Knowledge about tuberculosis and infection prevention behavior: A nine city longitudinal study from India.

Sophie Huddart,Thomas Bossuroy,Vincent Pons,Clara Delavallade,Siddhartha Baral,Madhukar Pai,Seyed Ehtesham Hasnain

doi:10.1371/journal.pone.0206245

Abstract

BackgroundImproving patients’ tuberculosis (TB) knowledge is a salient component of TB control strategies. Patient knowledge of TB may encourage infection prevention behaviors and improve treatment adherence. The purpose of this study is to examine how TB knowledge and infection prevention behaviors change over the course of treatment.MethodsA matched patient-health worker dataset (n = 6,031) of publicly treated TB patients with NGO-provided treatment support health workers was compiled in nine Indian cities from March 2013 to September 2014. At the beginning and end of TB treatment, patients were asked about their knowledge of TB symptoms, transmission, and treatment and infection prevention behaviors.ResultsPatients beginning TB treatment (n = 3,424) demonstrated moderate knowledge of TB; 52.5% (50.8%, 54.2%) knew that cough was a symptom of TB and 67.2% (65.6%, 68.7%) knew that TB was communicable. Overall patient knowledge was significantly associated with literacy, education, and income, and was higher at the end of treatment than at the beginning (3.7%, CI: 3.02%, 4.47%). Infection prevention behaviors like covering a cough (63.4%, CI: 61.2%, 65.0%) and sleeping separately (19.3%, CI: 18.0%, 20.7%) were less prevalent. The age difference between patient and health worker as well as a shared language significantly predicted patient knowledge and adherence to infection prevention behaviors.ConclusionsSocial proximity between health worker and patients predicted greater knowledge and adherence to infection prevention behaviors but the latter rate remains undesirably low.

Highlights

India bears almost 25% of the global tuberculosis (TB) burden with an estimated 2,800,000 new cases in 2016 [1]
The purpose of this study is to examine how TB knowledge and infection prevention behaviors change over the course of treatment
Patients beginning TB treatment (n = 3,424) demonstrated moderate knowledge of TB; 52.5% (50.8%, 54.2%) knew that cough was a symptom of TB and 67.2% (65.6%, 68.7%) knew that TB was communicable

Summary

Introduction

India bears almost 25% of the global tuberculosis (TB) burden with an estimated 2,800,000 new cases in 2016 [1]. Limiting the transmission of TB in the community is critical to curbing the spread of TB. Effective communication on the cause of tuberculosis, its symptoms, its treatment, and mode of spread is important, especially in countries like India where the disease is still heavily stigmatized [5]. It is assumed that the extended contact with the healthcare system required by lengthy TB treatment will present an opportunity to increase patient knowledge empowering them to reduce risk of spread, adhere to the full treatment course and potentially recognize symptoms of TB in others. Adequate TB knowledge, regarding how TB is spread, may encourage infection prevention behaviors like covering a cough

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Results

Conclusion