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Tuberculosis: Awareness about spread and control

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 TUBERCULOSIS 1

ORIGINAL PROF-1366

TUBERCULOSIS;
AWARENESS ABOUT SPREAD AND CONTROL.

DR. AFTAB ANJUM, MBBS, MCPS, FCPS DR. SEEMA DAUD, MBBS, MCPS, FCPS
Assistant Professor Professor
LMDC, Lahore
DR. FATIMA MUKHTAR, MBBS, DTM & H
Senior Lecturer

Article Citation:
Aftab Anjum, Seema Daud, Fatima Mukhtar. Tuberculosis; awareness about spread and control. Professional Med J Mar 2009; 16(1): 61-66.

ABSTRACT... Objective: To assess the awareness about spread and control of Tuberculosis amongst people presenting at Ghurki Trust
Hospital, Lahore. Design: A cross-sectional survey. Place of study: Lahore Medical and Dental College (LMDC), Lahore, Period: From
November and December 2006. Methodology: A cross-sectional survey was conducted among people presenting at Ghurki Trust Hospital,
Lahore, between November and December 2006. A structured questionnaire was used to collect the data. Descriptive statistics were
determined in terms of percentages. Results: In the present study, 82% respondents did not know the correct mode of transmission of
tuberculosis. Correct modes of transmission including coughing, sneezing, spitting and breathing air were mentioned only by 18%. A large
proportion of respondents (76%) knew that tuberculosis presents as cough lasting more than three (3) weeks and having prolonged fever
(68%). Fifty percent of respondents said that government health facilities are the best places for the treatment of TB. Twenty three percent
(23%) of respondent mentioned use of medicine as a method of management and treatment. Improving sanitation and nutrition was
mentioned to prevent and control TB by respondents in almost equal percentage (20% & 18%). Conclusion: Poor knowledge and
misconceptions concerning tuberculosis are rampant in Pakistani patients. Poor knowledge of TB patients concerning their disease may
contribute to the high burden of TB disease in the country.

Key words: Tuberculosis, modes of transmission, coughing, prolonged fever, government health facilities.

INTRODUCTION TB has been prevalent in Pakistan Current focus of

Tuberculosis (TB) is one of the most serious health National TB Control Programme used Directly Observed
problems, as globally, around one third of the population Treatment Short Course (DOTS) to achieve and maintain
has been infected with Mycobacterium tuberculosis1. TB cure rate of over 85% and augmentation of case finding
is a major public health problem and according to World activities to detect at least 70% of estimated cases.
Health Organization, Pakistan ranks 6th in the countries
having high disease burden and contributes about 44% Achieving these goals requires active community
of tuberculosis burden in the Eastern Mediterranean participation by way of creating awareness on the
Region2. TB contributes 26% of avoidable deaths among etiology, symptomatology, management, preventive
adults and children in Pakistan3. According to WHO, the measures, and information of availability of services, etc,
incidence of sputum positive TB cases in Pakistan is
80/100,000 per year and for all types it is 177/100,000 Article received on:
Accepted for Publication:
06/06/2008
26/11/2008
and about 361,000 new cases of TB are added every Received after proof reading: 07/02/2009
Correspondence Address:
year in Pakistan4. TB is responsible for 5.1 percent of the Dr. A ftab A njum , MB B S , MCP S, FCPS
aftab_anjum _000@ yahoo.com
total national disease burden in Pakistan. The impact of 248 G-I, Johar Town, Lahore.
TB on socio economic status is substantial5.

Professional Med J Mar 2009; 16(1): 61-66. (www.theprofesional.com) 61

TUBERCULOSIS 2

for TB5. could help to reduce the social isolation suffered by

people with tuberculosis21. The need for renewed efforts
The propensity to seek care depends on knowledge in health education for the public, clarifying areas of
about and perceived risk of TB within reference groups misunderstandings about important and common
(families, neighborhood) and communities at large. As diseases like tuberculosis, in developing countries14. To
demonstrated in studies in Ethiopia6, India7, Mexico8, reduce the stigma caused by traditional beliefs and
Nigeria9, Pakistan10 and Thailand11, patients with low negative attitudes towards TB, basic knowledge about
knowledge about symptoms are more likely to postpone the cause and mode of transmission is necessary22,23. It
care-seeking and get tested. is also essential to disseminate information and interact
with the people for removing fear and stigma associated
Various studies have been done all over the world to with TB so that people can come forward for seeking
assess the knowledge regarding various aspects of TB care10.
including its symptoms, modes of spread, its
presentations and its management, treatment, control OBJECTIVES
and prevention. Many studies12,13,14,15 found good 1. To assess the awareness about spread and
awareness of the cure and symptoms of TB among the control of Tuberculosis amongst people
patients and had shown that majority of the participants presenting at Ghurki Trust Hospital, Lahore.
of these studies perceived TB as a curable disease. Yet 2. To formulate recommendation to improve
a few respondents12,16,17 in these studies considered awareness about Tuberculosis.
tuberculosis as dangerous and incurable. Urban
population had better knowledge about general and METHODOLOGY
diagnostic aspects of tuberculosis than the rural ones, A cross-sectional descriptive study was conducted
though both populations were poorly acquainted with its amongst people presenting at Ghurki Trust Hospital,
preventive aspects. Similarly, general knowledge about Lahore, between November and December 2006.
tuberculosis was poor in illiterate and low socio-economic Non–Probability Sampling Technique was used to recruit
population and high in literate and high socio-economic 50 respondents. A structured questionnaire was used to
group18. A study done on Pakistani patients found various collect data on the perceptions of general public about
misconceptions concerning TB. Lack of knowledge on cause, spread and prevention of Tuberculosis. Data was
Tuberculosis was alarming among its participants19. analyzed using SPSS version 10 and Descriptive
statistics was determined in terms of percentages.
Stigma and misinformation about TB are still major
barriers to TB screening and treatment in some RESULTS
countries. As many people do not consider themselves to Socio-demographic profile
be at risk, so the chances of identifying people before A large number of respondents (60%) belonged to age
they reach the infectious stage of active, smear-positive group 20-39 years. Sixty six percent of respondents were
TB are lessened. This in turn prevents a country from male and 34% were female. Regarding educational
containing its TB epidemic20. status, 52% of respondents were matriculate or above
and only 16% of respondents were illiterate. Fifteen out
People with TB often suffer from discrimination and of 17 females were housewives. Other respondents were
stigma, rejection and social isolation. The disease has a either in regular employment (22%), had a business
worldwide stigma, which adds to the suffering. (22%) or they were day laborers (12%). The rest of the 5
Scientifically unfounded beliefs about the transmission of respondents (10%) were land owners, students and
the disease are the main significant predictor of the unemployed. Two respondents did not give any response
instrumental function of this attitude. Health education on the question of their occupation. Monthly Family
and, arguably, more successful control programmes Income of 10% of respondents was less than Rs. 3,000,

Professional Med J Mar 2009; 16(1): 61-66. (www.theprofesional.com) 62

 TUBERCULOSIS 3

of 30% respondents was between Rs. 3,001 and 5,000, breathing and night sweats were mentioned by 38%,
of 18% respondents was between rs. 5,001 and 10,000 14% and 8% of respondents respectively. Other
and of 34% respondents more than Rs.10,000. Four responses (16%) included dietary problems, weakness,
respondents (8%) did not reveal their monthly Family back pain, skin color change and pain in shoulder.
Income.
Fig-1. Knowledge about modes of presentation
Perceptions about Modes of Spread of Tuberculosis of TB N=50 (M ultiple Responses)
Table I shows the perceptions of respondents regarding
spread of tuberculosis.

Most common modes of transmission mentioned were,

coughing and sneezing (42%), eating with a TB patient
(42%), drinking dirty water (34%), spitting sputum (24%),
Breathing air (22%)and touching each other (14%).

Table-I. Perceptions about Modes of Spread of

Tuberculosis N=50 (Multiple Responses)

Perceived modes of spread Frequency %age of

respondents

Coughing and sneezing 21 34%

Eating together 21 34%

Drinking dirty water 17 34%

Perceptions about the curability of TB
Spitting sputum 12 24% When asked whether TB can be cured, 100% of
respondents affirmed that TB is a curable disease.
Breathing air 11 22%

Touching each other 8 14% Places where Tuberculosis treated best

Mother to child transmission 4 8%
Respondents were asked about the most suitable places
during pregnancy and for the treatment of tuberculosis. Multiple responses
delivery were obtained as 25 respondents (50%) said that
Breast feeding 1 2%
government health facilities and private hospitals are the
best places, 5 respondents (10%) mentioned
Others 15 30% Sanatoriums and GP clinics were named by 3
respondents (6%).
Other responses by 30% of respondents included social
pressure, careless attitude, sexual contact, living in small Management and Treatment of TB
houses, blood transfusion, smoking, open food, genetics The respondents were asked about various methods of
and tension. management and treatment of TB. As seen in Table II,
23% of respondent mentioned use of medicine as a
Presentation of Tuberculosis method of management and treatment, followed by
Figure 1 show that a large proportion of respondents improving nutrition (14%), improved sanitation (14%),
(76%) knew that tuberculosis presents as cough lasting good ventilation (10%), vaccination (9%), and cessation
more than three (3) weeks and having prolonged fever of smoking (8%). Among other methods mentioned by
(68%). Blood in sputum, weight loss, difficulty in respondents included avoiding the sour food and yogurt,

Professional Med J Mar 2009; 16(1): 61-66. (www.theprofesional.com) 63

TUBERCULOSIS 4

taking rest, improving food intake, timely checkups, advised better sanitation, 9 respondents (18%)
improved patient hygiene and making patients happy. recommended improvement in nutrition, 7 respondents
(14%) advocated for vaccination, 6 respondents (12%)
Table-II. Management & Treatment of TB mentioned good ventilation and 5 respondents (10%)
N=50 (Multiple Responses)) suggested cessation of smoking. Thirty percent of
respondents presented other methods of control and
Methods Frequency %age prevention which included, good environment, awareness
about TB leading to its prevention, avoiding contact and
Use of medicine 18 23%
eating with TB patients, use of sterilized syringes,
Improving nutrition 11 14% preventing open spitting, isolating TB patients from
children and avoiding blood transfusion.
Improving sanitation 11 14%

Good ventilation 8 10%

DISCUSSION
In the present study, cough lasting more than 3 weeks
Vaccination 7 9% (76%), fever (68%) and haemoptysis (38%), difficulty in
Cessation of smoking 6 8% breathing (14%) have been observed to be the symptoms
of tuberculosis known to the people indicating a fairly
Others* 18 23% good level of knowledge. Uplekar24 and Subramanian25
have reported that cough, haemoptysis and fever were
known to 66%, 13%, 6% of individuals respectively. Croft
Fig-2. Prevention and Control of TB reported 44% individuals to be aware of cough as a
N=50 (M ultiple Responses)
symptom in Bangladesh26. The greater awareness of
these symptoms in the present study is encouraging and
may help to improve the passive case finding. However
the correct route of transmission i.e., via air by coughing,
sneezing, spitting was cited by only 18% of respondents
in the present study. Wrong perception, that TB is spread
by eating or drinking with or touching a TB patient, sexual
contact, blood transfusion needs to be addressed to
remove misconceptions and stigma attached with the
disease. The fallacies regarding TB, prevalent among
patients and in the community are multi-dimensional.
Popular myths about cause of TB are contribution of wet
weather and poor housing17 hard work, emotional
trauma/stress15,19, eating contaminated food15,28, sharing
food or utensils with those who have TB21,29 and
smoking19,21,28. People generally did not recognize the
enormous role of crowded and poorly ventilated places in
spreading TB21.

Similar results regarding perceived modes of prevention

Prevention and Control of TB of TB as found in other studies done in Pakistan and
Figure 2 depicts that when asked about prevention and world over were also observed in the present study. Most
control of TB, 18 respondents (36%) said that this can be popular preventive measure worldwide is separation of
achieved by use of medicines, 10 respondents (20%) utensils21,23 Other measures prevalent in all societies are

Professional Med J Mar 2009; 16(1): 61-66. (www.theprofesional.com) 64

 TUBERCULOSIS 5

keeping body and house clean, avoiding infected people, Report 2003; profiles of high-burden countries. WHO.
regular exercise, eating clean food, water, clean dishes, 2003.
eating healthy food, dusty air and stop smoking28,29 3 Directorate of Tuberculosis Control (1988); Report on
National Tuberculosis Prevalence 1987-1988. Ministry
In the present study, majority of individuals favored of Health, Islamabad: The Ministry, 1988.
treatment from government health facilities and private
hospitals. This finding indicates that DOTS if 4 Appraisal Mission Aide Memoire; Second Social Action
Programme Project, Islamabad. October 1997; 11,1997,
implemented effectively can achieve its targets of V-31.
detection of TB among symptomatic and their treatment.
Vaccination as a preventive measure against 5 National TB Control Programme, Ministry of Health,
tuberculosis was mentioned by only 9% of individuals. Government of Pakistan. http://www.ntp.gov.pk/about.htm.
However, the lack of knowledge did not reflect the actual
6 Gelaw, M.et al. Attitude and social consequences of
immunization status of the children, as 85% infants in the tuberculosis in Addis Ababa, Ethiopia, East African
country have received BCG vaccination27. Medical Journal 2001; 78 (7): 382-8.

CONCLUSIONS 7 Atre S.R. et al. Cultural concepts of tuberculosis and

The study concludes that poor knowledge and gender among the general population without
tuberculosis in rural Maharashtra, India. Tropical
misconceptions concerning tuberculosis are common in Medicine and InternationalHealth 2004; 9(11):1228-38.
Pakistani communities. This may be an obstacle in
effective cure, prevention and control of the disease. 8 Alvarez Gordillo GC et al. Seeking tuberculosis care in
Chiapas, Mexico. Revista Panamericana de Salud
RECOMMENDATIONS Pública 2001; 9 (5): 285-293.
1. Public awareness raising programmes should be 9 Enwuru, C.A. et al. Care-seeking behavioral patterns,
arranged using electronic and print media. awareness and diagnostic process in patients with
These programmes should particularly address smear- and culture-positive pulmonary tuberculosis in
the myths and various misconceptions regarding Lagos, Nigeria. Transactions of the Royal Society of
transmission of TB and its cure. Tropical Medicine and Hygiene 2002; 96 (6): 614-6.

10 Ali S. S et al. Tuberculosis: do we know enough? A

2. Health education booths should be set up in the study of patients and their families in an out-patient
waiting rooms, which provide counseling and hospital setting in Karachi, Pakistan. Internaional
advisory sessions on TB and distribute leaflets Journal of Tuberculosis and Lung Disease 7 (11):1052-
and pamphlets on various issues related with 1058.
TB. 11 Ngamvithayapong, J. et al. Health seeking behavior and
diagnosis for pulmonary tuberculosis in an hiv-
3. Billboards and posters containing health epidemic mountainous area of Thailand, International
messages should be displayed at various places Journal of Tuberculosis and Lung Disease 5 (11): 1013-
of hospitals. 1020.
Copyright© 26 Nov, 2008. 12. Majidpoor, A., Fooladi, N., Faghihzadeh, S. Evaluation of
awareness, attitude and practice of general population
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