Tuberculosis Health Education Research Articles

Analysis of the awareness rate and correlates of core information on tuberculosis prevention and control in elderly in Chinese

Objective: To understand the awareness and influencing factors of core information on tuberculosis prevention and control in the elderly population in China. Methods: The study included all participants aged ≥60 from the "13th Five-Year" National Tuberculosis Control Plan end-term assessment in 2020, with 13 706 valid questionnaires obtained. Multivariate logistic regression was used to analyze the influencing factors of the awareness rate of core information on tuberculosis prevention and control in the elderly. Results: The total awareness rate of core information on tuberculosis prevention and control in the elderly aged ≥60 was 78.4%, with the highest for "suspicious symptoms of pulmonary tuberculosis" (85.4%) and the lowest for "whether pulmonary tuberculosis can be cured" (65.3%). The complete awareness rate of core information on tuberculosis prevention and control in the elderly was 41.3%, and the proportion of those who received tuberculosis health education is 67.6%. Multivariate logistic regression analysis results showed that factors associated with low awareness of core information included females (OR=0.93, 95%CI: 0.86-1.00), ages 70- (OR=0.91, 95%CI: 0.84-0.98) and ≥80 (OR=0.77, 95%CI: 0.68-0.87) and minority ethnicity (OR=0.85, 95%CI: 0.74-0.99). Factors associated with high awareness of core information included educational levels of junior high school (OR=1.46, 95%CI: 1.34-1.58), high school (OR=1.62, 95%CI: 1.45-1.81), junior college (OR=1.37, 95%CI: 1.11-1.68), and an undergraduate degree or higher (OR=1.52, 95%CI: 1.09-2.11), and receiving tuberculosis health education (OR=2.13, 95%CI: 1.97-2.27). Conclusions: In 2020, the awareness rate of core information on tuberculosis prevention and control in Chinese older adults aged ≥60 was lower than the national planning target. Therefore, there should be an increased focus on health education about tuberculosis for elderly females, those aged ≥70, ethnic minorities, and those with lower education levels.

Prejudice and determinants regarding tuberculosis patients among medical students in Dalian, Northeast China: a cross-sectional study.

Health workers play a central role in global tuberculosis (TB) elimination efforts. If medical students have prejudiced attitudes toward TB patients, this may make it difficult for them to provide effective health care to TB patients in their future roles as health workers. There is currently no research on prejudice toward TB patients among medical students in China. This study aimed to explore the current status of medical students' prejudice against patients with TB and its associated predictors. We conducted a cross-sectional questionnaire survey among medical students at a medical university in Dalian, Liaoning Province, Northeast China. Multiple logistic regression analysis was employed to determine the predictive factors of medical students' prejudice against patients with TB. More than half (57.23%) of the medical students held prejudices against individuals with TB. Multivariate logistic regression analysis revealed that not receiving TB health education (OR: 2.12, 95% CI: 1.35-3.32), not knowing a person with TB (OR: 2.52, 95% CI: 1.39-4.56), and fear of TB/TB patients (OR: 6.79, 95% CI: 4.36-10.56) were identified as risk factors for medical students' prejudice against TB patients. Conversely, residing in rural areas (OR: 0.60, 95% CI: 0.38-0.95), agreeableness (OR: 0.82, 95% CI: 0.73-0.92) and emotional stability (OR: 0.90, 95% CI: 0.81-1.00) in the Big Five personality traits, and a better understanding of TB knowledge (OR: 0.58, 95% CI: 0.38-0.89) were identified as protective factors. In China, a considerable number of medical students still exhibit prejudice against patients with TB. Targeted interventions, such as incorporating TB health education into the core curriculum of medical students, and enhance their agreeableness and emotional stability, are still needed. Furthermore, greater focus should be placed on medical students from urban backgrounds or those who harbor fear or do not know a person with TB.

Tuberculosis Health Education, Larval Survey, and Rat Identification in the Community on Satangnga Island, Takalar Regency

Tuberculosis disease is a direct infectious disease caused by Mycobacterium Tuberculosis bacteria or known as pulmonary TB, has a very fast transmission rate and is also very contagious. The method used in this activity is a quantitative pre-experimental method with a one group pretest-posttest design. This community service was carried out as a government effort in controlling the risk of tuberculosis disease and enlivening the tri dharma objectives of Hasanuddin University, namely carrying out community service. The community service activities were carried out with health counseling on tuberculosis disease which was held on October 7, 2023 at SMP 3 Mappakasunggu Satangnga Hamlet, Mattirobaji Village, Tanakeke Islands Sub-District, Takalar Regency in 2023. The number of counseling participants was 19 people and this activity was accompanied by the principal and 4 teachers. The community service activities that have been carried out show that there are differences before and after health counseling on tuberculosis disease at SMP Negeri 3 Mappakasunggu Satangnga Hamlet, Mattirobaji Village, Kec. Tanakeke Islands, Takalar Regency. This can be seen in the p-value (0.000) <0.05. For rat identification, the type of rat obtained was the rattus-rattus diardii type as many as 2 rats. Then the survey of larvae that were found were aedes aegepty larvae in 15 community houses. It is hoped that the people of Satanngga Hamlet will always adopt clean and healthy living habits and maintain a clean environment around their homes.
 Abstrak
 Penyakit tuberkulosis adalah penyakit menular langsung yang disebabkan oleh bakteri Mycobacterium Tuberculosis atau dikenal dengan TB paru, memiliki tingkat penularan yang sangat cepat dan juga sangat mudah menular. Metode yang digunakan dalam kegiatan ini adalah metode kuantitatif pre-experimental dengan desain one group pretest-posttest. Pengabdian masyarakat ini dilaksanakan sebagai upaya pemerintah dalam mengendalikan risiko penyakit tuberkulosis dan menyemarakkan tujuan tri dharma perguruan tinggi Universitas Hasanuddin yaitu melaksanakan pengabdian masyarakat. Kegiatan pengabdian dilakukan dengan penyuluhan Kesehatan mengenai penyakit tuberkulosis yang dilaksanakan pada tanggal 7 Oktober 2023 di SMP 3 Mappakasunggu Dusun Satangnga, Desa Mattirobaji, Kec. Kepulauan Tanakeke, Kabupaten Takalar Tahun 2023. Jumlah peserta penyuluhan sebanyak 19 orang dan kegiatan ini di damping oleh kepala sekolah dan 4 orang guru. Kegiatan pengabdian kepada masyarakat yang telah dilakukan menunjukkan bahwa terdapat perbedaan sebelum dan sesudah penyuluhan kesehatan penyakit tuberkulosis di SMP Negeri 3 Mappakasunggu Dusun Satangnga, Desa Mattirobaji, Kec. Kepulauan Tanakeke, Kabupaten Takalar. Hal ini dapat dilihat pada nilai p-value (0.000) < 0.05. Untuk identidikasi tikus, jenis tikus yang didapatkan adalah jenis rattus-rattus diardii sebanyak 2 ekor. Kemudian survey jentik yang banyak ditemukan adalah jentik aedes aegepty di 15 rumah masyarakat. Diharapkan masyarakat Dusun Satangnga agar selalu menerapkan perilaku hidup bersih dan sehat dan menjaga lingkungan kebersihan lingkungan sekitar rumah.

The necessity for enhancing awareness of tuberculosis starting from the early college semesters: empirical evidence from a cross-sectional research.

College students, especially those in the lower grades, constitute the main high-risk population for tuberculosis (TB). Insufficient knowledge about TB among college students contributes to an increased risk of TB infection. In Zhejiang Province, China, limited research has been conducted recently on the awareness of TB in schools among college students. Therefore, this study aims to gain insight into TB knowledge among low-grade college students in Zhejiang Province and develop effective strategies for TB education targeted at this specific population. A cross-sectional survey was conducted between 1st and 20th May 2022 in 20 colleges in Zhejiang Province, southeastern China. The survey aimed to assess the level of TB awareness among 1st and 2nd-year college students. Chi-square tests were performed to compare the rates, while multivariate logistic regression was used to identify the factors influencing the overall awareness level of students' regarding key knowledge about TB. A total of 4,414 lower-grade students participated in the study. The total awareness rate and entire awareness rate of key TB knowledge were 81.6 and 25.3%, respectively. Participants who demonstrated a relatively poor understanding of the definition were (51.0%), curable outcomes (75.7%), and preventive measures of TB (76.1%). Female participants [adjusted odds ratio (aOR):1.44; 95% confidence interval (CI):1.25-1.65], medical students (aOR:2.00; 95%CI:1.63-2.64), had a high level of monthly expenditures (aOR:2.50; 95%CI:1.49-4.19), had prior TB health education (aOR:1.95; 95%CI:1.68-2.25) and previous exposure to TB patients (aOR:2.13; 95% CI:1.48-3.08) indicating a better level of awareness of key knowledge about TB. Among the students, 58.5% expressed their willingness to acquire TB knowledge through "broadcasting, television, films, and audiovisual materials." The total awareness rate of key knowledge among low-grade college students in Zhejiang did not meet the national requirements. To effectively prevent TB in schools, it is crucial to develop a comprehensive understanding of the disease among college students. Therefore, it is necessary to enhance TB awareness through theoretical and practical education, starting from the early semesters of college.

How to Optimize Tuberculosis Health Education in College Under the New Situation? Based on a Cross-Sectional Study Among Freshmen of a Medical College in Guangxi, China.

BackgroundChina is a country with a high burden of tuberculosis (TB), and students are the high-risk group for TB. The enrollment scale of colleges has increased dramatically due to the advancement of the enrollment expansion system of Chinese colleges. Consequently, this has brought severe challenges to TB prevention and control in colleges. In 2017, a new TB control guide for schools was issued in China, which included the 8 core knowledge of TB. The target of the overall awareness rate on TB among population was “≥85%,” which was proposed by the “13th Five-Year” National TB Control Plan in China. The cognition of the 8 core knowledge of TB in the new guide among college students is crucial to achieve this target, but few studies on this have been reported. Based on the abovementioned new situation and the new guide, this study aimed to investigate and analyze the cognition, attitudes, and health education needs on TB among freshmen of a medical college in Guangxi province, and discuss how to optimize TB health education in colleges in China.MethodsA cross-sectional study was conducted among freshmen of a medical college in Guangxi, China. A self-designed questionnaire was used to conduct an on-site questionnaire survey. The data was entered in Epidata 4.4.2.1 and was analyzed using SPSS version 25.0. Including descriptive statistics and t-test, and the criterion for statistically significant difference was p < 0.05.ResultsA total of 583 freshmen responded to the survey questionnaires. Regarding cognition about the 5 related knowledge of TB, 551 (94.5%) freshmen knew about the predilection site of TB, while 333 (57.1%), 328 (56.4%), 257 (44.1%), and 201 (34.5%) freshmen knew about the pathogen, the policies about free treatment, the designated hospitals, and the World TB Day, respectively. Regarding cognition on the 8 core knowledge of TB, the overall awareness rate among the freshmen is 73.3%(3,420/4,664); the awareness rate of the knowledge that “guarantee adequate sleep, reasonable diet, and strengthen physical exercise can reduce the incidence of TB” among them was the highest at 88.7% (517/583); and the awareness rate of the knowledge that “coughing or sputum expectoration occurred for more than 2 weeks should be suspected of infecting TB and seeking medical treatment in time” among them was the lowest at 47.5% (277/583). Whether students received health education on TB (T = 4.267, p = 0.000) and whether students heard of TB (T = 3.739, p = 0.000) are the main factors of cognition. Five hundred sixty-two (96.4%) and 565 (96.9%) freshmen were willing to learn and tell others about the knowledge of TB, respectively. Three hundred seventy (63.5%.) freshmen, the highest amount, were willing to accept TB health education in the forms of “website, Weibo, and WeChat.”ConclusionThe cognition on the 5 related knowledge of TB among freshmen is unbalanced, and the overall awareness rate of the 8 core knowledge of TB among freshmen still needs to be improved. Freshmen who have not heard of TB and have not received TB health education before enrollment are the key intervention groups. It is recommended that institutions make full use of modern multimedia technology, continuously optimize the health education forms, implement precise policies, and strengthen the theoretical and practical health education on TB from the initial entry of freshmen into colleges.

Factors associated with mortality among patients with culture-positive pulmonary tuberculosis in the urban poor population of Osaka City, Japan.

ObjectiveTo determine the characteristics associated with mortality in patients with culture-positive pulmonary tuberculosis (PTB) in Airin, Osaka City, Japan.MethodsThe characteristics of patients with culture-positive PTB registered between 2015 and 2018 in Airin, Osaka City, Japan, were compared between those who died of all causes before or during treatment and those who completed treatment.ResultsOf the 241 culture-positive PTB patients eligible for this study, 170 completed treatment, with negative sputum culture tests, and 62 died. The all-cause case fatality rate was 26.7% (62/232). Multivariate analysis showed that mortality was associated with age 370 years, having a positive sputum smear, a body mass index of < 18.5 and serious comorbidities such as cancer and heart and renal disease. Detection of tuberculosis (TB) by screening or in an outpatient department (OPD) for other diseases was inversely associated with mortality.DiscussionDetection of PTB by chest X-ray screening and during regular visits to OPDs for other diseases was associated with non-fatal TB and might contribute to early case finding. Therefore, current active TB case finding and health education on regular visits to physicians for other diseases should be strengthened further for the urban poor population of Osaka City, Japan.

The burden of drug resistant tuberculosis in a predominantly nomadic population in Uganda: a mixed methods study

BackgroundEmergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population in Karamoja, Uganda with a high-TB burden (3500 new cases annually) and sought to determine the prevalence, patterns, factors associated with DR-TB.MethodsWe used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case control study with conditional logistic regression and robust standard errors respectively were used to the determine prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth interviews and key informant interviews.ResultsThe overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64,197 (0.1%) among the new and 37/2693 (1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI 1.552–110.135) and drug stock-outs aOR 0.027 (95%CI 0.002–0.364). The nomadic lifestyle, substance use, congested homesteads and poor health worker attitudes were a great challenge to effective treatment of TB.ConclusionDespite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education may help to stem the burden of TB disease in this nomadic population.

Knowledge and perception of treatment among tuberculosis patients attending primary care clinics in Malaysia.

Tuberculosis is a disease of public health concern. It can be treated effectively with good knowledge about the disease and complete adherence to the recommended treatment regime. This study is intended to assess the level of knowledge and perception of treatment among tuberculosis patients attending primary care clinics. We conducted a cross-sectional study using a validated self-administered questionnaire among tuberculosis patients attending primary care clinics in Johor Bahru district. A total of 208 tuberculosis patients were enrolled in this study through convenience sampling. We assessed the general knowledge, transmission, causes, and prevention of tuberculosis, where higher scores indicated better knowledge. For the perception of treatment, a higher mean score indicated a more negative perception. The mean score for knowledge on tuberculosis was 54.33 ± 12.78, ranging from 25 to 88.9%. The mean score for perception was 2.75±0.52, ranging from 2.15-3.39. We found that although 88.9% of respondents knew a person could be infected with TB through inhalation of tuberculosis bacilli, a majority believed that smoking (68.2%), sharing food (69.2%), and eating from the same plate (66.8%) are causes of tuberculosis. Moreover, there was still a negative perception regarding the treatment of tuberculosis with the highest mean score for the statement 'I am afraid if I am told I am tuberculosis positive'. We found that there were gaps in knowledge among tuberculosis patients. Intermittent counseling during the treatment re-enforces the knowledge of tuberculosis. An updated standardized counseling sheet of tuberculosis Health Education should be included along with staff training to update their knowledge as part of their important role in health education in tuberculosis prevention.

Integrated Health Education (IHE) Method: An Impact on Tuberculosis Health Education for the Sub-district of Sumowono Society, Indonesia

Tuberculosis (TB) case results in Semarang Regency is still in the low category. The IHE method was developed through counseling and training to support the community empowerment needed in assisting TB cases handling and determination. This study aims to determine the IHE method's effect and effectiveness on the knowledge and attitudes of Pemberdayaan Kesejahteraan Keluarga (Empowerment of Family Welfare; PPK) members regarding TB disease. A quasi-experimental one-group pretest-postest design and a sample size of 25 active PKK members in the Sumowono sub-district were used. Then, the data were analyzed using the Wilcoxon test and N-Gran Score. The results showed the IHE method's effect on PKK members knowledge and attitudes regarding TB disease with P-values of 0.034 and 0.029, respectively. The IHE method effectively improved the PKK members attitudes towards TB disease (mean= 61.43%). There was an increase in the knowledge and attitudes of PKK mothers about TB disease through health education using the IHE method. The development in IHE is needed to be applied as a health education method in various other diseases.

Acceptability and Feasibility of a Nurse-Led, Community Health Worker Partnered Latent Tuberculosis Medication Adherence Model for Homeless Adults.

Homeless adults are at increased risk of latent tuberculosis infection (LTBI), which can lead to active tuberculosis (TB) disease. The purpose of this study was to assess acceptability and feasibility of a six-month, nurse-led, community health worker-partnered short-course treatment (3HP) LTBI adherence model for a high risk, LTBI positive, homeless population. Informed by our community advisory board (CAB) and community-based participatory research principles (CBPR), a qualitative study was undertaken and used focus group discussions to identify perspectives of homeless men and women who had undergone LTBI treatment (N = 11, Mage = 51.2, SD 8.60, range 35–60). Three themes formed, which were engaging and recruiting LTBI intervention participants, delivering an LTBI intervention, and retaining LTBI intervention participants. Within those themes, barriers (e.g., lack of LTBI treatment readiness, substance use, etc.), and facilitators (e.g., LTBI and TB health education, familiarity with homeless population, etc.) were discussed to facilitate program recruitment, program delivery and program retention. These findings provide a greater understanding of how to effectively utilize a nurse-led, Community Health Worker (CHW) intervention delivery method to not only improve 3HP LTBI medication adherence, but also decrease substance use, improve mental health, and decrease unstable housing among this vulnerable population at high risk for active tuberculosis.

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

BackgroundTailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.MethodsWe used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016–May 2018). We used a thematic analysis to identify, analyse and report patterns in the data.ResultsDespite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment.ConclusionThe inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

Impact of educational intervention on the tuberculosis knowledge among the medical students, Chennai

Background: Knowledge of tuberculosis has recognized as important tool to prevent the occupational risk of contracting tuberculosis among the medical students. Though tuberculosis health education has been recognized in the medical college’s curriculum, the studies suggest the lack of knowledge of this killer disease among the medical students. This study was conducted with objective to assess level of knowledge of tuberculosis among the medical students and impact of education intervention on their knowledge.Methods: A quasi experimental study was conducted in a tertiary care teaching hospital, Chennai from January to March 2019 with a sample size of 119. The participants were assessed using a pre-tested, semi- structured questionnaire. An educational intervention was given through audio visual aid and post-test was conducted after one month. The median scores were calculated and Wilcoxon signed ranks test was applied.Results: Among the study participants, the mean age was 20.32±0.7 years. There was a significant improvement in the adequate knowledge of etiology, risk factors, clinical features and treatment following health education intervention. The post-test median score was statistically significant in all the domains of knowledge.Conclusions: The study showed poor existing knowledge of tuberculosis among the medical students which improved with an educational intervention which implies a need to revamp the undergraduate curriculum to improve the knowledge and practices among medical students.

Development and psychometric testing of the Knowledge, Attitudes and Practices (KAP) questionnaire among student Tuberculosis (TB) Patients (STBP-KAPQ) in China

BackgroundTB outbreaking in schools is extremely complex, and presents a major challenge for public health. Understanding the knowledge, attitudes and practices among student TB patients in such settings is fundamental when it comes to decreasing future TB cases. The objective of this study was to develop a Knowledge, Attitudes and Practices Questionnaire among Student Tuberculosis Patients (STBP-KAPQ), and evaluate its psychometric properties.MethodsThis study was conducted in three stages: item construction, pilot testing in 10 student TB patients and psychometric testing, including reliability and validity. The item pool for the questionnaire was compiled from literature review and early individual interviews. The questionnaire items were evaluated by the Delphi method based on 12 experts. Reliability and validity were assessed using student TB patients (n = 416) and healthy students (n = 208). Reliability was examined with internal consistency reliability and test-retest reliability. Content validity was calculated by content validity index (CVI); Construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA); The Public Tuberculosis Knowledge, Attitudes and Practices Questionnaire (PTB-KAPQ) was applied to evaluate criterion validity; As concerning discriminant validity, T-test was performed.ResultsThe final STBP-KAPQ consisted of three dimensions and 25 items. Cronbach’s α coefficient and intraclass correlation coefficient (ICC) was 0.817 and 0.765, respectively. Content validity index (CVI) was 0.962. Seven common factors were extracted by principal factor analysis and varimax rotation, with a cumulative contribution of 66.253%. The resulting CFA model of the STBP-KAPQ exhibited an appropriate model fit (χ2/df = 1.74, RMSEA = 0.082, CFI = 0.923, NNFI = 0.962). STBP-KAPQ and PTB-KAPQ had a strong correlation in the knowledge part, and the correlation coefficient was 0.606 (p < 0.05). Discriminant validity was supported through a significant difference between student TB patients and healthy students across all domains (p < 0.05).ConclusionsAn instrument, “Knowledge, Attitudes and Practices Questionnaire among Student Tuberculosis Patients (STBP-KAPQ)” was developed. Psychometric testing indicated that it had adequate validity and reliability for use in KAP researches with student TB patients in China. The new tool might help public health researchers evaluate the level of KAP in student TB patients, and it could also be used to examine the effects of TB health education.

Low contribution of health extension workers in identification of persons with presumptive pulmonary tuberculosis in Ethiopian Somali Region pastoralists

BackgroundTo accelerate the expansion of primary healthcare coverage, the Ethiopian government started deploying specially trained community health workers named Health Extension Workers (HEWs) in 2003. HEWs work on sixteen health service packages; one being tuberculosis (TB) control and prevention. However, their contribution to TB care and prevention services among pastoralist communities has not been evaluated. Thus, this study has assessed their contribution in identification of persons with presumptive pulmonary TB in Ethiopian Somali Pastoralist Region.MethodA cross sectional study with mixed approach of quantitative and qualitative methods was applied. A randomly selected cross-sectional sample of 380 pulmonary TB cases from 20 health facilities was selected to obtain information on the role of HEWs in the identification of persons with presumptive TB, and their referral. Purposively selected HEWs were also interviewed individually to obtain in-depth information on their in-service training and experiences with referring TB cases. SPSS version20 was used to summarize the quantitative data and test statistical significance using chi-square test and logistic regression model. The qualitative data was analyzed under the principles of thematic analysis.ResultOverall, 20.3% [95% CI = 16.6–24.5] of pulmonary TB patients were referred by HEWs; while the majority were referred by healthcare workers (52.6%), family members (13.4%), neighbours/friends (2.4%) and self-referred (11.3%). Out of all, 66.1% and 53.4% had neither received community TB health education nor home visit from HEW respectively. Multivariate analysis indicated that provision of community health education [AOR = 14.0, 95% CI = 6.6–29.5], being model household [AOR = 21.2, 95% CI = 9.5–47.3], home visit from HEW [AOR = 2.8, 95% CI = 1.2–9.6] and rural residence [AOR = 3.0, 95% CI = 1.2–7.7] were significantly associated with referral by HEW. The qualitative findings supported that HEWs’ involvement in referral of persons with presumptive TB was limited. Communities’ low confidence in HEWs, inaccessibility of TB services at nearest health centers and lack of in-service trainings for HEWs were identified by the interviewee HEWs as underlying factors for their limited involvement.ConclusionThe contribution of health extension workers in identifying and referring presumptive TB cases is limited in Ethiopian Somali pastoralist region. Increased community health education and home visits by HEWs could contribute to increased identification and referral of persons with presumed TB. HEW should be properly trained on TB through in-service refreshment trainings and supported by routine supervision. Further expansion of TB diagnostic services would benefit to increasing case detection.

Is tuberculosis health education reaching the public in China? A cross-sectional survey in Guizhou Province

BackgroundKnowledge about tuberculosis (TB) is important for TB control, and China's national TB control guidelines emphasise TB health promotion. A 2010 national TB epidemiology survey showed that the general public...

Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon.

Lambaréné, Gabon. To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB. Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic. Patients generally described TB as a natural and/or magical disease. The majority of the patients combined treatment at the hospital with (herbal) self-treatment and traditional/spiritual healing. Despite the free availability of anti-tuberculosis treatment in principle, patient adherence was problematic, hindering effective TB control. Most patients delayed or defaulted from treatment due to financial constraints, stigmatisation, ignorance about treatment, change of health care service or use of non-prescribed antibiotics. The situation was occasionally complicated by drug stockouts. There is an urgent need to bridge the gap between patients and the hospital by avoiding drug shortages, intensifying culturally sensitive TB health education, embedding TB care into the cultural context and enhancing cooperation between hospitals, patients, traditional healers and communities.

An exploration of NHS staff views on tuberculosis service delivery in Scottish NHS boards.

Tuberculosis (TB) is a bacterial disease and major worldwide killer with an increased UK incidence rate. This study aimed to explore the views of National Health Service (NHS) staff on TB service delivery models of care in NHS boards across Scotland. Eighteen semi-structured interviews were conducted with 13 nurse specialists and five consultants in public health medicine (CPHM) across five Scottish NHS boards. Five main themes emerged and findings showed that: directly observed treatment (DOT) was provided only to patients assessed to be at high risk of poor treatment adherence; contact tracing was conducted by participating NHS boards but screening at ports was thought to be weak; all NHS boards implemented TB awareness campaigns for TB health professionals; three NHS boards conducted team meetings that monitored TB patient progress; participants believed that TB funding should be increased; contact tracing was routinely conducted by TB nurses. Improved TB screening at airports was recommended and a need for TB health education for high risk groups was identified.

Effectiveness of Interventions to Increase Referral of Clients Exhibiting TB Symptoms by Pharmacies and Corner Stores in Santo Domingo, Dominican Republic

Engagement of the private sector and community leaders are popular strategies for improving tuberculosis (TB) case detection. However the impact of engaging pharmacies and community shop keepers in TB referral varies and the best method to achieve it are unknown. To evaluate changes in referral and TB case detection following workshops and/or motivational detailing visits, mystery clients visited 188 pharmacies and 103 grocery stores to seek advice for chronic symptoms reflecting pulmonary TB. Most sites (89% n=255) were exposed to detailing and 26.8% (76) also attended 1 hour workshops designed by the National TB program and KNCV Tuberculosis Foundation (KNCV). Sites were scored pre- and post-intervention, obtaining 1 point each for a) spontaneous recognition of TB symptoms, b) acknowledgement of symptoms as possibly TB when prompted, c) referral to medical care d) not promoting drugs e) exhibiting TB health education materials on site and f) referral of mystery clients to the TB program. The TB recognition and referral scores of all exposed establishments increased by an average of 2.0 points (95%C.I. 1.9- 2.1) at post-test compared with an increase of 0.6 points (95%C.I. 0.4-.0.9) among those in the comparison group (p<0.001). Attempted sales of antibiotics and palliatives declined from 38.3% at baseline to 16.1%. After six months, 33.1% of pharmacies and 22.7% of grocery stores reported referring. Seven smear-positive TB cases were diagnosed from among 70 TB suspects referred by pharmacies, but none from among 30 suspects sent by groceries. TB investigations rose by 8.4% in the area for a six month period. The intervention is likely to have contributed to the doubling of TB case notifications over two years. A simple motivation intervention led to improvement in referral and TB case detection. The National TB program introduced interventions with pharmacies to other provinces.

The perception and beliefs on tuberculosis among traditional healers in Remo North Local Government Area, Ogun State, Southwestern Nigeria

With the aid of a pre-tested semi-structured interview questionnaire, 30 traditional healers in Remo North Local Government Area of Ogun State in the Southwestern part of Nigeria were identified by their certificate of apprenticeship. A cross-sectional study was carried out to assess their knowledge on the symptoms of tuberculosis, their perceptions, beliefs and their practices as regards to the management of tuberculosis. A large percentage (60.0%) of the traditional healers knew the symptoms of tuberculosis but did not refer to the hospital because they believed that the disease is due to witchcraft, spells, poisons, eating forbidden food, familial causes, alcohol, cigarette smoking or mystical causes, and 70.0% rely on herbal concoctions to treat the disease. Intensive tuberculosis health education should be extended to traditional healers. Government through public health institutions should mobilize health educators and organize workshops to educate the traditional healers about tuberculosis. The referral system should be improved- that is, via these organized workshops. The traditional healers need to be conversant with early signs and symptoms of tuberculosis for early referral to the appropriate health institutions. Key words: Tuberculosis, perception, tuberculosis health education, referral system.

A cross-sectional study of sputum handling by and supervision of patients with pulmonary tuberculosis treated at home in China

Disposal of sputum from patients with pulmonary tuberculosis (TB) who are treated at home is an important aspect of preventing the spread of TB. However, few studies have examined disposal of sputum by patients with TB who are treated at home. Patients with pulmonary TB who are treated at home were surveyed regarding sputum handling and supervision. A cross-sectional survey of a representative sample of patients with pulmonary TB who are treated at home was conducted in Shandong Province. Participants were individuals with TB who had been registered with a local agency responsible for TB control. Participants completed a questionnaire with both qualitative and quantitative questions. How sputum was handled was determined and factors associated with sputum disposal were analyzed using a non-parametric test, logistic regression, and content analysis. Responses were received from 720 participants. Patients expectorated sputum 4.56 ± 10.367 times a day, and 68.6% of patients responded that they correctly disposed of their sputum. Supervision as part of TB control focused on the efforts of health agencies and paid little attention to waste management by patients. A non-parametric test showed that sputum disposal was significantly associated with gender, age, education, sputum smear results, attitudes toward waste management, and attitudes toward supervision (all p < 0.05). Logistic regression analysis showed that gender (OR = 0.482, 95% CI: 0.329-0.704), sputum smear results (OR = 1.300, 95% CI: 1.037-1.629), and level of education (OR = 0.685, 95% CI: 0.528-0.889) were associated with receipt of TB health education (all p < 0.05). Sputum handling by and supervision of patients with pulmonary TB who are treated at home is severely wanting. From a policy perspective, special attention should be given to the definition, details, and methods of supervision of waste management by patients with TB to give them relevant health education and enhance their willingness to be supervised. A financial incentive should be provided to health workers supervising management of TB-related waste.