Knowledge, attitude and practice towards tuberculosis in Gambia: a nation-wide cross-sectional survey

Abstract

Background Early diagnosis and treatment of tuberculosis (TB) are the mainstay of global and national TB control efforts. However, the gap between expected and reported cases persists for various reasons attributable to the TB services and care-seeking sides of the TB care cascade. Understanding individual and collective perspectives of knowledge, attitudes, beliefs and other social circumstances around TB can inform an evidence-based approach in engaging communities and enhance their participation in TB case detection and treatment. Methods The study was conducted during the Gambian survey of TB prevalence. This was a nationwide cross-sectional multistage cluster survey with 43,100 participants aged ≥15 years in 80 clusters. The study sample, a random selection of 10% of the survey population within each cluster responded to a semi-structured questionnaire administered by trained fieldworkers to assess the knowledge, attitudes and practice of the participants towards TB. Overall knowledge, attitude and practice scores were dichotomised using the computed mean scores and analysed using descriptive, univariable and multivariable logistic regression. Results All targeted participants (4309) were interviewed. Majority were females 2553 (59.2%), married 2614 (60.7%), had some form of education 2457 (57%), and were unemployed 2368 (55%). Although 3617 (83.9%) of the participants had heard about TB, only 2883 (66.9%) were considered to have good knowledge of TB. Overall 3320 (77%) had unfavourable attitudes towards TB, including 1896 (44%) who indicated a preference for staying away from persons with TB rather than helping them. However, 3607(83.7%) appeared to have the appropriate health-seeking behaviours with regard to TB as 4157 (96.5%) of them were willing to go to the health facility if they had symptoms suggestive of TB. Conclusions About 3 in 10 Gambians had poor knowledge on TB, and significant stigma towards TB and persons with TB persists. Interventions to improve TB knowledge and address stigma are required as part of efforts to reduce the burden of undiagnosed TB in the country.

Knowledge, attitudes and practices on tuberculosis infection prevention and associated factors among rural and urban adults in northeast Tanzania: A cross-sectional study

“…Although the majority (95%) of adults from the study area are aware of TB, less than half (44%) has good overall knowledge about TB infection. In this study, the proportion of the study participants with good overall knowledge is almost the same as that of Nigeria but lower than in the Gambian study [26,27]. The variation in the proportions of population with good knowledge about TB infection between urban and rural in not a new phenomenon.…”

“…Despite a larger proportion of adults having good knowledge on symptoms, transmission and good practices about TB infection, it is surprising that as few as only 11% have positive attitudes towards the TB infection. This level is in contrast with recent figures from Nigeria, Gambia and Ethiopia [26,27,37]. In 2019, a study in Nigeria reported a link between education among men and their families and TB knowledge scores [38].…”

“…It is of critical importance to underscore the knowledge gap especially of TB transmission in rural areas in this study. It is underscored that inadequate knowledge about TB symptoms and transmission is among the threats to employ good prevention practices [24,27,31,39]. Therefore, one of the implications from this study is that, with poor knowledge and negative attitudes towards TB it is likely the community will have poor efforts in prevention practices against TB infection and possibly end up with limited health care seeking behaviors [40,41].…”

“…At an individual level, some studies suggest sex, age, education, marital status, main sources of income and exposure to mass media are associated with knowledge, attitudes and practices (KAP) towards TB prevention and control [19][20][21][22][23][24][25]. In addition, adults living in urban areas have been associated with higher overall better knowledge of TB as compared to their counterparts in rural areas [26,27].…”

Effectiveness of a case management model in newly treated smear-positive pulmonary tuberculosis patients

“…The questionnaire [12] was used to investigate the KAP level of newly treated smear-positive pulmonary tuberculosis patients. The 24 items in the questionnaire included knowledge, attitude, and the behavior of tuberculosis.…”