TB Knowledge Research Articles

Workplace pulmonary tuberculosis case detection in Mansoura City and neighborhood villages

ContextTuberculosis (TB) represents a high burden in workplaces. Aims Therefore, the aim of this study was to detect pulmonary TB cases in the workplace and assess the associated risk factors. Settings and design This cross section study was carried out from January 2011 to December 2013. This study included 253 participants recruited from Mansoura City and neighborhood villages Dakahlia Governorate. The catchment areas and occupational categories were determined according to a 1-year retrospective study reviewing hospital records.Participants and methodsAll participants were subjected to the following: (a) assessment of sociodemographic data, occupational data, and risk factors for TB. (b) Clinical examination. (c) Screening by chest radiography, the tuberculin skin test, and sputum Ziehl–Neelsen stain. (d) Assessment of knowledge of TB. Data were analyzed using statistical package for the social sciences, version 15. Qualitative data were presented as number and percentage. Comparison between groups was carried out using the χ2-test.ResultsMost participants were younger than 35 years of age, men, smokers, married, and with low educational and monthly income. Silica-related occupations were the most common. History of Bacillus Calmette–Guérin vaccination was not found among TB participants and was found in only 8.9% of non-TB participants. The majority of participants reported 8 working hours with no use of protective tools. The TB participants had significantly lower knowledge scores than nontuberculous participants. A total of 136 out of 148 participants had a positive tuberculin skin test. Chest radiography indicated an abnormality in six out of 253 participants and five of these were positive for sputum Ziehl–Neelsen.ConclusionTB screening in workplaces is mandatory because it can identify asymptomatic cases with active TB. A poor knowledge score may be considered a risk factor for TB infection in the workplace.

Exploring workplace TB interventions with foreign-born Latino workers.

Persons born outside the United States are more likely to be diagnosed with tuberculosis disease (TB) than native-born individuals. Foreign-born Latinos at risk of TB may be difficult to reach with public health interventions due to cultural and institutional barriers. Workplaces employing large concentrations of foreign-born Latinos may be useful locations for TB interventions targeting this high-risk population. This study used a two-phase approach to investigate the feasibility of workplace TB interventions. The first phase investigated employer knowledge of TB and receptiveness to allowing TB interventions in their businesses through 5 structured interviews. The second phase investigated foreign-born workers' knowledge of TB and their receptiveness to receiving TB interventions in their places of employment through 12 focus groups stratified by gender and education. Phase 1: Only 1 of the 5 employers interviewed had a high level of knowledge about TB, and three had no knowledge other than that TB was a disease that involved coughing. They were receptive to workplace TB interventions, but were concerned about lost productivity and customers finding out if an employee had TB. Phase 2: There was no observed differences in responses between gender and between the bottom two education groups, so the final analysis took place between a gender-combined lower education group and higher education group. The higher education group tended to have knowledge that was more accurate and to view TB as a disease associated with poverty. The lower education group tended to have more misconceptions about TB and more often expressed concern that their employers would not support worksite interventions. The results from both phases indicate that more TB education is needed among both foreign-born Latino workers and their employers. Obstacles to implementing workplace TB interventions include knowledge, potential productivity loss, employer liability, and perceived customer response.

Effectiveness of health education intervention in improving knowledge, attitude, and practices regarding Tuberculosis among HIV patients in General Hospital Minna, Nigeria – A randomized control trial

IntroductionThe risk of development of active TB in HIV-infected individuals is 20–37 times higher than those that are HIV negative. Poor knowledge of TB amongst people living with HIV has been associated with high transmission.ObjectivesTo determine the effectiveness of a new health education intervention module in improving knowledge, attitude, and practice (KAP) regarding tuberculosis among HIV patients in General Hospital Minna, Nigeria.MethodsA randomized control trial was carried out from July 2015 to June 2017. A random number generating program was used to allocate 226 respondents into 2 groups. The intervention group received health education regarding tuberculosis using the developed module. The control group received the normal services provided for HIV patients. Data were collected from December 2015 to September 2016 at baseline, immediate post intervention, three, six and nine months. The outcome measures were knowledge, attitude, and practice.ResultsThere was no significant difference with respect to socio-demographic characteristics, KAP of the respondents in the intervention and control group at baseline. However, there was significant improvement in knowledge in the intervention group compared to the control group, group main effect (F = (1,218) = 665.889, p = 0.001, partial ἠ2 = 0.753, d = 5.4); time (F = (3.605, 218) = 52.046, p = 0.001, partial ἠ2 = 0.193, d = 1.52) and interaction between group with time (F = (3.605, 218) = 34.028, p = 0.001, partial ἠ2 = 0.135, d = 1.23). Likewise, there was significant improvement in attitude, group main effect (p = 0.001, d = 1.26) and time (p = 0.001, p, d = 0.65). Similarly, there was improvement in practice, group main effect, time, and interaction of group with time (p < 0.05).ConclusionThe health education intervention program was effective in improving KAP regarding tuberculosis among HIV patients.

Delay in diagnosis of Pulmonary Tuberculosis: Study of factors related to patients and health care system

Objective: To find factors related with delayed diagnosis of pulmonary tuberculosis in patients presenting to the hospitals of Rawalpindi. Methods: A cross sectional observation study was carried out in Benazir Bhutto Hospital, District head quarter Hospital, Fauji Foundation Hospital, Military Hospital and Holy Family Hospital, Rawalpindi from February 2016 to September 2016. A total of one hundred ninety patients of pulmonary tuberculosis were interviewed through convenient sampling by a formulated questionnaire. Results: Mean total delay was 114.48 days whereas median total delay was 53.5 days. Mean patient delay was 33.25 days and mean health care delay was 81.23 days. On multivariate analysis unemployment was associated with patients delay whereas healthcare delay was associated with smear negative TB and patients self-realization that there is delay in diagnosis. Conclusion: This study shows that there is a long delay in the diagnosis of pulmonary tuberculosis in our country. Unemployment is main factor related to patient delay. Improving TB knowledge and socio-economic status of individuals may help in the earlier diagnosis. Adequate training of healthcare workers in diagnosing smear negative TB and improvement in health care services may also help to reduce the long healthcare delays. J Microbiol Infect Dis 2017; 7(3):119-124

English

Tuberculosis is a chronic infections disease caused by Mycobacterium tuberculosis attributable to nearly 9.3 million new cases and 2 million deaths a year, most of which occurring in developing countries. Besides its public health impact, tuberculosis continues to be a challenge for holistic development. Lack of proper knowledge regarding treatment of tuberculosis and consequences of defaulting lead to poor adherence in turn resulting to unsuccessful control program. To assess treatment defaulter rate and associated factors among tuberculosis patients on follow up attending Jimma University Specialized Hospital tuberculosis clinic. An institution based cross sectional study was conducted in JUSH, Southwest Ethiopia from March 1st to 30th March, 2016. The study population were tuberculosis patients on treatment during study period. Data was collected using face to face interview and record review using semi-structured questionnaires and checklists. Data was edited and entered to a statistical software, SPSS version 20.0 and then analyzed using of the same software. Chi-square test and p-value were done to show statistical significance of findings and in addition, association among different variables was determined. A total of 138 respondents were participated with a response rate of 95 of whom 83 (60%) were females and 40 (29%) were in 15 to 24 years age group. TB patients under new treatment regimen constitute for 128 (92.8%) and the rest 10 (7.2%) cases were under re-treatment regimen. About 85% (118/138) participants replied that they have heard about TB, and nearly 37% (51/138) stated that direct coughing or sneezing as a means of transmitting TB and 51 (37%) respondents tried at least 2 TB specific symptoms. However, based on assessment of the overall knowledge of TB, only 21(22.3%) of them were knowledgeable about tuberculosis in the context of knowing cause, transmission, prevention and treatment of tuberculosis while 73(77.7%) of were not knowledgeable. The high defaulting rate and the factors associated with defaulting in this study show high prevalence of defaulting rate and also the challenges faced by patients in the course of TB treatment. Key words: Defaulter, TB and default.

Improving active case finding for tuberculosis in South Africa: informing innovative implementation approaches in the context of the Kharitode trial through formative research

BackgroundTuberculosis (TB) is the leading infectious killer worldwide, with approximately 1.8 million deaths in 2015. While effective treatment exists, implementation of active case finding (ACF) methods to identify persons with active TB in a timely and cost-effective manner continues to be a major challenge in resource-constrained settings. Limited qualitative work has been conducted to gain an in-depth understanding of implementation barriers.MethodsQualitative research was conducted to inform the development of three ACF strategies for TB to be evaluated as part of the Kharitode cluster-randomised trial being conducted in a rural province of South Africa. This included 25 semi-structured in-depth interviews among 8 TB patients, 7 of their household members and 10 clinic health workers, as well as 4 focus group discussions (2 rural and 2 main town locations) with 6–8 participants each (n = 27). Interviews and focus group discussions explored the context, advantages and limitations, as well as the implications of three ACF methods. Content analysis was utilised to document salient themes regarding their feasibility, acceptability and potential effectiveness.ResultsStudy participants (TB patients and community members) reported difficulty identifying TB symptoms and seeking care in a timely fashion. In turn, all stakeholder groups felt that more proactive case finding strategies would be beneficial. Clinic-based strategies (including screening all patients regardless of visit purpose) were seen as the most acceptable method based on participants’ preference ranking of the ACF strategies. However, given the resource constraints experienced by the public healthcare system in South Africa, many participants doubted whether it would be the most effective strategy. Household outreach and incentive-based strategies were described as promising, but participants reported some concerns (e.g. stigma in case of household-based and ethical concerns in the case of incentives). Participants offered insights into how to optimise each strategy, tailoring implementation to community needs (low TB knowledge) and realities (financial constraints, transport, time off from work).ConclusionsFindings suggest different methods of TB ACF are likely to engage different populations, highlighting the utility of a comprehensive approach.Trial registrationClinicaltrials.gov (NCT02808507). Registered June 1, 2016. The participants in this formative study are not trial participants.

A Unique Survey on Tuberculosis in Urban Slums of Mysore City, Karnataka, India

Background: Tuberculosis remains a major public health problem in India. The objective of this study was to assess the knowledge, attitude and practices with respect to knowledge of TB among the selected urban slums‟ population between the age group of 18 – 65 years in Mysore city, Karnataka, South India. Design: Community based cross-sectional survey in 10 randomly selected slums and 500 systematically selected individuals. Study was carried out from January to February 2015 using the WHO (KAP) survey tool. Results: Overall knowledge about TB was low (percent mean 45.7), with no difference between gender. Knowledge about TB increased with increasing educational level. Majority of the respondents obtained knowledge regarding TB from their family, friends and teachers (percent mean 77.6), whereas print media (percent mean 10.6) was least. Respondents gaining information through health professionals had a significantly higher knowledge on treatment of TB (percent mean 30.7, p=0.011).Digital media had a positive impact on the attitude and practices regarding TB. Conclusion: Though most persons were aware about TB, the awareness regarding diagnosis and treatment was poor. This may affect treatment seeking behaviour among persons dwelling in slums. Frequent and continuous Information Education and Communication along with Social Behaviour Change Communication activities with the help of civil societies help to improve awareness regarding all aspects of TB.

An assessment of the HIV/TB knowledge and skills of home-based carers working in the North West province in South Africa: a cross-sectional study

BackgroundHome-based carers (HBCs) play a critical role in ensuring the success of the primary health care re-engineering strategy in South Africa. Their role includes ensuring improved access to and delivery of primary health care at the household level, and better co-ordination and improved linkages between community and health facilities for HIV/TB services. The objective of this study was to assess the knowledge, skills, challenges and training needs of HBCs involved in HIV/TB care in one sub-district in the North-West province of South Africa.MethodsWe conducted a descriptive, cross-sectional study in which 157 HBCs were interviewed to assess their knowledge and skills regarding HIV and TB. Data were collected using a pre-tested semi-structured questionnaire. Quantitative and qualitative data were analysed using SPSS statistical software and thematic analysis respectively.ResultsOne hundred and forty-four (92%) of the interviewees were female and 13 (8%) were male. The median age of the participants was 35 years (interquartile range (IQR): 22–27). The median score for knowledge of both HIV and TB questions was 66% (IQR: 57–75). In general, HIV knowledge scores were higher than TB knowledge scores (73% versus 66%). A significant association was found between knowledge scores and formal training (p < 0.05), and knowledge scores and highest educational levels (p < 0.05). Irrespective of knowledge, HBCs reported providing a variety of services to support HIV/TB services in the communities in which they worked. HBCs also reported facing various challenges in their jobs related to stigma and the social contexts in which they work.ConclusionThe study showed that the overall knowledge of HBCs was limited, given the skills required and the services they provide. Given the increasing role of HBCs in various health initiatives, targeted interventions are required to support and improve their competencies and service provision.

Relationship Between TB Treatment Phase and Knowledge of MDR TB with TB Patient’s Compliance

Indonesia is in second rank of pulmonary TB cases in the world after India. Forty-six percent total cases in the world are accounted from India, Indonesia and China. It is estimated that 3,3% of new cases is multidrug-resistant tuberculosis (MDR TB), a level that has remained unchanged in recent years. Pulmonary tuberculosis is a cronic infectious disease. Long-time treatment with the amount of medication and variying treatment effects causes sufferers often treatened to drop out treatment during recovery. This research was aimed to analyze relationship between treatment phase and knowledge of MDR TB with TB patient compliance in the treatment. The method was used an observational analitic study with cross sectional design. The questionnaire was conducted on 59 patients TB. Sampling method is simple random sampling. Questionnaire were conducted to obtain more in-depth information about the variables studied. The research variable include patient characteristics (age, gender, education, occupation), treatment phase, knowledge of MDR TB and TBpatient compliance in the treatment. Based on Chi Square test, there was signifi cant relationship between TB treatment phase with TB patient compliance (p = 0.03;PR =1.593). There was relationship between knowledge of MDR TB patient with TB patient compliance (p = 0.039;PR = 1.164). The conclusion is that there was relationship between TB treatment phase and knowledge of MDR TB patient with TB patient compliance in the treatment. Knowledge of MDR TB enable the patient to understand that the disease can be cured with regular medical treatment as instructed.Keywords: treatment phase, knowledge of MDR TB, patient compliance

Relationship Between TB Treatment Phase and Knowledge of MDR TB with TB Patient’s Compliance

Indonesia is in second rank of pulmonary TB cases in the world after India. Forty-six percent total cases in the world are accounted from India, Indonesia and China. It is estimated that 3,3% of new cases is multidrug-resistant tuberculosis (MDR TB), a level that has remained unchanged in recent years. Pulmonary tuberculosis is a cronic infectious disease. Long-time treatment with the amount of medication and variying treatment effects causes sufferers often treatened to drop out treatment during recovery. This research was aimed to analyze relationship between treatment phase and knowledge of MDR TB with TB patient compliance in the treatment. The method was used an observational analitic study with cross sectional design. The questionnaire was conducted on 59 patients TB. Sampling method is simple random sampling. Questionnaire were conducted to obtain more in-depth information about the variables studied. The research variable include patient characteristics (age, gender, education, occupation), treatment phase, knowledge of MDR TB and TBpatient compliance in the treatment. Based on Chi Square test, there was signifi cant relationship between TB treatment phase with TB patient compliance (p = 0.03;PR =1.593). There was relationship between knowledge of MDR TB patient with TB patient compliance (p = 0.039;PR = 1.164). The conclusion is that there was relationship between TB treatment phase and knowledge of MDR TB patient with TB patient compliance in the treatment. Knowledge of MDR TB enable the patient to understand that the disease can be cured with regular medical treatment as instructed.Keywords: treatment phase, knowledge of MDR TB, patient compliance

“It’s about my life”: facilitators of and barriers to isoniazid preventive therapy completion among people living with HIV in rural South Africa

ABSTRACTDespite the recent rollout of Isoniazid Preventive Therapy (IPT) to prevent TB in people living with HIV in South Africa, adherence and completion rates are low. To explore barriers to IPT completion in rural KwaZulu-Natal, South Africa, we conducted individual semi-structured interviews among 30 HIV patients who had completed or defaulted IPT. Interview transcripts were analyzed according to the framework method of qualitative analysis. Facilitators of IPT completion included knowledge of TB and IPT, accepting one’s HIV diagnosis, viewing IPT as similar to antiretroviral therapy, having social support in the community and the clinic, trust in the healthcare system, and desire for health preservation. Barriers included misunderstanding of IPT’s preventive role in the absence of symptoms, inefficient health service delivery, ineffective communication with healthcare workers, financial burden of transport to clinic and lost wages, and competing priorities. HIV-related stigma was not identified as a significant barrier to IPT completion, and participants felt confident in their ability to manage stigma, for example by pretending their medications were for unrelated conditions. Completers were more comfortable communicating with health care workers than were defaulters. Efforts to facilitate successful IPT completion must include appropriate counseling and education for individual patients and addressing inefficiencies within the health care system in order to minimize patients’ financial and logistical burden. These patient-level and structural changes are necessary for IPT to successfully reduce TB incidence in this resource-limited setting.

Prevalence, patterns, and correlates of HIV disclosure among TB-HIV patients initiating antiretroviral therapy in Lesotho

ABSTRACTDisclosure of HIV-positive status has important implications for patient outcomes and preventing HIV transmission, but has been understudied in TB-HIV patients. We assessed disclosure patterns and correlates of non-disclosure among adult TB-HIV patients initiating ART enrolled in the START Study, a mixed-methods cluster-randomized trial conducted in Lesotho, which evaluated a combination intervention package (CIP) versus standard of care. Interviewer-administered questionnaire data were analyzed to describe patterns of disclosure. Patient-related factors were assessed for association with non-disclosure to anyone other than a health-care provider and primary partners using generalized linear mixed models. Among 371 participants, 95% had disclosed their HIV diagnosis to someone other than a health-care provider, most commonly a spouse/primary partner (76%). Age, TB knowledge, not planning to disclose TB status, greater perceived TB stigma, and CIP were associated with non-disclosure in unadjusted models (p < .1). In adjusted models, all point estimates were similar and greater TB knowledge (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.39–0.90) and CIP (aOR 0.20, 95% CI 0.05–0.79) remained statistically significant. Among 220 participants with a primary partner, 76% had disclosed to that partner. Significant correlates of partner non-disclosure (p < .1) in unadjusted analyses included being female, married/cohabitating, electricity at home, not knowing if partner was HIV-positive, and TB knowledge. Adjusted point estimates were largely similar, and being married/cohabitating (aOR 0.03, 95% CI 0.01–0.12), having electricity at home (aOR 0.38, 95% CI 0.17–0.85) and greater TB knowledge (aOR 0.76, 95% CI 0.59–0.98) remained significant. In conclusion, although nearly all participants reported disclosing their HIV status to someone other than a health-care provider at ART initiation, nearly a quarter of participants with a primary partner had not disclosed to their partner. Additional efforts to support HIV disclosure (e.g., counseling) may be needed for TB-HIV patients, particularly for women and those unaware of their partners’ status.

Knowledge, attitudes and practices regarding tuberculosis care among health workers in Southern Mozambique

BackgroundTuberculosis (TB) control is more likely to be achieved if the level of knowledge regarding TB is increased among health workers managing high-risk groups. No formal assessments regarding knowledge, attitudes and practises of health workers about TB have been published for Mozambique, a country facing challenges in the fight against TB, with a fragile health system and considerable work overload of health personnel. The main objective of the study was to determine the level of knowledge, identify attitudes and assess practices regarding TB care and control among health care workers of the district of Manhiça.MethodsA descriptive cross-sectional study was performed through the use of a specifically designed Knowledge, Attitudes and Practices (KAP) questionnaire in the district of Manhiça, a high tuberculosis and HIV burden rural area in Southern Mozambique. In this district, 14 health care facilities service a population of approximately 160,000 people. The questionnaire took 30–45 min to administer with external assistance not permitted. The survey contained 79 questions pertaining to four different areas: demographics, TB knowledge, attitudes and practices.ResultsThe study sample included 170 health care workers. The average knowledge score was 14.89 points (SD = 3.61) out of a total possible 26 points. Less than 30% of respondents had heard of Xpert MTB/RIF®. Seventy per cent agreed there was stigma associated with TB and 48.2% believed this stigma was greater than that associated with HIV. The average practice score was 3.2 out of 9 points (35.6%, SD = 2.4).ConclusionHealth care worker’s knowledge gaps identified in this study may result in substandard patient care. Specific deficiencies in understanding existed in terms of paediatric TB and Xpert MTB/RIF® testing. The present study provides impetus for tailored TB education among health care workers from a high TB burden rural area in Southern Mozambique.

Tuberculosis patients' pre-hospital delay and non-compliance with a longstanding DOT programme: a mixed methods study in urban Zambia.

BackgroundTuberculosis (TB) remains a major health problem in Zambia, despite considerable efforts to control and prevent it. With this study, we aim to understand how perceptions and cultural, social, economic, and organisational factors influence TB patients’ pre-hospital delay and non-compliance with care provided by the National Tuberculosis Programme (NTP).MethodsA mixed methods study was conducted with 300 TB patients recruited at Kanyama clinic for structured interviews. Thirty were followed-up for multiple in-depth interviews. Six focus group discussions were organised and participant observation was conducted. Ten biomedical care providers, 10 traditional healers, and 10 faith healers were interviewed. Factors associated with non-compliance (disruption of treatment > one week) were assessed by applying logistic regression analyses; qualitative analysis was used to additionally assess factors influencing pre-hospital delay and for triangulation of study findings.ResultsTB treatment non-compliance was low (10 %), no association of outcome with cultural or socio-economic factors was found. Only patients’ time constraints and long distance to the clinic indicated a possible association with a higher risk of non-compliance (OR 0.52; 95 % CI 0.25, 1.10, p = 0.086). Qualitative data showed that most TB patients combined understandings of biomedical and traditional TB knowledge, used herbal, traditional and/or faith healing, suffered from stigmatizing attitudes, experienced poverty and food shortages, and faced several organisational obstacles while being on treatment. This led in some cases to pre-hospital delay or treatment non-compliance.ConclusionsMixed methods analysis demonstrated the importance of in-depth information ascertained by qualitative approaches to understand how cultural, socio-economic and organisational factors are influencing patients’ pre-hospital delay and treatment compliance. To strengthen the Zambian NTP, combating stigma is of utmost priority coupled with programmes addressing poverty. Organisational barriers and co-operation between (private) clinics and traditional/faith healers should be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3771-9) contains supplementary material, which is available to authorized users.

Tuberculosis infection control knowledge and attitudes among health workers in Uganda: a cross-sectional study.

BackgroundThe World Health Organization recommends TB infection control (TBIC) in health care facilities. In 2008, the Ministry of Health Uganda initiated efforts to implement TBIC by training of health care workers (HCWs). This study was carried out to assess knowledge and attitudes towards TBIC among HCWs.MethodsWe conducted a cross-sectional study among HCWs in health facilities in the districts of Mukono and Wakiso in Uganda, from October 2010 to February 2011. We assessed HCWs’ knowledge of basic standards of TB diagnosis, treatment and TBIC and attitudes towards TBIC measures.ResultsTwenty four percent of the participants answered correctly all the basic TB knowledge questions. Overall, 62 % of the HCWs were judged to have adequate basic TB knowledge. At multivariable analysis, non-clinical cadres, were more likely to have poor basic TB knowledge, [adjusted odds ratio (aOR) 0.43; 95 % confidence interval (CI) 0.27–0.68)]. Only 7 % of the respondents answered all the questions on TBIC correctly. Almost all the respondents (98 %; 529/541) knew that TB was transmitted through droplet nuclei, while only a third (34 %; 174/532) knew that masks do not protect the wearer from getting TB. Overall, 69 % (355/512) of the HCWs were judged to have adequate TBIC knowledge. At multivariable analysis, non-clinical cadres (aOR 0.61; 95 % CI 0.38–0.98) and having not attended TBIC training, (aOR 0.65; 95 % CI 0.42–0.99), were more likely to have poor TBIC knowledge. More than three quarters (77 %; 410/530) and 63 % (329/522) of the respondents had a high self-efficacy and perceived threat of acquiring TB at work, respectively. Having not attended a TBIC training was significantly associated with a low self-efficacy (aOR 0.52; 95 % CI 0.33–0.81) and low perceived threat of acquiring TB infection at work, (aOR 0.54; 95 % CI 0.36–0.81).ConclusionsOur study finds moderate number of HCWs with correct knowledge and attitudes towards TBIC. Efforts should be put in place to train all HCWs in TBIC, with particular emphasis on the non-clinical staff due to their limited grasp of TBIC measures.

Multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa: An overview of patients' reported knowledge and attitudes.

BackgroundThe incidence and prevalence of multidrug–resistant tuberculosis (MDR TB) in the province of KwaZulu-Natal, South Africa, are amongst the highest in the world. Previously, interventions have been largely biomedical based; however, there is growing opinion that interventions must include social aspects such as patient education and attitudes.MethodsThis observational study assessed the knowledge and attitudes of 380 patients diagnosed with MDR TB at a centralised MDR TB unit in Durban. Data were collected using a questionnaire that was distributed to every third patient attending the outpatient MDR TB clinic. Data were collected over an 8-week period and analysed descriptively.ResultsJust under half of the respondents had primary MDR TB. Most respondents were young, female unemployed and did not receive a social grant. Knowledge around diagnosis of MDR TB was generally adequate. There were important misconceptions about spread of the disease and duration of treatment. Most respondents received knowledge of MDR TB from healthcare workers. Some respondents received knowledge from friends, family and Sangomas and believed that the disease was caused by bewitchment or as a form of punishment.DiscussionThe need for strengthening the role of primary care physicians in promoting education and providing support is highlighted. Further study is needed to investigate the high rate of primary MDR TB and to identify the unique challenges faced by women who have MDR TB. Future research could include the possibility of involving traditional healers in a contextually sensitive MDR TB education, training and support programme.

Knowledge of multidrug-resistant tuberculosis in the Thabo Mofutsanyana District, Free State: A Grade 10 learner’s project

The learner’s hypothesis was that the people in the Thabo Mofutsanyana District have limited knowledge of TB and MDR-TB, which could relate to the high disease burden and defaulter rate. A questionnaire to test the knowledge of MDR-TB was designed and translated to all local languages in the area. The questionnaire was distributed to high school learners at five district schools as well as to nursing personnel working at the local clinics and hospitals. Of the 550 questionnaires handed out, 500 were returned and analysed (response rate of 90.9%). Learners accounted for 57.2% of the participants. The results showed that 67.2% of people in the district had no knowledge of MDR-TB. Possible reasons given were lack of posters, posters not in their local language, illiteracy, and not being informed by healthcare facilities. Participants with knowledge of MDR-TB indicated that they gained information from local clinics (45.7%), the media (33.5%) and other sources including family members, friends and schools (20.7%). Only 44.5% of the knowledgeable participants knew that the duration of MDR-TB treatment is 24 months. It was encouraging to see that 93.3% of the knowledgeable participants knew the main symptoms of MDR-TB. With the results showing a severe lack of knowledge in an area with a high TB burden, the learner designed and produced pamphlets with information on TB and MDR-TB and distributed these to schools and clinics in the district. The pamphlets included a list of TB symptoms and an explanation of TB, stating that it is curable. Furthermore, she organised workshops to educate people. To reach the youth, she initiated a project on social media, by successfully distributing information via Instagram and other social media platforms.

Assessment of current practices in management of childhood TB among frontline clinicians in Southern Nigeria.

Poor competence of clinicians may be a critical factor responsible for the under-diagnosis of childhood TB in high-burden settings. Our objective was to assess the current practices of management of childhood TB among clinicians in Nigeria. A cross-sectional survey was conducted among clinicians recruited through a three-stage sampling technique from 76 health facilities in Southern Nigeria. A semi-structured questionnaire was administered to all participants. Of 106 clinicians who completed the survey, 73 (68.9%) were <40 years and 67 (63.2%) were males. Also, 14 (13.2%) were paediatricians, 22 (20.8%) were paediatric specialist trainees and 70 (66%) were medical officers in primary and secondary care health facilities. About 94% of the respondents perceived diagnosis of childhood TB a challenge in Nigeria. The overall mean (SD) knowledge score was 3.8±0.9 (maximum 5), and 68 (64.2%) had good knowledge of childhood TB. The mean (SD) appropriate practice score was 4.0±1.7 (maximum 10) and, only 8 (7.5%) of them were considered to have adopted appropriate practices regarding childhood TB care. There are gaps in practices adopted by frontline clinicians in the management of childhood TB in Nigeria. Focused training of health workers on childhood TB care is urgently recommended.

Lay Health Workers experience of a tailored knowledge translation intervention to improve job skills and knowledge: a qualitative study in Zomba district Malawi.

BackgroundLike many sub-Saharan African countries, Malawi is facing a critical shortage of skilled healthcare workers. In response to this crisis, a formal cadre of lay health workers (LHW) has been established and now carries out several basic health care services, including outpatient TB care and adherence support. While ongoing training and supervision are recognized as essential to the effectiveness of LHW programs, information is lacking as to how these needs are best addressed. The objective of this qualitative study was to explore LHWs responses to a tailored knowledge translation intervention they received, designed to address a previously identified training and knowledge gap.MethodsForty-five interviews were conducted with 36 healthcare workers. Fourteen to sixteen interviews were done at each of 3 evenly spaced time blocks over a one year period, with 6 individuals interviewed more than once to assess for change both within and across individuals overtime.ResultsReported benefits of the intervention included: increased TB, HIV, and job-specific knowledge; improved clinical skills; and increased confidence and satisfaction with their work. Suggestions for improvement were less consistent across participants, but included: increasing the duration of the training, changing to an off-site venue, providing stipends or refreshments as incentives, and adding HIV and drug dosing content.ConclusionsDespite the significant departure of the study intervention from the traditional approach to training employed in Malawi, the intervention was well received and highly valued by LHW participants. Given the relative low-cost and flexibility of the methods employed, this appears a promising approach to addressing the training needs of LHW programs, particularly in Low- and Middle-income countries where resources are most constrained.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0580-x) contains supplementary material, which is available to authorized users.

Factors Contributing to Delay in Seeking Treatment among Pulmonary Tuberculosis Patients in Suneka Sub-County, Kenya

Tuberculosis is a major global public health problem and a leading cause of morbidity and mortality in Kenya. TB control has remained a major challenge for the TB control programme especially in this HIV/AIDS era and the emergence of multi-drug resistant TB (MDR-TB). Early identification of cases and commencement of effective chemotherapy is an effective method to control the spread of TB. Reliance on passive case finding means that patients play a key role in reducing delay to diagnosis and treatment. Patient delay (duration from onset of symptoms to first contact with a health care provider at a public health facility) is a major challenge to TB control and is dependent on several factors. The purpose of this study was to determine the duration from onset of symptoms to seeking appropriate TB treatment among pulmonary TB (PTB) patients and investigate the factors associated with patient delay in Suneka sub-County, Kisii County, Kenya. A cross-sectional survey, using a semi-structured questionnaire, was carried out at five public health facilities in the sub-County. Data entry, management and analysis were done using SPSS Version 15. The mean patient delay and associations between length of patient delay and the various independent variables was determined. Multiple logistic regression was performed to determine the factors independently associated with patient delay. The mean patient delay was 54 days and 65.4% of the study subjects had delayed for more than 30 days. Delay in seeking appropriate TB treatment among PTB patients in Suneka sub-County was associated with poor perception of services in public health facilities (OR=4.91; CI=1.6-15.3; P=0.0061), visiting a private clinic (OR=4.24; CI=1.5-11.6; P=0.0052) and stigma (OR=2.46; CI=1.9-12.2; P=0.0178). Most PTB patients in Suneka sub-County delay in presenting at public health facilities after the onset of major TB symptoms and the main factors responsible for this delay include having a poor perception of the quality of services offered in public health facilities, prior attendance at a private clinic and stigma associated with the disease. Delay was not found to be associated with the patient socio-demographic characteristics, knowledge of TB, distance or transport cost to the nearest public health facility. Since TB services are integrated in the general health care system, the findings highlight the need by the Ministry of Health (MOH) to improve service delivery at public health facilities and thereby encourage patients to seek early diagnosis and treatment of communicable diseases or reduce patient delays. Educational campaigns should go beyond providing general information about TB to emphasize embracing a positive attitude of transmission reduction through early treatment.