International Journal of Community Medicine and Public Health Ram SA et al. Int J Community Med Public Health. 2020 Dec;7(12):4941-4946 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040
DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20205166
Original Research Article
A study on awareness on tuberculosis among
urban slum population of Hyderabad
Sai Ram A.1, Rama Krishna M. N.2*, Sunil Pal Singh C.2
1Kamineni Institute of Medical Sciences, Narkatpally, Nalgonda, Telangana, India 2Kamineni Academy of Medical Sciences and Research Centre, L B Nagar, Hyderabad, India Received: 28 August 2020 Revised: 28 October 2020 Accepted: 29 October 2020 *Correspondence: Dr. Rama Krishna M. N., E-mail: drrkmn@rediffmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT Background: Tuberculosis a major public health problem in India with highest burden of cases. India accounts for about 24% of global prevalence, 23% of the global incidence cases and 21% of global TB deaths. Irregular and inappropriate treatment of persons with active TB, unawareness about TB symptoms and treatment course, illiteracy, may be the major hurdles for TB eradication. Methods: A cross sectional, community based study was conducted in urban slum dwellers (n=153). Data compilation and analysis: All the data collected was entered and analyzed with MS excel software 2007 and Epi info 3.5.3. All tests were considered significant at p<0.05 level. Results: 18.3% told that cough+expectoration+evening rise of temperature+weight loss are the signs and symptoms of TB. 55.5% know that it spreads through cough and sneezing mixed with air. 23.5% knows blood examination, sputum examination, X-ray is the mode of diagnosis of TB. Conclusions: Literacy plays major role in creating awareness on TB. Keywords: Awareness, Diagnosis, Management of TB, Signs and symptoms, Tuberculosis
INTRODUCTION
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It remains a major public health problem in India with highest burden of cases.1 India accounts for about 24% of global prevalence, 23% of the global incidence cases and 21% of global TB deaths.2 Even though the organism was discovered a century ago and effective drugs and vaccine are available, it could not eradicated even today. As per the estimations one third of world population are infected asymptomatically with tuberculosis.3 After the discovery of AIDS the burden of Tuberculosis has been enormously increased as TB became an opportunistic infection in
persons suffering from AIDS.4 In India Tuberculosis is mainly a disease of the poor. The poor living conditions, malnutrition and overcrowding are the main reasons for the spread of the disease.5
Irregular and inappropriate treatment of persons with active TB, unawareness about TB symptoms and treatment course, illiteracy, may be the major hurdles for TB eradication. An attempt has been made to assess various causes for the highest burden of TB in urban areas by conducting a health survey.
Aim of the study was to assess the awareness of Tuberculosis among urban slum dwellers of Hyderabad.
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Objectives of the study was to assess the knowledge about the signs, symptoms, diagnosis, complications and treatment of TB among the study population and to study the factors associated with the level of awareness among the study population.
METHODS
A cross sectional, community-based study was done on 153 urban slum dwellers of urban slum areas under the field Practice areas of Department of Community medicine, KAMSRC. Study was conducted during November 2019 - December 2019 in two randomly selected slum areas.
Details of the study subjects were recorded using structural predesigned and pretested questionnaire. It includes socio-demographic variables (age, sex, address) and knowledge about the signs and symptoms, diagnosis, complications and treatment and prevention of TB.
An elder person per house during the time of survey were included in the study. One person per house hold was included. (Out of 200 households, 153 houses were surveyed as per the availability of the elder /head of the family)
Out of 08 urban slums under the field Practice areas of Department of Community medicine, 02 slums were randomly selected. At first urban slum areas selected for the study were thoroughly surveyed and number of houses were estimated. The urban slums selected for the study were RTC colony and Saraswathi Nagar.
The staff deployed for the survey were identified as two assistant professors from the department of Community Medicine, two ANMs and two health educators and three internees posted in the department of Community Medicine.
All the data collected was entered and analyzed with MS excel software 2007 and Epi info 3.5.3. All tests were considered significant at p<0.05 level.
Inclusion criteria
An elder person or those who are present in the house during the time of survey and those who gave oral consent were included in the study.
Exclusion criteria
Those who are not willing to participate in the study were excluded from the study.
Ethical clearance was taken from institutional ethical committee.
Study subjects were informed about the purpose of the study and have been explained in their language. Oral consent has been taken. To achieve our objective we contacted the local leaders of the slums, and took their help for smooth running of our survey.
A total of 25 questions were included in the scoring system. Each correct answer is awarded one mark. A score of >15/25 is considered good knowledge and <15/25 is considered as average knowledge
Table 1: Knowledge assessment questions.
RESULTS
A total number of 153 subjects were interviewed, out of which 87 (56.86%) are males and 66 (43.13%) are females. In that 22 are illiterates and the remaining 131 are educated and in that 41 are graduates and post graduates. When we look into the occupation, 61 are
unskilled, 55 are semi-skilled and 16 are skilled workers. Four are professionals and 16 are in semi-profession. (Table 2).
In our study, the knowledge about signs and symptoms, almost all the subjects know one are two signs and symptoms of TB. Out of 153, 48 people (31.4%) told that
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cough is the main symptom, 33 people (21,5%) told that cough with expectoration, 44 subjects (28.8%) told that cough + expectoration + evening rise of temperature, and the remaining 28 persons(18.3%) told that cough + expectoration + evening rise of temperature + weight loss will be there (Table 3).
In the present study, on mode of spread of TB, 85 subjects (55.5%), know that it spreads through cough & sneezing mixed with air. 29 subjects (18.9%) told that it spreads through direct contact and remaining 39 persons (25.5%) told that it spreads through food and utensils.
It has been found that knowledge of diagnosis of TB, 68 persons (44.4%) or of the opinion that it spreads through sputum examination, 49 subjects (32.1%) sputum + blood examination and the remaining 36 persons (23.5%) told that in addition to blood and sputum, x–ray is also necessary.
Table 2: Demographic profile of the of study
population.
The opinion of the subjects on treatment is, that 30 subjects (19.6%) told that Antibiotics are necessary, 33 persons (21.5%) in addition to Antibiotics, Anti- tubercular treatment (ATT) at DOTS Centre. 46 persons (30.1%) told that only ATT is necessary. 32 persons (20.9%) told about Homeopathy treatment and 12 persons (7.8%) about Ayurveda treatment.
On the knowledge of prevention of TB, about 23.5% told to avoid contact with TB patient, 20.2% about
immunization, 17.6% about regular and appropriate treatment, 14.4% about personal hygiene and remaining 18.3% told about good nutritional food regarding preventive measures of TB. Regarding complications, our study revealed that 60.1% people are of the opinion that it is life threatening. 29.4% people told that it spreads to other parts of body and 10.5% people said that it leads to infertility.
Table 3: Knowledge regarding signs and symptoms,
mode of spread and diagnosis of TB.
It was found that out of 153, 101 study population had good knowledge regarding signs and symptoms, 87 had good knowledge about diagnosis, 79 had good knowledge about treatment and 105 had good knowledge about preventive measures of tuberculosis (Table 4).
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Table 4: Factors influencing the knowledge of TB among the study population.
It was found that the knowledge regarding clinical signs and symptoms was found to be higher in the literate population and was statistically significant. A significant relation was found in literacy status and the knowledge regarding diagnosis of TB among study population. Knowledge regarding Treatment of TB and preventive measures was found to be higher in literate study population (statistically not significant).
DISCUSSION
A total number of 153 subjects were enrolled, out of which 87 (56.86%) are males and 66 (43.13%) are females. In that 22 are illiterates and the remaining 131 are educated and in that 41 were graduates and post graduates. When we look into the occupation, 61 are unskilled, 55 are semi-skilled and 16 are skilled workers. Four are professionals and 16 are in semi-profession. (Table 1). In a study by conducted by Jangid, males were 65.7% and females 34.3% and 27.5% of the study populations were literate.6
We found that, out of 153, 48 people (31.4%) knows that cough is the main symptom, 33 people (21.5%) cough with expectoration, 44 subjects (28.8%) cough+expectoration+evening rise of temperature, and the remaining 28 persons (18.3%) revealed that cough+expectoration+evening rise of temperature+weight loss. In our study on mode of spread of TB, 85 subjects (55.5%), know that it spreads through cough and sneezing mixed with air. 29 subjects (18.9%) spreads through direct contact and remaining 39 persons (25.5%) told that it spreads through food and utensils. In a study conducted by Sharad et al it was found that 36.9% urban population knew that TB is associated with cough and 30% knew that it is associated with weight loss.7 And it was found that 21.5% of urban population knew that it is transmitted through droplets of air. A study conducted Chinnakali et al found that 82% knew that TB spreads through cough, followed by weight loss (28%) and fever (14%) and 81% revealed that spread can be from person to person.8 In a study by conducted by Jangid et al found that 81.3% considered the cough as commonest symptom.6 In a study
by Chandrashekar, the common misconceptions about transmission were "Through food" (32.4%), "Sharing utensils" (18.2%), and "Touching a person with tuberculosis" (12.3%).9 Only 29.7% participants had correct knowledge without misconceptions. In our study, regarding knowledge of diagnosis of TB, 68 persons (44.4%) knew that through sputum examination, 49 subjects (32.1%) sputum + blood examination and the remaining 36 persons (23.5%) knew that in addition to blood and sputum, X–ray is also necessary. A study conducted Chinnakali et al, found that 40.% of the study population knew that diagnosis of TB is by sputum examination, 8% by X-ray chest and 32% by blood test A study by Jangid et al 64.7% study population agreed that X-ray chest and 59.8% considered sputum examination for the diagnosis of TB.6,8 In the present study, regarding knowledge of treatment, we found that 30 subjects (19.6%) said Antibiotics, 33 persons (21.5%) revealed that in addition to Antibiotics, Anti-tubercular treatment (ATT) is necessary. 46 persons (30.1%) knows that only ATT is necessary and it is available free of cost at DOTS center. 32 persons (20.9%) told about Homeo treatment and 12 persons (7.8%) about Ayurveda treatment. A study by Jangid et al 73.5% of the study population knew that treatment is available in Government centers free of cost and 9.8% have heard about DOTS.6
In our study, we found that various measures of prevention of TB, to avoid contact with TB patient (23.5%) immunization (20.2%) regular and appropriate treatment of TB case (17.6%), personal hygiene (14.4%) and remaining told about good nutritional food (18.3%). In the study by Sharad, only 3.1% of population knew that TB can be prevented by BCG vaccine.7 Madhu et al in their study found that 9.1% knew about BCG vaccine for prevention.10 Amgain et al in their study found that 81.5% knew about prevention of TB through vaccination.11 A study by Jangid et al, it is observed that 83.4% subjects have not heard about vaccination.6
In the present study, on knowledge of complications, 60.1% people knew that it is life threatening. 29.4% people revealed that it spreads to other parts of body and
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10.5% people told that it leads to infertility. A study conducted by Jangid et al found that 7.8% respondents said that TB can affect any organ of the body.6 A study conducted Chinnakali et al,71% of the study population considered it as a serious disease.8
We found that out of 153, 101 study population had good knowledge regarding signs and symptoms, 87 had good knowledge about diagnosis, 79 had good knowledge about treatment and 105 had good knowledge about preventive measures of tuberculosis. In our study we found that the knowledge regarding clinical signs and symptoms was higher in the literate population and was statistically significant. A significant relation was found in literacy status and the knowledge regarding diagnosis of TB, among our study population. Knowledge regarding treatment of TB and preventive measures was found to be higher in literate study population (statistically not significant).
In a study by Jangit et al, it was found that the knowledge about TB was more significant in literates.6 In a study conducted by Das et al, the literacy status had a significant influence on awareness about TB.12 A study conducted in Tamilnadu by Kala et al there was significant association between the knowledge on TB among study population and the demographic variables of educational status AOR 2.48 (95% CI 1.46 -4.22), marital Status AOR 2.23 (95% CI 1.21-4.10) and Caste AOR 2.22 (95%CI 1.14-4.34) respectively.13
Limitation
Persons who are not available during the survey were not included in the study. The same area was not visited again
CONCLUSION
In our study, 18.3% told that cough+expectoration+evening rise of temperature+weight loss are the signs and symptoms of TB. Majority revealed (55.5%) that it spreads through cough and sneezing mixed with air. Regarding the diagnosis, 23.5% knows blood examination, sputum examination, x –ray is the mode of diagnosis of TB. 60.1% people knew that it is life threatening condition. We found that out of 153, 101 study population had good knowledge regarding signs and symptoms. A significant relation was found in literacy status and the knowledge regarding diagnosis of TB, among our study population. Knowledge regarding treatment of TB and preventive measures was found to be higher in literate study population.
Literacy plays major role in creating awareness on TB.
Recommendations
Awareness programmes are to be conducted at regular intervals in the urban slums and rural areas also with
latest updates on TB, to bring the nation to at least “Elimination Stage”.
Funding: No funding sources Conflict of interest: None declared Ethical approval: The study was approved by the Institutional Ethics Committee
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district of Nepal. Int J Health Allied Sci. 2014;20(12):10-5. 12. Das P, Basu M, Dutta S, Das D. Perception of tuberculosis among general patients of tertiary care hospitals of Bengal. Lung India. 2012;29(4):319-24. 13. Kala M, John KR, Logaraj M. A study on awareness on pulmonary tuberculosis among population
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Cite this article as: Ram SA, Krishna RMN, Singh SPC. A study on awareness on tuberculosis among urban slum population of Hyderabad. Int J Community Med Public Health 2020;7:4941-6.
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