget, poor management practice and TB program support, inadequate TB commodity suppliers, and less accessible geographic locations of health facilities were identified as barriers to TB service readiness distribution. Conclusion Considerable proportion of the population in the study area have poor access to quality TB diagnostic services due to low THSC and poor facility readiness. Barriers to TB service availability and readiness were health system related. Regular refresher training of health workers on TB, creating mechanisms to attract laboratory personnel to work in the study area and scaling up of sputum smear microscopy services, establishing an efficient mechanism for procurement, distribution, utilization and reporting of TB commodity supplies, and good management practices are crucial to enhance TB service readiness in the study zone.
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Affiliation(s)
- Mulusew Andualem Asemahagn
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Solomon Abebe Yimer
- Department of Microbiology, Unit for Genome Dynamics, Faculty of Medicine, University of Oslo, Oslo, Norway.,Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
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Wang W, Wang F, Peng Y, Liu K, Chen X, Chai C, Wang X, Chen B. Factors Associated with Health-Seeking Preference Among People Who Were Supposed to Cough for More Than 2 Weeks: A Cross-Sectional Study in Southeast China. Patient Prefer Adherence 2020; 14:1173-1183. [PMID: 32764890 PMCID: PMC7372003 DOI: 10.2147/ppa.s257722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The health-seeking preference of people with a cough >2 weeks had not been extensively researched in southeast China. The study aimed to explore factors associated with health-seeking preference, which could provide more evidence to improve individuals' appropriate health-seeking behavior. MATERIALS AND METHODS From October 2018 to December 2018, this cross-sectional study was conducted in Zhejiang, China. A questionnaire was used to collect information on sociodemographic characteristics, knowledge of tuberculosis (TB), and health-seeking preference. The chi-square test and multivariable logistic regression were performed to evaluate factors associated with health-seeking preference. RESULTS Of the 7174 participants, 3321 (46.3%) were men, 6148 (85.7%) were married, and 6013 (83.8%) knew about TB. Appropriate health-seeking preference was reported by 6229 (86.8%) participants. Respondents knowing about TB were more likely to seek appropriate care than those did not (89.6% vs 72.4%, p<0.001). Of the 6013 participants knowing about TB, respondents with higher scores on five key items of TB knowledge were more likely to get appropriate health-seeking preference. About 805 (96.6%) participants with 5 scores on TB knowledge had appropriate care preference. Only 97 (72.4%) participants with a score of 0 reported an appropriate preference. Multivariable logistic regression showed residence, marital status, education level, occupation, and awareness of TB knowledge were predictors of appropriate health-seeking preference. Compared to participants with a score of 0 on five TB key knowledge, participants with a score of 5 were 8.57 times more likely to have appropriate health-seeking preference (95% confidence interval [CI]: 4.97-14.78), followed by a score of 4 (odds ratio [OR]=5.99, 95% CI, 3.23-8.03); 3 (OR=3.74, 95% CI, 2.44-5.74); 2 (OR=1.99, 95% CI, 1.30-3.02) and 1 (OR=1.17, 95% CI, 0.76-1.80). CONCLUSION Participants with little knowledge of TB had a low level of appropriate health-seeking preference. Appropriate health-seeking preference of the participants improved with increased key knowledge level of TB.
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Affiliation(s)
- Wei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Fei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Ying Peng
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Xinyi Chen
- Department of Preventive Medicine, Epidemiology and Health Statistics, School of Medicine, Ningbo University, Ningbo315211, People’s Republic of China
| | - Chengliang Chai
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Xiaomeng Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Bin Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
- Correspondence: Bin Chen; Xiaomeng Wang Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399, Binsheng Road, Binjiang District, Hangzhzou, Zhejiang Province310051, People’s Republic of China Tel/Fax +86 571 8711 5183; Tel +86 571 8711 5181Fax +86 571 8711 5189 Email ;
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Knowledge, Attitudes, and Prevention Practices of Drug Resistant Tuberculosis in the Eastern Cape Province, South Africa. Tuberc Res Treat 2019; 2019:8978021. [PMID: 31885917 PMCID: PMC6925671 DOI: 10.1155/2019/8978021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to assess community members' knowledge and awareness levels, attitudes, and practices of Drug Resistant Tuberculosis. A quantitative descriptive cross sectional study was carried out in the Eastern Cape Province of South Africa. The sample size consisted of four hundred (400) respondents aged 18 years and above on their last birthday who were purposively and conveniently selected from Port Elizabeth area in the Nelson Mandela Municipality. Data were collected using close-ended questions, which were administered by the researcher and two research assistants to the selected respondents. Data were analysed using descriptive statistics. The results of this study show poor knowledge and awareness levels, unfavourable attitudes, but good prevention practices of Drug Resistant Tuberculosis among Port Elizabeth community members. This study also found a statistically significant association between knowledge and attitudes (p value = <0.001), and no statistically significant association between knowledge and practices and attitude and practices, respectively (p values = 0.120 and 0.136). The study also revealed low literacy levels, inadequate information, misconceptions and erroneous beliefs about causes, transmission, prevention, treatment, and management of Drug Resistant Tuberculosis among the respondents. This study also highlighted the use and existence of dual healthcare system (traditional spiritual and western).The study found that the main source of Drug Resistant TB information was radio and television among the majority of research respondents. It is recommended that in future health education interventions and awareness campaigns need to be intensified in the area so that misconceptions and erroneous beliefs that exist in society can be addressed. It is also recommended that training programs that are culturally sensitive should be developed and delivered taking into account different languages and literacy levels that exist in society. Such education interventions should be facilitated in collaboration with people living with Drug Resistant Tuberculosis. A multidisciplinary approach should be fostered and collaborations with spiritual healers and various congregational leaders, traditional health practitioners, community leaders, and government leaders in the health sector should be promoted in order to deal with Drug Resistant Tuberculosis. It is also recommended that a similar study be conducted using a qualitative research approach in urban and rural areas of the Eastern Cape. Lastly, assessment of knowledge, attitudes, and practices of spiritual and traditional healers with regard to Drug Resistant Tuberculosis should be conducted as they can influence health-seeking behaviour.
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Datiko DG, Habte D, Jerene D, Suarez P. Knowledge, attitudes, and practices related to TB among the general population of Ethiopia: Findings from a national cross-sectional survey. PLoS One 2019; 14:e0224196. [PMID: 31658300 PMCID: PMC6816561 DOI: 10.1371/journal.pone.0224196] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 10/08/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Ethiopia is among the high-burden countries for tuberculosis (TB), TB/HIV, and drug-resistant TB. The aim of this nationwide study was to better understand TB-related knowledge, attitudes, and practices (KAPs) and generate evidence for policy and decision-making. MATERIALS AND METHODS We conducted a cross-sectional TB KAP survey in seven regions and two city administrations of Ethiopia. Eighty kebeles (wards) and 40 health centers were randomly selected for the study. Using systematic sampling, 22 households and 11 TB patients were enrolled from each selected village and health center, respectively. Variables with a value of p = < 0.25 were included in the model for logistic regression analysis. RESULTS Of 3,503 participants, 884 (24.4%), 836 (24.1%), and 1,783 (51.5%) were TB patients, families of TB patients, and the general population, respectively. The mean age was 34.3 years, and 50% were women. Forty-six percent were heads of households, 32.1% were illiterate, 20.3% were farmers, and 19.8% were from the lowest quintile. The majority (95.5%) had heard about TB, but only 25.8% knew that TB is caused by bacteria. Cough or sneezing was reported as the commonest means of TB transmission. The majority (85.3%) knew that TB could be cured. Men, better-educated people, and TB patients and their families have higher knowledge scores. Of 2,483 participants, 96% reported that they would go to public health facilities if they developed TB symptoms. DISCUSSION Most Ethiopians have a high level of awareness about TB and seek care in public health facilities, and communities are generally supportive. Inadequate knowledge about TB transmission, limited engagement of community health workers, and low preference for using community health workers were the key challenges. CONCLUSIONS Given misconceptions about TB's causes, low preference for use of community health workers, and inadequate engagement, targeted health education interventions are required to improve TB services.
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Affiliation(s)
- Daniel G Datiko
- Challenge TB and Management Sciences for Health, Addis Ababa, Ethiopia
| | - Dereje Habte
- Challenge TB and Management Sciences for Health, Addis Ababa, Ethiopia
| | - Degu Jerene
- Challenge TB and Management Sciences for Health, Addis Ababa, Ethiopia
| | - Pedro Suarez
- Management Sciences for Health, Infectious Diseases Cluster, Arlington, Virginia, United States of America
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Knowledge, awareness, and perception towards tuberculosis disease among International Islamic University Malaysia Kuantan students. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rakhmawati W, Nilmanat K, Hatthakit U. Moving from fear to realization: Family engagement in tuberculosis prevention in children living in tuberculosis Sundanese households in Indonesia. Int J Nurs Sci 2019; 6:272-277. [PMID: 31508446 PMCID: PMC6722465 DOI: 10.1016/j.ijnss.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/24/2019] [Accepted: 06/05/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Children living in tuberculosis households need protection. However, families need to be engaged to prevent tuberculosis transmission to children. This study aimed to analyze the details of "moving from fear to realization," which is one category of a substantive theory of family engagement in tuberculosis prevention in children. METHODS Fourteen family caregivers participated as key informants after their families met the criteria. The participants were recruited at a lung clinic in West Java, Indonesia and followed up at their homes. The data were gathered using in-depth interviews and analyzed following the coding procedures of the Straussian grounded theory. FINDINGS "Moving from fear to realization" was the main category that emerged from the experiences of the Sundanese families to begin engaging in tuberculosis prevention in children living in tuberculosis households. It was composed of four sub-categories, namely, fear of tuberculosis, seeking information, following God's will, and awareness of tuberculosis transmission risks. CONCLUSIONS This study showed how a family moves from fear to the realization of tuberculosis transmission risks. Its findings are useful for nurses to provide optimum care in order to prevent tuberculosis transmission to children with household contact by providing both education and counseling for families.
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Affiliation(s)
- Windy Rakhmawati
- Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
- Department of Pediatric Nursing, Faculty of Nursing, University of Padjadjaran, Indonesia
| | - Kittikorn Nilmanat
- Department of Adult and Elderly Nursing, Prince of Songkla University, Songkhla, Thailand
| | - Urai Hatthakit
- Department of Nursing Administration, Prince of Songkla University, Songkhla, Thailand
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Heath K, Byard RW. Tuberculosis-related stigma contributing to a 'hidden' disease at autopsy. MEDICINE, SCIENCE, AND THE LAW 2019; 59:135-138. [PMID: 31081464 DOI: 10.1177/0025802419849350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 29-year-old African immigrant to Australia was found dead in bed. She had no known medical history, except for recent weight loss and hip/leg pain. Autopsy examination revealed extensive tuberculous consolidation with widespread cavitation of the lungs, with multiple caseating granulomas containing large numbers of acid fast bacilli on histology. Similar granulomas were also present in lymph nodes of the porta hepatis, mediastinum and pulmonary hilum, and within the liver, spleen and mesentery. Mycobacterial polymerase chain reaction analysis confirmed tuberculous infection. Her serum was negative for human immunodeficiency virus infection. Death was due to disseminated tuberculosis. In many parts of Africa, there are negative cultural associations attached to tuberculosis, which often leads to a delay in diagnosis. The case demonstrates the extent of active disease that may be uncovered at autopsy in decedents from societies where tuberculosis is stigmatised and therefore concealed. It also emphasises the risk of infection for forensic workers.
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Affiliation(s)
- Karen Heath
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Australia
| | - Roger W Byard
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Australia
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Kasa AS, Minibel A, Bantie GM. Knowledge, attitude and preventive practice towards tuberculosis among clients visiting public health facilities. BMC Res Notes 2019; 12:276. [PMID: 31092282 PMCID: PMC6521470 DOI: 10.1186/s13104-019-4292-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/03/2019] [Indexed: 12/01/2022] Open
Abstract
Objective The aim of the study was to assess knowledge, attitude and preventive practice towards tuberculosis. Result More than half of the study participants stated that bacteria are responsible agents in causing tuberculosis and as the same time 12.2% study participants thought that tuberculosis is not preventable disease. Overall, 54% of study participants had good knowledge, 68% had good attitude but only 48% had good practice in preventing tuberculosis. Compared to many national and international studies, knowledge, attitude and preventive practice towards tuberculosis was not satisfactory. Strengthening of awareness creation and health education program towards tuberculosis is needed.
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Affiliation(s)
- Ayele Semachew Kasa
- Department of Adult Health Nursing, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Alebachew Minibel
- Department of Adult Health Nursing, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getasew Mulat Bantie
- GAMBY Medical and Business College, Public Health Department, Bahir Dar, Ethiopia
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Shiferaw MB, Zegeye AM. Delay in tuberculosis diagnosis and treatment in Amhara state, Ethiopia. BMC Health Serv Res 2019; 19:232. [PMID: 30991995 PMCID: PMC6469046 DOI: 10.1186/s12913-019-4056-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background Delayed presentation is a major problem contributing to the high burden and transmission of tuberculosis (TB) in developing countries. The delay may be due to patient delay if the patient visits health-facility for diagnosis after the onset of symptoms of more than 3 weeks or health system delay if the patient is not diagnosed and treated at the time of the first visit. Ethiopia, where no more than two-thirds of TB cases are detected is no exception. Therefore, the aim of this study was to assess delay in diagnosis of tuberculosis among patients taking anti-TB treatment in North Shoa Zone, Ethiopia. Methods Institution based cross-sectional study was conducted from 01 to 30 December 2017. All TB patients who took their treatment in the health facilities of the seven selected districts of North Shoa Zone were included. Data was entered into EPI INFO version 3.5.1 statistical software and transferred into SPSS version 20.0 for further analysis. Bivariate and multivariate analysis was used to identify associated factors for delayed TB diagnosis. Results Out of 170 tuberculosis patients included, 162 patients were studied with a response rate of 95.3%. The proportion of tuberculosis patients who had delayed diagnosis was 59.9%. The mean time of health-seeking after developing the symptom of tuberculosis was 7.6 weeks. Tuberculosis patients with extra pulmonary site involvements were about four times more likely to be delayed in seeking health services (OR: 4.00, 95% CI: 1.77–9.03) as compared to patients with pulmonary TB. New patients were about three times more likely to come lately for TB diagnosis (OR: 2.94, 95% CI: 1.26–6.84) as compared to patients who had previous-history of treatment. Patients who had no information about TB before they started TB treatment were also around three times to be delayed (OR: 3.37, 95% CI: 1.43–8.00) as compared to those who had the information. Conclusions More than 50% of TB patients reported in health-seeking relatively a longer time. Strengthening the health education activities for the community about tuberculosis and capacity building of the health care provider to increase suspicion of identifying tuberculosis and early diagnosis is crucial. Electronic supplementary material The online version of this article (10.1186/s12913-019-4056-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Amtatachew Moges Zegeye
- North Shoa Zone Health Department Tuberculosis, HIV and Leprosy program coordinator, Debre Birhan, Shoa, Ethiopia
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Community Knowledge about Tuberculosis and Perception about Tuberculosis-Associated Stigma in Pakistan. SOCIETIES 2019. [DOI: 10.3390/soc9010009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Tuberculosis- (TB) associated stigma is a well-documented phenomenon with various factors, both individual and societal, manifesting its role in shaping health-seeking behavior and contributing to suboptimal TB care in Pakistan. The objective of this study was to assess TB-related knowledge and perceived stigma among community members. This was a cross-sectional survey using a convenience sample of 183 individuals recruited between October and December 2017. A validated stigma measurement tool developed by Van Rie et al. was adapted. Data was analyzed using SPSS version 20.0. A clear majority was aware that TB is curable disease and that it is transmitted by coughing. However, respondents also thought that TB spread through contaminated food, sharing meals, sharing utensils, and by having sexual intercourse with a TB patient. In addition, females, unemployed, and persons having less than six years of education were also more likely to associate stigma with TB. We found an association between the lack of knowledge about TB and perceived stigma. This study highlights the need for improved TB-related education among communities.
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