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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 2  |  Page : 76-78

The knowledge, attitude, and practices relating to tuberculosis among drug-resistant tuberculosis patients


Division of Epidemiology, National Centre for Disease Control, New Delhi, India

Date of Submission12-Nov-2018
Date of Decision01-Feb-2019
Date of Acceptance13-Mar-2018
Date of Web Publication10-Apr-2019

Correspondence Address:
Dr. Kevisetuo Anthony Dzeyie
Epidemiology and Disease Control Complex, National Centre for Disease Control, 22 Sham Nath Marg, Civil Lines-54, New Delhi - 110 054
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_31_18

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  Abstract 


Introduction: A tuberculosis patient infects several healthy people prior to the diagnosis and initiation of treatment. Indiscriminate spitting in the community has been identified as a challenge to the prevention of tuberculosis; however, knowledge is still limited in terms of actual practices. Methodology: We conducted a descriptive cross-sectional study at a tertiary care hospital to evaluate knowledge, attitude, and practices relating to tuberculosis by interviewing patients of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis using a semi-structured questionnaire. We evaluated knowledge of tuberculosis on etiology, mode of spread, treatment factors, attitudes on the importance the respondent attributed to the factor and practices on adherence to treatment, and hygiene for the prevention of spread including safe sputum disposal. Results: We enrolled 250 patients (165 males) with a mean age of 29 ± 11 (mean ± standard deviation) years. On knowledge of tuberculosis, most of the patients had correct knowledge regarding tuberculosis symptoms (241, 96%), mode of spread (235, 94%), and correct duration of treatments 246 (98%) for drug sensitive tuberculosis. On attitude, all the patients consider adherence to their prescribed anti-tubercular treatment, 246 (98%) on covering mouth while coughing or sneezing and 239 (96%) on safe disposal of sputum as important. However, only 45 (18%) reported practicing correct sputum disposal and 66 (26%) patients reported disposing of their sputum in the open. Conclusion: This study suggests that despite good knowledge and attitude, there is a lack in practice of safe disposal of sputum by tuberculosis patients. Efforts toward sensitization regarding safe disposal of sputum need to be strengthened.

Keywords: Attitude, India, knowledge, practice, tuberculosis


How to cite this article:
Dzeyie KA, Basu S, Dikid T. The knowledge, attitude, and practices relating to tuberculosis among drug-resistant tuberculosis patients. Indian J Med Spec 2019;10:76-8

How to cite this URL:
Dzeyie KA, Basu S, Dikid T. The knowledge, attitude, and practices relating to tuberculosis among drug-resistant tuberculosis patients. Indian J Med Spec [serial online] 2019 [cited 2019 Aug 19];10:76-8. Available from: http://www.ijms.in/text.asp?2019/10/2/76/255797




  Introduction Top


The emergence of drug-resistant tuberculosis (DR-tuberculosis) is a worldwide problem. India has the highest absolute burden (2.8 million) of tuberculosis and multidrug-resistant (MDR) tuberculosis (0.13 million) patients in the world.[1] A tuberculosis patient can infect several people prior to the diagnosis and initiation of treatment through droplet nuclei by coughing or sneezing.[2],[3] Practices like covering of mouth before coughing/sneezing along with safe disposal of sputum can prevent spread of tuberculosis.[4] Moreover, safe disposal of sputum can significantly reduce the spread of disease.[5] Knowledge and perception of contact susceptibility to droplet infection in tuberculosis patients is known to establish their behavior and determine the quantum of incidence and level of transmission in the contacts.[3] A study done in Namibia has shown that knowledge regarding tuberculosis and its treatment are significantly associated with high rates of default in tuberculosis patients.[6] Imparting health education relating to safe sputum disposal among tuberculosis patients is recommended by the tuberculosis control program in India.[7] The estimation of the knowledge, attitude, and practices (KAP) relating to tuberculosis in tuberculosis patients provides valuable information regarding functioning of the tuberculosis control program. Patients of DR-tuberculosis admitted in health facilities for initiation of treatment represent a vital cohort since most DR-tuberculosis patients have previously undergone treatment for tuberculosis and often multiple times. Indiscriminate spitting in the community has been identified as a challenge to prevention of tuberculosis; however, knowledge is still limited in terms of actual practices. We conducted the present study with the objective of evaluating the knowledge, attitude, and practices relating to tuberculosis among these patients.


  Methodology Top


We conducted a descriptive cross-sectional study during the period from July to November 2013 at Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), New Delhi, India. All patients diagnosed with MDR-tuberculosis and extensively drug-resistant-tuberculosis admitted for the initiation of treatment were enrolled and interviewed using a semi-structured questionnaire. The KAP study variables included knowledge of tuberculosis (etiology, mode of spread, and treatment factors), attitude, and practices on adherence to treatment, hygiene for the prevention of spread. The attitude to tuberculosis was judged on the importance that the respondent attributed to the factor or behavior on a five-item rating scale ranging from “don't know, not important, somewhat important, important, and very important” designed by the researcher for this study. In this study, safe sputum disposal was defined as pouring boiling water into the sputum container or spitting in a bactericidal container (containers with 5% phenol/sodium hypochlorite) or spitting on a paper and burning it. Unsafe sputum disposal practices were defined as spitting indiscriminately, spitting in an open drain, spitting in container and then discarding it in the garbage, spitting in a public dustbin.

The data were entered and analyzed using Epi Info 7.2 (Software of Centers for Disease Control and Prevention, Atlanta, USA) and the results expressed in frequency, proportions, mean, and standard deviation.

The ethics approval for the study was obtained from the National Centre for Disease Control, New Delhi and the same was approved by the hospital authority of RBIPMT. Written and informed consent in adults and assent in minors was obtained from all the patients before their enrolment in the study.


  Results Top


We enrolled a total of 250 patients (165 male) with a mean age of 29 ± 11 (mean ± standard deviation) years. There were 47 (19%) patients illiterate, 70 (28%) educated below high school, and 133 (53%) who had a high school degree or higher educational status.

Regarding knowledge of tuberculosis, 241 (96%) patients identified fever of prolonged period and cough >2 weeks as main symptoms for suspecting someone as having tuberculosis. There were 157 (63%) patients who were aware that tuberculosis is caused by a germ; although, 92 (37%) were unaware of the exact cause of tuberculosis. On the spread of tuberculosis, 235 (94%) were aware that tuberculosis can spread from one person to another through close contact by coughing and sneezing. There were 246 (98%) who knew about the correct duration of treatment for drug-sensitive tuberculosis, 227 (91%) affirmed that tuberculosis is curable and 248 (99%) responded that complete treatment duration is required for cure of tuberculosis [Table 1].
Table 1: Knowledge of etiology, spread, and treatment of tuberculosis among patients with drug-resistant tuberculosis (n=250)

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Regarding attitude to tuberculosis, there were 225 (90%) patients who considered important to very important, 20 (8%) somewhat important and 5 (2%) don't know regarding taking meals on time and tuberculosis, 250 (100%) on adherence to their prescribed anti-tubercular treatment, 246 (98%) on covering mouth while coughing or sneezing, and 239 (96%) on properly disposing sputum.

On assessing the common practices, 243 (97%) reported covering their mouth most of the time while coughing and 230 (92%) reported making effort to take complete and regular treatment. Only 45 (18%) patients reported practicing correct disposal of sputum. Ninety-two (37%) of them used open drain, 85 (34%) used spit box, 72 (29%) used washbasin, and 64 (26%) used waste bin to dispose off their sputum. However, 66 (26%) were spitting in open, whereas 17 (7%) did not maintain any particular place for sputum disposal. To prevent the spread of tuberculosis to their contacts, almost all (98%) of the patients reported covering their mouth during coughing and sneezing while a quarter resided in separate rooms. Keeping away from the children of the household was reported by 7.2% of patients [Figure 1].
Figure 1: Common practices for prevention of spread of tuberculosis among drug resistant-tuberculosis patients, Delhi (n = 250)

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  Discussion Top


The study assessed the knowledge, attitude, and practices relating to tuberculosis among drug-resistant tuberculosis patients. The study found that the knowledge and attitude regarding tuberculosis was high. However, safe methods for disposal of sputum were not widely practiced.

Almost all the patients in our study were aware that tuberculosis can be spread from one person to another through close contact by means of cough/sneezing. The higher knowledge of tuberculosis in this study in contrast to the studies done at Namibia and Ethiopia could be due to the study population that comprised patients of drug-resistant tuberculosis most of whom would have received previous treatment and counseled relating to tuberculosis management from their health-care providers.[6],[8]

Almost all the participants considered it important the methods that are necessary for prevention of contracting tuberculosis, spread and treatment of tuberculosis-like covering mouth while coughing or sneezing and proper disposal of sputum. However, nearly 4/5th of the patients reported following unsafe disposal of sputum. A third of the patients were spitting in open and not maintaining any particular place for sputum disposal. Similar practices to unsafe disposal of sputum among DR-tuberculosis patients were reported in studies done at Ahmedabad and Kolkata in India.[9],[10] A study in South India reported safe disposal of sputum by half of the registered directly observed treatment short-course patients with almost a third of the patients spitting in the recommended bactericidal containers.[11]


  Conclusion Top


Our findings suggest that knowledge is not enough when it comes to safe disposal of sputum by tuberculosis patients. It is, thus, important for health-care providers managing tuberculosis patients to repeatedly emphasize the need to properly dispose sputum and explain the multiple valid methods for doing so. Future studies should assess the barriers and challenges against proper disposal of sputum in tuberculosis patients and further design and evaluate cost-effective interventions for promoting safe sputum disposal.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Global Tuberculosis Report 2016. Geneva: World Health Organization; 2016.  Back to cited text no. 1
    
2.
Singla N, Singla R, Jain G, Habib L, Behera D. Tuberculosis among household contacts of multidrug-resistant tuberculosis patients in Delhi, India. Int J Tuberc Lung Dis 2011;15:1326-30.  Back to cited text no. 2
    
3.
Yang S, Lee GW, Chen CM, Wu CC, Yu KP. The size and concentration of droplets generated by coughing in human subjects. J Aerosol Med 2007;20:484-94.  Back to cited text no. 3
    
4.
World Health Organization. Tuberculosis. Blood Safety and Clinical Technology: Guideline on Standard Operating Procedures on Microbiology. Ch. 17. Geneva, Switzerland: World Health Organization; 2007.  Back to cited text no. 4
    
5.
Lala Ram Sarup Institute. Minutes of the 3rd Meeting of National Airborne Infection Control Committee, 2009. New Delhi, India: LRS Institute; 2009.  Back to cited text no. 5
    
6.
Ricks PM, Mavhunga F, Modi S, Indongo R, Zezai A, Lambert LA, et al. Characteristics of multidrug-resistant tuberculosis in Namibia. BMC Infect Dis 2012;12:385.  Back to cited text no. 6
    
7.
Revised National Tuberculosis Control Programme. National Strategic Plan for Tuberculosis Elimination 2017-2025. New Delhi, India: Central TUBERCULOSIS Division, Directorate General of Health Services. Government of India; 2017.  Back to cited text no. 7
    
8.
Esmael A, Ali I, Agonafir M, Desale A, Yaregal Z, Desta K. Assessment of patients' knowledge, attitude, and practice regarding pulmonary tuberculosis in Eastern Amhara regional state, Ethiopia: Cross-sectional study. Am J Trop Med Hyg 2013;88:785-8.  Back to cited text no. 8
    
9.
Bhatt G, Vyas S, Trivedil K. An epidemiological study of multi drug resistant tuberculosis cases registered under revised national tuberculosis control programme of Ahmedabad city. Indian J Tuberc 2012;59:18-27.  Back to cited text no. 9
    
10.
Bhattacharyya K, Rama R, Mitra SP, Bhattacharyya SK, Sarkar T, Dasgupta U, et al. Perceptions and practices of sputum-positive pulmonary tuberculosis patients regarding their disease and its management. NTI Bull 2005;41:11-7.  Back to cited text no. 10
    
11.
Rekha T, Singh P, Unnikrishnan B, Prasanna Mithra P, Kumar N, Prasad KD, et al. Sputum collection and disposal among pulmonary tuberculosis patients in coastal South India. Int J Tuberc Lung Dis 2013;17:621-3.  Back to cited text no. 11
    


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  [Table 1], [Table 1]



 

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