Knowledge, attitudes, and practices related to TB among the general population of Ethiopia: Findings from a national cross-sectional survey
Autoři:
Daniel G. Datiko aff001; Dereje Habte aff001; Degu Jerene aff001; Pedro Suarez aff002
Působiště autorů:
Challenge TB and Management Sciences for Health, Addis Ababa, Ethiopia
aff001; Management Sciences for Health, Infectious Diseases Cluster, Arlington, Virginia, United States of America
aff002
Vyšlo v časopise:
PLoS ONE 14(10)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0224196
Souhrn
Introduction
Ethiopia is among the high-burden countries for tuberculosis (TB), TB/HIV, and drug-resistant TB. The aim of this nationwide study was to better understand TB-related knowledge, attitudes, and practices (KAPs) and generate evidence for policy and decision-making.
Materials and methods
We conducted a cross-sectional TB KAP survey in seven regions and two city administrations of Ethiopia. Eighty kebeles (wards) and 40 health centers were randomly selected for the study. Using systematic sampling, 22 households and 11 TB patients were enrolled from each selected village and health center, respectively. Variables with a value of p = < 0.25 were included in the model for logistic regression analysis.
Results
Of 3,503 participants, 884 (24.4%), 836 (24.1%), and 1,783 (51.5%) were TB patients, families of TB patients, and the general population, respectively. The mean age was 34.3 years, and 50% were women. Forty-six percent were heads of households, 32.1% were illiterate, 20.3% were farmers, and 19.8% were from the lowest quintile. The majority (95.5%) had heard about TB, but only 25.8% knew that TB is caused by bacteria. Cough or sneezing was reported as the commonest means of TB transmission. The majority (85.3%) knew that TB could be cured. Men, better-educated people, and TB patients and their families have higher knowledge scores. Of 2,483 participants, 96% reported that they would go to public health facilities if they developed TB symptoms.
Discussion
Most Ethiopians have a high level of awareness about TB and seek care in public health facilities, and communities are generally supportive. Inadequate knowledge about TB transmission, limited engagement of community health workers, and low preference for using community health workers were the key challenges.
Conclusions
Given misconceptions about TB’s causes, low preference for use of community health workers, and inadequate engagement, targeted health education interventions are required to improve TB services.
Klíčová slova:
Patients – Tuberculosis – Public and occupational health – Socioeconomic aspects of health – Extensively drug-resistant tuberculosis – Health education and awareness – Ethiopia – Coughing
Zdroje
1. World Health Organization (WHO). Global tuberculosis report 2018. Geneva, Switzerland: WHO; 2018.
2. Jackson S, Sleigh AC, Wang GJ, Liu XL. Poverty and the economic effects of TB in rural China. Int J Tuberc Lung Dis. 2006 Oct;10:1104–10. 17044202
3. Muniyandi M, Ramachandran R, Gopi PG, Chandrasekaran V, Subramani R, Sadacharam K, et al. The prevalence of tuberculosis in different economic strata: a community survey from South India. Int J Tuberc Lung Dis. 2007 Sep;11(9):1042–45. 17705985
4. Marais BJ, Hesseling AC, Cotton MF. Poverty and tuberculosis: is it truly a simple inverse linear correlation? Eur Respir J. 2009 Apr;33(4):943–44. doi: 10.1183/09031936.00173608 19336600
5. Davies PD. The world-wide increase in tuberculosis: how demographic changes, HIV infection and increasing numbers in poverty are increasing tuberculosis. Ann Med. 2003;35(4):235–43. doi: 10.1080/07853890310005713 12846265
6. Elender F, Bentham G, Langford I. Tuberculosis mortality in England and Wales during 1982–1992: its association with poverty, ethnicity and AIDS. Soc Sci Med. 1998 Mar;46(6):673–81. doi: 10.1016/s0277-9536(97)00178-0 9522427
7. Carter DJ, Glaziou P, Lonnroth K, Siroka A, Floyd K, Weil D, et al. The impact of social protection and poverty elimination on global tuberculosis incidence: a statistical modelling analysis of Sustainable Development Goal 1. Lancet Glob Health. 2018 May;6(5):e514–e22. doi: 10.1016/S2214-109X(18)30195-5 29580761
8. Saunders MJ, Evans CA. Fighting poverty to prevent tuberculosis. Lancet Infect Dis. 2016 Apr;16(4):395–6. doi: 10.1016/S1473-3099(15)00434-X 26725447
9. Barter DM, Agboola SO, Murray MB, Barnighausen T. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa: a systematic review. BMC Public Health. 2012 Nov 14;12:980. doi: 10.1186/1471-2458-12-980 23150901
10. Juniarti N, Evans D. A qualitative review: the stigma of tuberculosis. J Clin Nurs. 2011 Jul;20(13–14):1961–70. doi: 10.1111/j.1365-2702.2010.03516.x 21040040
11. Daftary A. HIV and tuberculosis: the construction and management of double stigma. Soc Sci Med. 2012 May;74(10):1512–9. doi: 10.1016/j.socscimed.2012.01.027 22444460
12. Sommerland N, Wouters E, Mitchell EMH, Ngicho M, Redwood L, Masquillier C, et al. Evidence-based interventions to reduce tuberculosis stigma: a systematic review. Int J Tuberc Lung Dis. 2017 Nov 1;21(11):81–86. doi: 10.5588/ijtld.16.0788 29025489
13. Cambanis A, Yassin MA, Ramsay A, Bertel Squire S, Arbide I, Cuevas LE. Rural poverty and delayed presentation to tuberculosis services in Ethiopia. Trop Med Int Health. 2005 Apr;10(4):330–35. doi: 10.1111/j.1365-3156.2005.01393.x 15807796
14. Johansson E, Long NH, Diwan VK, Winkvist A. Gender and tuberculosis control: perspectives on health seeking behaviour among men and women in Vietnam. Health Policy. 2000 May;52(1):33–51. 10899643
15. Kasse Y, Jasseh M, Corrah T, Donkor SA, Antonnio M, Jallow A, et al. Health seeking behaviour, health system experience and tuberculosis case finding in Gambians with cough. BMC Public Health. 2006 Jun 5;6:143. doi: 10.1186/1471-2458-6-143 16753057
16. Abebe G, Deribew A, Apers L, Woldemichael K, Shiffa J, Tesfaye M, et al. Knowledge, health seeking behavior and perceived stigma towards tuberculosis among tuberculosis suspects in a rural community in southwest Ethiopia. PLoS One. 2010 Oct 11;5(10):e13339. doi: 10.1371/journal.pone.0013339 20948963
17. Musuka G, Teveredzi V, Mutenherwa F, Chingombe I, Mapingure M. Tuberculosis knowledge, misconceptions/myths in adults: findings from Lesotho, Malawi, Namibia and Zambia Demographic Health Surveys (2013–2016). BMC Res Notes. 2018 Oct 31;11(1):778. doi: 10.1186/s13104-018-3884-6 30382927
18. Chang SH, Cataldo JK. A systematic review of global cultural variations in knowledge, attitudes and health responses to tuberculosis stigma. Int J Tuberc Lung Dis. 2014 Feb;18(2):168–73, i-iv. doi: 10.5588/ijtld.13.0181 24429308
19. Agho KE, Hall J, Ewald B. Determinants of the knowledge of and attitude towards tuberculosis in Nigeria. J Health Popul Nutr. 2014 Sep;32(3):520–38. 25395915
20. Wandwalo ER, Morkve O. Knowledge of disease and treatment among tuberculosis patients in Mwanza, Tanzania. Int J Tuberc Lung Dis. 2000 Nov;4(11):1041–46. 11092716
21. Ottmani S, Obermeyer Z, Bencheikh N, Mahjour J. Knowledge, attitudes and beliefs about tuberculosis in urban Morocco. East Mediterr Health J. 2008 Mar-Apr;14(2):298–304. 18561721
22. Haasnoot PJ, Boeting TE, Kuney MO, van Roosmalen J. Knowledge, attitudes, and practice of tuberculosis among Maasai in Simanjiro district, Tanzania. Am J Trop Med Hyg. 2010 Oct;83(4):902–5. doi: 10.4269/ajtmh.2010.10-0061 20889888
23. Bati J, Legesse M, Medhin G. Community's knowledge, attitudes and practices about tuberculosis in Itang Special District, Gambella Region, South Western Ethiopia. BMC Public Health. 2013 Aug 7;13:734. doi: 10.1186/1471-2458-13-734 23924362
24. Tadesse S. Stigma against Tuberculosis Patients in Addis Ababa, Ethiopia. PloS One. 2016 Apr 7;11(4):e0152900. doi: 10.1371/journal.pone.0152900 27054714
25. Yassin MA, Datiko DG, Tulloch O, Markos P, Aschalew M, Shargie EB, et al. Innovative community-based approaches doubled tuberculosis case notification and improve treatment outcome in Southern Ethiopia. PloS One. 2013 May 27;8(5):e63174. doi: 10.1371/journal.pone.0063174 23723975
26. Fekadu L, Hanson C, Osberg M, Makayova J, Mingkwan P, Chin D. Increasing access to tuberculosis services in Ethiopia: findings from a patient-pathway analysis. J Infect Dis. 2017 Nov 6;216(suppl_7):S696–S701. doi: 10.1093/infdis/jix378 29117346
27. 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 Apr;88(4):785–8. doi: 10.4269/ajtmh.12-0312 23419364
28. Tolossa D, Medhin G, Legesse M. Community knowledge, attitude, and practices towards tuberculosis in Shinile town, Somali regional state, eastern Ethiopia: a cross-sectional study. BMC Public Health. 2014 Aug 7;14:804. doi: 10.1186/1471-2458-14-804 25099209
29. Central Statistical Agency [Ethiopia] and ICF International. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia, and Calverton [MD], USA: Central Statistical Agency and ICF International; 2012.
30. WHO and Stop TB Partnership. Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys. Geneva, Switzerland; 2008.
31. Samal J. Health seeking behaviour among tuberculosis patients in India: a systematic review. J Clin Diagn Res. 2016 Oct;10(10):LE01–LE06. doi: 10.7860/JCDR/2016/19678.8598 27891362
32. Hassan AO, Olukolade R, Ogbuji QC, Afolabi S, Okwuonye LC, Kusimo OC, et al. Knowledge about tuberculosis: a precursor to effective TB control-findings from a follow-up national KAP study on tuberculosis among Nigerians. Tuberc Res Treat. 2017;2017:6309092. doi: 10.1155/2017/6309092 29075531
33. Tobin EA, Okojie PW, Isah EC. Community knowledge and attitude to pulmonary tuberculosis in rural Edo state, Nigeria. Ann Afr Med. 2013 Jul-Sep;12(3):148–54. doi: 10.4103/1596-3519.117623 24005586
34. Obuku EA, Meynell C, Kiboss-Kyeyune J, Blankley S, Atuhairwe C, Nabankema E, et al. Socio-demographic determinants and prevalence of tuberculosis knowledge in three slum populations of Uganda. BMC Public Health. 2012 Jul 23;12:536. doi: 10.1186/1471-2458-12-536 22824498
35. Paul S, Akter R, Aftab A, Khan AM, Barua M, Islam S, et al. Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh. BMC Public Health. 2015 Jan 31;15:52. doi: 10.1186/s12889-015-1390-5 25636624
36. Tasnim S, Rahman A, Hoque FM. Patient's knowledge and attitude towards tuberculosis in an urban setting. Pulm Med. 2012;2012:352850. doi: 10.1155/2012/352850 23346396
37. Mushtaq MU, Shahid U, Abdullah HM, Saeed A, Omer F, Shad MA, et al. Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan's Punjab province. Int J Equity Health. 2011 Feb 4;10:8. doi: 10.1186/1475-9276-10-8 21294873
38. Mekhtiev AK. [Knowledge of the urban and rural population with regard to tuberculosis]. Probl Tuberk. 1990;(3):51–54. 2142299
39. Wakabi W. Extension workers drive Ethiopia's primary health care. Lancet. 2008 Sep 13;372(9642):880. doi: 10.1016/s0140-6736(08)61381-1 18795419
40. Fetene N, Linnander E, Fekadu B, Alemu H, Omer H, Canavan M, et al. The Ethiopian Health Extension Program and variation in health systems performance: what matters? PloS One. 2016 May 26;11(5):e0156438. doi: 10.1371/journal.pone.0156438 27227972
41. Datiko DG, Lindtjorn B. Health extension workers improve tuberculosis case detection and treatment success in southern Ethiopia: a community randomized trial. PloS One. 2009;4(5):e5443. doi: 10.1371/journal.pone.0005443 19424460
42. Datiko DG, Yassin MA, Theobald SJ, Blok L, Suvanand S, Creswell J, et al. Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study. BMJ Glob Health. 2017 Nov 2;2(4):e000390. doi: 10.1136/bmjgh-2017-000390 29209537
43. Datiko DG, Yassin MA, Theobald SJ, Cuevas LE. A community-based isoniazid preventive therapy for the prevention of childhood tuberculosis in Ethiopia. Int J Tuberc Lung Dis. 2017 Sep 1;21(9):1002–7. doi: 10.5588/ijtld.16.0471 28826449
44. Hoa NP, Chuc NT, Thorson A. Knowledge, attitudes, and practices about tuberculosis and choice of communication channels in a rural community in Vietnam. Health Policy. 2009 Apr;90(1):8–12. doi: 10.1016/j.healthpol.2008.08.006 18835056
45. Gelaw SM. Socioeconomic factors associated with knowledge on tuberculosis among adults in Ethiopia. Tuberc Res Treat. 2016;2016:6207457. doi: 10.1155/2016/6207457 26949546
46. Hossain S, Zaman K, Quaiyum A, Banu S, Husain A, Islam A, et al. Factors associated with poor knowledge among adults on tuberculosis in Bangladesh: results from a nationwide survey. J Health Popul Nutr. 2015 May 1;34:2. doi: 10.1186/s41043-015-0002-4 26825614
47. Gelaw M, Genebo T, Dejene A, Lemma E, Eyob G. Attitude and social consequences of tuberculosis in Addis Ababa, Ethiopia. East Afr Med J. 2001 Jul;78(7):382–88. doi: 10.4314/eamj.v78i7.9014 11957266
48. Buregyeya E, Kulane A, Colebunders R, Wajja A, Kiguli J, Mayanja H, et al. Tuberculosis knowledge, attitudes and health-seeking behaviour in rural Uganda. Int J Tuberc Lung Dis. 2011 Jul;15(7):938–42. doi: 10.5588/ijtld.10.0211 21682968
49. Ige OM, Lasebikan VO. Prevalence of depression in tuberculosis patients in comparison with non-tuberculosis family contacts visiting the DOTS clinic in a Nigerian tertiary care hospital and its correlation with disease pattern. Ment Health Fam Med. 2011 Dec;8(4):235–41. 23205064
50. Daftary A, Padayatchi N. Social constraints to TB/HIV healthcare: accounts from coinfected patients in South Africa. AIDS Care. 2012;24(12):1480–6. doi: 10.1080/09540121.2012.672719 22530855
51. Zolowere D, Manda K, Panulo B Jr., Muula AS. Experiences of self-disclosure among tuberculosis patients in rural Southern Malawi. Rural Remote Health. 2008 Oct-Dec;8(4):1037. 19072002
52. Baral SC, Karki DK, Newell JN. Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study. BMC Public Health. 2007 Aug 16;7:211. doi: 10.1186/1471-2458-7-211 17705841
53. Amo-Adjei J. Individual, household and community level factors associated with keeping tuberculosis status secret in Ghana. BMC Public Health. 2016 Nov 25;16(1):1196. doi: 10.1186/s12889-016-3842-y 27887600
54. Kuyinu YA, Adeyeye OO, Goodman OO, Odusanya OO. Knowledge of tuberculosis and self disclosure amongst patients accessing treatment in an urban local government area, Lagos, South West Nigeria. Journal of Community Medicine and Primary Health Care. 2016;28(2):34–39.
55. Deribew A, Abebe G, Apers L, Jira C, Tesfaye M, Shifa J, et al. Prejudice and misconceptions about tuberculosis and HIV in rural and urban communities in Ethiopia: a challenge for the TB/HIV control program. 2010 Jul 6;10:400. doi: 10.1186/1471-2458-10-400. 20604951
Článok vyšiel v časopise
PLOS One
2019 Číslo 10
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Eliquis (apixaban) nově hrazen ze zdravotního pojištění
Najčítanejšie v tomto čísle
- Correction: Low dose naltrexone: Effects on medication in rheumatoid and seropositive arthritis. A nationwide register-based controlled quasi-experimental before-after study
- Combining CDK4/6 inhibitors ribociclib and palbociclib with cytotoxic agents does not enhance cytotoxicity
- Risk factors associated with IgA vasculitis with nephritis (Henoch–Schönlein purpura nephritis) progressing to unfavorable outcomes: A meta-analysis
- Prevalence of pectus excavatum (PE), pectus carinatum (PC), tracheal hypoplasia, thoracic spine deformities and lateral heart displacement in thoracic radiographs of screw-tailed brachycephalic dogs