Knowledge, Attitudes and Health-seeking behaviour among Patients with Tuberculosis: A Cross-sectional Study

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Abstract

Background:

South Africa is hugely overburdened with the cases of Tuberculosis (TB); individual’s lack of knowledge, attitude towards the disease and delays in health-seeking behaviour, are indirectly associated with death. This study assessed the knowledge, attitude and treatment of TB, and further examined the health-seeking behaviour of TB patients.

Methods:

This cross-sectional study involved 327 conveniently selected participants with TB from three community health centres in Nelson Mandela Bay Health District, Eastern Cape, South Africa. A close-ended questionnaire was used to collect demographic details, knowledge, attitude and health-seeking behaviour variables. Descriptive and multivariate logistic regression analyses were performed. Statistical significance was considered at alpha <0.05 and a confidence interval of 95%.

Results:

The majority of these TB patients indicated that cold air (76.5%), a dusty environment (85.9%), TB bacteria in the air (88.4%), and smoking (84.7%) had caused the disease. About 87.2% of the respondents indicated that TB treatment duration took six months or longer. Participants thought that follow-up sputum tests are an important part of TB treatment (70.6%); non-adherence to TB treatment might lead to drug-resistant TB or death (80%); TB disease could turn into HIV if not properly treated (77.4%) and that individuals with TB disease have HIV (59.9%). About 56.9% participants felt that TB treatment is difficult, takes a long time, is unpleasant, interferes with work or marriage, and people who drink and smoke are to blame for its spread (60.6%). The majority of the participants (74.0%) disagreed with TB being an African disease and 53.5% did not associate TB with poverty. The majority of the participants (92%) indicated that follow-ups at clinics were avoided because of stigmatisation. In the multivariate logistic regression analysis, the informal housing scheme was a statistically significant (p<0.05) factor determining the correct knowledge of TB (AOR=0.556; 95% CI: 0.316-0.977). There was a statistically significant association among TB knowledge, attitude and health-seeking behaviour.

Conclusion:

The participants generally had good knowledge about TB; however, there were misconceptions regarding its spread by cold air and dusty environments. The majority of participants did not attend follow-up TB treatment because of fear of stigmatisation. Formal settlements are associated with the correct knowledge of TB. Measures aimed at addressing the misconceptions about TB and its treatment are needed.

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Community knowledge, attitude, and practices towards tuberculosis in Shinile town, Somali regional state, eastern Ethiopia: a cross-sectional study

Daniel Tolossa, Girmay Medhin, Mengistu Legesse (2014)

Background Though tuberculosis (TB) is preventable and curable, its global burden remains enormous. Similarly, TB is one of the major public health problems in Ethiopia, particularly in geographically isolated areas like Shinile town. The people in Shinile town, Somali Regional State of Ethiopia, are underserved in all forms of health care and suffer from high burden of TB. Low level of knowledge about TB could affect the health-seeking behavior of patients and sustain the transmission of the disease within the community. Therefore, the current study was undertaken in Shinile town with the objective of assessing communities’ knowledge, attitude and practices towards TB. Methods Community-based cross-sectional survey, involving 410 randomly selected individuals, was conducted in Shinile town from January to May, 2013. Data were analyzed using STATA V.11. Logistic regression technique was used to determine the association between socio-demographic characteristics and communities’ knowledge of TB. Results While 94.9% of the respondents said that they ever heard about TB, only 22.9% knew that TB is caused by bacteria. Eighty percent have awareness that TB can be transmitted from a patient to another person and 79.3% know that transmission of TB can be preventable. Persistence cough (72.4%) was the most commonly stated symptom of TB and modern drugs used in health institutions (68.1%) was the preferred choice of treatment. Two hundred and ninety one respondents (71.0%) said that they would seek treatment at health facility if they realized that they had symptoms related to TB. Two hundred and twenty seven respondents (55.4%) considered TB as a very serious disease and 284 (69.3%) would experience fear if they themselves had TB. Individuals with educational level of grade 8 up to grade 12 had increased odds of having good level of overall TB knowledge compared to illiterate individuals (OR = 2.3; 95% CI: 1.2 to 4.6). Conclusion The communities in Shinile town have basic awareness about TB which is not translated into the knowledge about the cause of the disease. Therefore, health education directed towards bringing a significant change in the knowledge of TB must be stepped-up within the TB control program. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-804) contains supplementary material, which is available to authorized users.

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TB treatment initiation and adherence in a South African community influenced more by perceptions than by knowledge of tuberculosis

Jane Cramm, Harry Finkenflügel, Valerie Møller … (2010)

Background Tuberculosis (TB) is a global health concern. Inadequate case finding and case holding has been cited as major barrier to the control of TB. The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. The Eastern Cape is known as a province with high TB incidence, prevalence and with one of the worst cure rates of South Africa. Its inhabitants can be considered lay experts when it comes to TB. Therefore, we investigated knowledge, perceptions of (access to) TB treatment and adherence to treatment among an Eastern Cape population. Methods An area-stratified sampling design was applied. A total of 1020 households were selected randomly in proportion to the total number of households in each neighbourhood. Results TB knowledge can be considered fairly good among this community. Respondents' perceptions suggest that stigma may influence TB patients' decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Regression analyses revealed that in this population young and old, men and women and the lower and higher educated share the same attitudes and perceptions. Our findings are therefore likely to reflect the actual situation of TB patients in this population. Conclusions The lay experts' perceptions suggests that stigma appears to effect case holding and case finding. Future interventions should be directed at improving attitudes and perceptions to potentially reduce stigma. This requires a patient-centered approach to empower TB patients and active involvement in the development and implementation of stigma reduction programs.

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Why healthcare workers are sick of TB

Arne von Delft, Angela Dramowski, Celso Khosa … (2015)

Dr Thato Mosidi never expected to be diagnosed with tuberculosis (TB), despite widely prevalent exposure and very limited infection control measures. The life-threatening diagnosis of primary extensively drug-resistant TB (XDR-TB) came as an even greater shock. The inconvenient truth is that, rather than being protected, Dr Mosidi and thousands of her healthcare colleagues are at an increased risk of TB and especially drug-resistant TB. In this viewpoint paper we debunk the widely held false belief that healthcare workers are somehow immune to TB disease (TB-proof) and explore some of the key factors contributing to the pervasive stigmatization and subsequent non-disclosure of occupational TB. Our front-line workers are some of the first to suffer the consequences of a progressively more resistant and fatal TB epidemic, and urgent interventions are needed to ensure the safety and continued availability of these precious healthcare resources. These include the rapid development and scale-up of improved diagnostic and treatment options, strengthened infection control measures, and focused interventions to tackle stigma and discrimination in all its forms. We call our colleagues to action to protect themselves and those they care for.