Abstract
BackgroundEarly 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.MethodsThe 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.ResultsAll 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.ConclusionsAbout 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.
Highlights
Diagnosis and treatment of tuberculosis (TB) are the mainstay of global and national TB control efforts
Knowledge about TB Overall, most participants indicated they had heard about TB (Table 2), TB awareness was 5% higher in rural compared to urban residents and this was significantly different (p < 0.001)
We found a population with a predominantly negative attitude to TB including high levels of stigmatising behaviour, especially in rural residents which may contribute to the gaps in TB detection and treatment seen in The Gambia and other African TB prevalence surveys
Summary
Diagnosis and treatment of tuberculosis (TB) are the mainstay of global and national TB control efforts. With the implementation of the End TB strategy, the global incidence of tuberculosis (TB) fell at ~ 2% annually from 2000 to 2018, but this decline was too slow to attain global TB control targets – 20% reduction in global incidence between 2015 and 2018, 80% reduction in TB incidence and 90% reduction in TB deaths by 2030 in comparison to 2015 [1, 2] This situation is replicated in The Gambia where the decline in TB incidence has stagnated - 175 per 100,000 population in 2012 [3] to 174 per 100,000 population in 2018 [1]. Interventions to address these societal or community-level factors are required to improve or contribute to TB case detection and treatment success It is for this reason that effective community engagement including advocacy, communication and social mobilisation activities (ACSM) is an essential component of the 2nd pillar of the World Health Organisation’s End TB strategy [1]
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