Tuberculosis Knowledge, Attitudes, and Practice in Middle- and Low-Income Countries: A Systematic Review

Abstract

Tuberculosis (TB) is the leading cause of death from an infectious agent in the world. Most tuberculosis cases are concentrated in low- and middle-income countries. The aim of this study is to better understand tuberculosis-related knowledge about TB disease, prevention, treatment and sources of information, attitudes towards TB patients and their stigmatization and prevention, diagnosis and treatment practices in the general population of middle- and low-income countries, with a high tuberculosis burden, and provide evidence for policy development and decision-making. A systematic review of 30 studies was performed. Studies reporting on knowledge, attitudes, and practices surveys were selected for systematic review through database searching. Population knowledge about TB signs and symptoms, prevention practices, and treatment means was found inadequate. Stigmatization is frequent, and the reactions to possible diagnoses are negative. Access to health services is limited due to difficulties in transportation, distance, and economic cost. Deficiencies in knowledge and TB health-seeking practices were present regardless of the living area, gender, or country; however, it seems that there is a frequent association between less knowledge about TB and a lower socioeconomic and educational level. This study revealed gaps in knowledge, attitude, and practices in focused in middle- and low-income countries. Policymakers could take into account the evidence provided by the KAP surveys and adapt their strategies based on the identified gaps, promoting innovative approaches and empowering the communities as key stakeholders. It is necessary to develop education programs on symptoms, preventive practices, and treatment for TB, to reduce transmission and stigmatization. It becomes also necessary to provide communities with innovative healthcare solutions to reduce their barriers to access to diagnosis and treatment.

Towards comprehensive clinical trials for new tuberculosis drug regimens: policy recommendations from a stakeholder analysis

“…Past delays in transferring new tools from high-income countries capable of affording them to less economically developed countries have several explanations: problems with local registration, 1 10 11 need for testing locally, [12][13][14] lack of endorsement by entities such as WHO, 1 5 15 16 high price, [17][18][19] constraints in procurement and supply management, 5 20 21 limited manufacturing capacity, 4 22 23 as well as lack of awareness and false perceptions on potential adverse reactions and other complications. 24 25 Therefore, engaging key stakeholders from the first step of designing a clinical trial may facilitate and accelerate the future uptake of new TB regimens in any country, especially the low-income and middle-income countries (LMICs) with high TB burden. While these principles emerge clearly from R&D efforts in TB, rapid implementation of innovations is a general concern to be addressed for any high-burden disease.…”

A Cross-Sectional Study on Awareness of Tuberculosis Control Among Post-Treatment Tuberculosis Patients in a City in China

“…In 2014 and 2015, all Member States of WHO and the United Nations (UN) committed to ending the TB epidemic, through their adoption of WHO's End TB Strategy and the UN Sustainable Development Goals (SDGs), a key component of which is comprehensive patient-centred care and prevention. Previous studies have shown that knowledge of the core knowledge of TB prevention and treatment has a positive impact on the treatment outcome of TB patients, 2 and improving the level of knowledge of the core knowledge of TB prevention and treatment can effectively avoid the occurrence of delayed diagnosis, thus achieving early detection of active TB patients, and targeting the prevention and treatment of TB. Numerous studies have been conducted on the awareness of core knowledge about TB prevention and control in patients with tuberculosis in treatment, [3][4][5] but few studies have been conducted on patients with tuberculosis who have completed treatment.…”

Insights, beliefs, and myths surrounding tuberculosis among pulmonary patients with delayed healthcare access in a high-burden TB state in Nigeria – a qualitative inquiry

“…The symptoms of TB range from a persistent cough and chest pain to weight loss, fatigue, and fever (Peirse and Houston, 2017;Field et al, 2018;Long et al, 2020). Despite being treatable with antibiotics, challenges such as drug-resistant strains and societal stigmas surrounding the disease continue to complicate efforts to control its spread (Bashorun et al, 2020;Craciun et al, 2023).…”