Spatial Analysis of Pulmonary Tuberculosis in Antananarivo Madagascar: Tuberculosis-Related Knowledge, Attitude and Practice

Abstract

IntroductionTuberculosis infection may remain latent, but the disease is nevertheless a serious public health issue. Various epidemiological studies on pulmonary tuberculosis have considered the spatial component and taken it into account, revealing the tendency of this disease to cluster in particular locations. The aim was to assess the contribution of Knowledge Attitude and Practice (KAP) to the distribution of tuberculosis and to provide information for the improvement of the National Tuberculosis Program.MethodsWe investigated the role of KAP to distribution patterns of pulmonary tuberculosis in Antananarivo. First, we performed spatial scanning of tuberculosis aggregation among permanent cases resident in Antananarivo Urban Township using the Kulldorff method, and then we carried out a quantitative study on KAP, involving TB patients. The KAP study in the population was based on qualitative methods with focus groups.ResultsThe disease still clusters in the same districts identified in the previous study. The principal cluster covered 22 neighborhoods. Most of them are part of the first district. A secondary cluster was found, involving 18 neighborhoods in the sixth district and two neighborhoods in the fifth. The relative risk was respectively 1.7 (p<10−6) in the principal cluster and 1.6 (p<10−3) in the secondary cluster. Our study showed that more was known about TB symptoms than about the duration of the disease or free treatment. Knowledge about TB was limited to that acquired at school or from relatives with TB. The attitude and practices of patients and the population in general indicated that there is still a stigma attached to tuberculosis.ConclusionThis type of survey can be conducted in remote zones where the tuberculosis-related KAP of the TB patients and the general population is less known or not documented; the findings could be used to adapt control measures to the local particularities.

Knowledge, attitude and practices regarding tuberculosis among new pulmonary tuberculosis patients in a new urban township in India

“…[12,16,17] The implication of such misconceptions regarding the cause of TB is that it may have a negative impact on patients' attitude toward health-seeking behavior as people with such misconceptions may not visit health facilities or consider self-treatment, both of which delay case detection and treatment of patients with TB in the community. This study revealed that the study participants had basic knowledge about the symptoms of TB and its modes of transmission which agrees with prior studies in Crotia, [9] Madagascar, [18] Ethiopia, [19] and India. [20] The symptom most frequently reported by the study participants was persistence cough similar to finding reported in a study in Brazil.…”

Spatial-temporal analysis of pulmonary tuberculosis in the northeast of the Yunnan province, People’s Republic of China

“…Fourth, the potential risk factors that could be associated with clustering were not assessed in this study. The high PTB prevalence is frequently associated with individual and socio-economic factors [25–29]. Fifth, we did not get each patient’s geographic coordinates in this study.…”

Evaluation of the Xpert MTB/RIF assay for the diagnosis of smear-negative pulmonary and extrapulmonary tuberculosis in Madagascar

“…All suspected TB cases at inclusion were re-evaluated at the end of the study by an international panel of three infectious diseases specialists (validation team) not directly involved in the inclusion process or the follow-up of cases. Following this evaluation, patients were classified into the following four clinical categories: (Rakotonirina et al, 2016) proven TB: culture-positive for M. tuberculosis in any sample; (World Health Organization, 2014a) probable TB: culture-negative, but with clinical data compatible with TB and a clinical response to anti-TB specific treatment in the absence of other antimicrobial therapy; (Rakotosamimanana et al, 2014) possible TB: culture-negative, but clinical and biological data compatible with TB; clinical evolution on anti-TB therapy not available, but no other alternative diagnosis; (Ramarokoto et al, 2010) alternative diagnosis: another clinical condition was confirmed and retained and there was no later evidence suggesting TB.…”

“…Approximately one-third of all TB cases are extrapulmonary and another third are smearnegative. Antananarivo is the most populous city in Madagascar and TB is also a major health concern here (Rakotosamimanana et al, 2014).…”