Knowledge, Attitude, and Practices on Drug-Resistant Tuberculosis Infection Control in Nepal: A Cross-Sectional Study.

Sailesh Kumar Shrestha,Nilaramba Adhikari,Lok Raj Joshi,Rajendra Basnet,Kedar Narsingh K C,Ratna Bahadur Bhattarai,Suvesh Kumar Shrestha,Adwoa Asante-Poku

doi:10.1155/2021/6615180

Abstract

Drug-resistant tuberculosis (DR-TB) transmission is an important problem, particularly in low-income settings. This study is aimed at assessing the knowledge, attitude, and practices of DR-TB infection control among the healthcare workers under the National Tuberculosis Control Program in Nepal. In this cross-sectional study, we studied the healthcare workers from all the 11 functioning DR-TB treatment centers across Nepal in March 2018. Through face-to-face interviews, trained data collectors collected data on the characteristics of healthcare workers, their self-reported knowledge, attitude, and practice on DR-TB infection control. We entered the data in Microsoft Excel and analyzed in the R statistical software. We assigned a score of one to the correct response and zero to the incorrect or no response and calculated a composite score in each of the knowledge, attitude, and practice domains. We ascertained the healthcare workers as having good knowledge, appropriate attitude, and optimal practices when the composite score was ≥50%. We summarized the numerical variables with median (interquartile range (IQR)) and the categorical variables with proportions. We ran appropriate correlation tests to identify relationships between knowledge, attitude, and practice scores. We regarded a p value of <0.05 as significant. A total of 95 out of 102 healthcare workers responded. There were 46 male respondents. The median age was 33 years (IQR 26-42). Most of them (53, 55.79%) were midlevel paramedics. We found 91 (95.79%) respondents had good knowledge, 49 (51.58%) had an appropriate attitude, and 35 (36.84%) had optimal practices on DR-TB infection control. We found a statistically significant positive correlation between attitude and practice scores (ρ = 0.37, p ≤ 0.001). The healthcare workers at the DR-TB treatment centers in Nepal have good knowledge of DR-TB infection control, but it did not translate into an appropriate attitude or optimal practices.

Highlights

Drug-resistant tuberculosis (DR-TB), a form of tuberculosis (TB) resistant to one or more antitubercular drugs, has emerged as a major public health challenge
In 2018 alone, there were an estimated 484000 new cases of TB caused by the bacilli resistant to Rifampicin (RR TB), out of which 78% were resistant to Isoniazid (Multidrug Resistant TB (MDR-TB))
We found that most of the study participants had a good knowledge of DR-TB infection control

Summary

Introduction

Drug-resistant tuberculosis (DR-TB), a form of tuberculosis (TB) resistant to one or more antitubercular drugs, has emerged as a major public health challenge. In 2018 alone, there were an estimated 484000 new cases of TB caused by the bacilli resistant to Rifampicin (RR TB), out of which 78% were resistant to Isoniazid (Multidrug Resistant TB (MDR-TB)). The bacilli infecting 6.2% of the MDR-TB cases were resistant to at least a Fluoroquinolone and a second line injectable antitubercular agent (Extensively Drug-Resistant Tuberculosis (XDR-TB)). The provision of effective first-line treatment was hoped to prevent the emergence of DR-TB. Growing evidence suggests that person-to-person transmission, not just inadequate treatment, is driving the spread of DR-TB.

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