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| ORIGINAL ARTICLE |
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| Ahead of print publication |
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A study of the level of awareness about tuberculosis among employees of a tertiary care hospital
Shivangi Saxena, Rajesh Kunwar, Amit K Mourya
Department of Community Medicine, T. S. Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India
| Date of Submission | 07-May-2022 |
| Date of Decision | 07-Jun-2022 |
| Date of Acceptance | 08-Jun-2022 |
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Correspondence Address:
Shivangi Saxena,
Junior Resident PG Second Year, Department of Community Medicine, T. S. Misra Medical College and Hospital, Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjdrdypu.mjdrdypu_387_22
Background: Tuberculosis (TB) in India is a major public health problem. Government of India has committed to end TB by 2025 through its National Tuberculosis Elimination Programme. Awareness about tuberculosis especially among healthcare workers (HCWs) is considered crucial for the success of the program. Objective: The study aimed to assess TB awareness level among HCWs (other than the medical officers) and other employees. Methods: The study was carried out in a large city in Uttar Pradesh, India, from Jul 2021 to Dec 2021. Study population included all employees of the hospital except medical officers. The employees other than the HCWs provided the inbuilt comparison group. Data were collected using structured interviewer-administered questionnaires which included questions related to cause, mode of transmission, organ involvement, preventive, and treatment aspects of TB. Data were analyzed using STATA 17.0 statistical software. Results: Out of 244 study subjects, 128 (52.5%) were HCWs and 116 (47.5%) were other than HCWs. More than 80% of HCWs correctly knew that TB was a communicable disease that spread through air; most commonly affected lungs; was preventable as well as treatable; and the Govt. of India provided free of cost medicine to all TB patients. The overall awareness level among HCWs and Others was 74.5% and 66.0%, respectively. Compared to Others, HCWs were found more aware about 9 out of 10 aspects included in the questionnaire. The difference was found statistically significant in 4 out of 10 aspects. Conclusion: TB awareness among HCWs was found better than other hospital employees.
Keywords: Healthcare worker, hospital employees, TB awareness, tuberculosis
How to cite this URL:
Saxena S, Kunwar R, Mourya AK. A study of the level of awareness about tuberculosis among employees of a tertiary care hospital. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2023 Mar 20]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=351333 |
| Introduction | |  |
The Government of India launched National Tuberculosis Elimination Programme and committed itself to end TB by 2025.[1] India's achievements in TB Control had been remarkable but did not achieve the projected increase in case detection by the Revised National Tuberculosis Control Programme (RNTCP).[2] One of the reasons cited for this is lack of awareness about the disease.[3],[4],[5],[6] Healthcare worker (HCW) level of awareness plays a crucial role and may guide the course of disease management. Previous studies carried out have shown limited awareness about various aspects of tuberculosis (TB) among HCWs.[7],[8]
In view of the above, the present study was undertaken to assess the level of awareness about TB among HCWs (other than the medical officers) and other employees in a tertiary care hospital in a large city of Uttar Pradesh, India.
| Materials and Methods | | |
The present cross sectional analytical study was carried out in a private tertiary care hospital located in a large city in Uttar Pradesh, India from Jul 2021 to Dec 2021. The study population included all the employees of the hospital except the medical officers as they are expected to be well aware of all the aspects of TB and may tilt the findings in favor of other HCWs. The employees other than the HCWs provided the inbuilt comparison group. Thus, the HCWs included all the nurses, pharmacists, intensive care unit (ICU) technicians, lab technicians, operation room assistants, X-ray technicians, ward ayahs, and safaikarmies. Others included clerks, computer operators, security staff members.
Considering the level of awareness about various aspects of TB in general population as 60%,[4],[9] with an allowable margin of 5% at 95% confidence interval and accounting for the finite population for 550 employees, the sample size was calculated using STATCALC of epi info7 software as 221. Another 10% study subjects were added to the estimated sample size to further improve the precision of the study. List of all the employees were obtained from the office and the study subjects were selected using simple random technique.
Data were collected using structured questionnaires prepared with the help of experts in the field. The questionnaire was in two parts – Part I consisted of sociodemographic details of the study participant and Part II consisted of questions related to awareness regarding cause, mode of transmission, organ involvement, preventive, and treatment aspects of TB. There were 10 questions in Part II and all were close-ended, that is, each question had multiple choices with one correct answer. Pilot study was carried out on 10 subjects by administration of the questionnaire by interviewers who were duly trained for the same by the Principal Investigator. These 10 subjects were included in the study sample. Based on the findings of the study the questionnaire was refined and the findings were included in the results. Reliability of the questionnaire was tested using Cronbach's alpha (r = 0.83). Time required by the interviewer to fill a questionnaire completely ranged from 15 min to 20 min.
The data were recorded on Excel sheet and were analyzed using STATA 17.0 statistical software.
The awareness level in respect of each question was recorded as a dichotomous variable. For each question answered correctly, the respondent scored 'one' point and scored 'zero' point if answered incorrectly. The overall level of awareness about TB based on the findings of the study was categorized as poor, satisfactory, good, and excellent if the respondents correctly answered four or less than four questions; five or six questions; seven or eight questions; and nine or ten questions, respectively.
Ethical clearance for the study was obtained from the Institutional Ethics Committee. All participants were individually briefed about the study. Participation was voluntary and Informed consents were obtained from all the participants. Confidentiality was maintained.
| Results | | |
Out of 244 study subjects, 128 (52.5%) were HCWs and 116 (47.5%) were other than HCWs. As can be seen from [Table 1], 77.3% of HCWs and 70.7% of Others were less than 35 years of age. The mean age and standard deviation (SD) of HCWs and Others were 30.3 + 8.86 years and 32.1 + 10.30 years, respectively. This difference was statistically not found significant (t = -1.4670, df = 242, P = 0.1437). As far as gender was concerned, HCWs group had 57.8% females as compared to 23.3% females in Others group. This difference caused due to predominance of female nurses and aaya in HCWs, was found statistically significant. Literacy level was also found higher among HCWs because the minimum level of education for them was intermediate level. The difference in literacy level was found highly significant statistically. Income from salary was significantly more for HCWs as compared to Others.
Findings regarding awareness about TB among HCWs and others are shown in [Table 2]. As can be seen from the table, more than 80% of HCWs correctly knew that TB was a communicable disease that spread through air; most commonly affected lungs; was preventable as well as treatable; and the Govt of India provided free of cost medicine to all TB patients. Among Others, 90.5% knew that TB was treatable; 81.9% knew that free treatment was provided by the government; and 81.9% knew that the most commonly involved organ was lungs; 76.7% knew that TB was preventable. Awareness about each of the remaining aspects was below 75% in Others group. The overall awareness level among HCWs and Others was 74.5% and 66.0%, respectively. Compared to Others, HCWs were found more aware about 9 out of 10 aspects included in the questionnaire. The difference was found statistically significant in 4 out of 10 aspects. | Table 2: Awareness about tuberculosis among healthcare workers and Others (n=244)
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The awareness level was further recategorized into poor, satisfactory, good, and excellent levels. As can be seen from [Table 3], 44.5% of HCWs had excellent and 32.8% had good awareness level. Among Others, 23.3% had excellent and 35.3% had good awareness level. The statistical association between the awareness level and the occupation, tested using Chi-squared test, was found significant.
| Discussion | | |
TB caused by Mycobacterium tuberculosis, is one of the most common communicable diseases and is a leading cause of death worldwide in spite of it being curable and preventable.[10] India has the highest burden of TB in the world. Its National Tuberculosis Elimination Programme aims to eliminate TB from the country by 2025. But TB cannot be eliminated without active participation of community and all the stakeholders. Spreading awareness on TB as a curable disease, maintaining stigma and discrimination free environment and garnering resources from private sectors are essential for the success of the program.[11]
Awareness about TB is a very important parameter to be assessed. It provides baseline data to decision-makers who in turn can plan and execute programs for improving the awareness level and effective TB control.[12] In the present study, more of HCWs were found to have excellent TB awareness among HCWs as compared to Others.
Over the years, TB awareness studies having varied participants have been conducted all over the world. Many of these had HCWs including medical professionals, some had only medical professionals, some had only patients, some had general population and some a mix of all. Additionally, questions included in interview schedule also varied from very basic to highly technical depending on the study objective and study participants. This has made it difficult to compare the findings of our study with that of other studies.
In a cross-sectional study conducted in a tertiary care hospital in South India to assess the TB awareness among population other than HCWs, all patients attending general outpatient department were interviewed. 80.48% of these, considered cough as most common symptom. 40.95% knew about the availability of free treatment, and 53.10% were aware of the curability of the disease.[13] In our study, 85.2% of HCWs and 90.5% of Others knew that the disease was treatable; and 87.5% of HCWs and 81.9% of Others knew about the availability of free treatment.
In another population-based cross-sectional study carried out to assess the awareness, attitude, and treatment seeking behaviour regarding TB in rural Tamil Nadu, out of 1985 people interviewed, only 20% were aware of the cause and mode of spread of TB, 34% people were aware that treatment for TB was available free of cost.[14] In our study, 70.3% of HCWs and 56.0% of Others knew about the cause of the disease; and 81.3% of HCWs and 69.8% of Others knew about the mode of spread of TB. The higher awareness noted in our study could be because of higher education and urban population.
To evaluate knowledge related to transmission, prevention, and treatment of TB amongst medical and nursing students, a study was carried out among 200 final year undergraduate medical and nursing students at a teaching medical college hospital. 98.5% of the participants believed that TB is a disease that can be prevented, treated, and cured.[15] TB awareness observed among medical and nursing students was better than that observed in our study as the HCWs in our study did not include medical professionals.
A cross-sectional study conducted across 250 primary healthcare centres throughout Iraq to evaluate knowledge, attitudes, and practices towards TB showed that 64.4% of patients and 95.5% of HCWs had good knowledge about TB.[16] The HCWs in the study, also included medical professionals which could explain better awareness level than that observed in our study.
Overall TB awareness level of 74.5% among HCWs compared to 66.0% among Others, observed in our study, may give a sense of satisfaction but, in our opinion, this is far from adequate if the goal of TB elimination is to be achieved. The study observed that 25.5% of HCWs could not answer the very basic questions about TB which a common person should be able to answer in a country where TB is such a common disease. Till the time, TB awareness is increased to such an extent that not only HCW but every citizen of the country is also aware of the basic facts about TB, TB elimination will remain a dream to be visualised.
| Conclusion | | |
The study has brought out that TB awareness among HCWs was better as compared to other employees of the hospital. The study has also observed that the level of awareness among HCWs was far less than what was desired of them. We need to run a program to improve their awareness to achieve NTEP targets. The findings of the study may be substantiated by a large multi-centric study conducted to evaluate the TB awareness of HCWs other than medical professionals.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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