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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 1  |  Page : 36-38

Awareness of tuberculosis control program among health-care workers in a tertiary hospital, South India


1 GSL Medical College, Rajahmundry, Andhra Pradesh, India
2 Department of Microbiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Date of Web Publication21-May-2019

Correspondence Address:
Dr. T Jaya Chandra
Department of Microbiology, GSL Medical College, Rajahmundry, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_84_18

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  Abstract 


Objectives: The objective of the study is to access the awareness of tuberculosis control program (TCP) among health-care workers (HCWs) in a tertiary hospital and to compare the knowledge on TCP between HCWs and the public. Materials and Methods: The participants were provided with printed, multiple-choice questionnaire, containing 28 questions and options to mark the correct answer. All the questions were provided with “not aware” option also. The results were tabulated and analyzed by giving 1 for correct answer, −1 for wrong answer, and 0 for not aware option. The Mann–ANOVA test was used to find the statistical difference. Results: The mean average of scores was 18.52 in the test group and − 0.12 in the control group. Statistical mean significant difference was observed between the groups (P < 0.05). Conclusion: Awareness among the public and HCWs is important for the success of Revised National Tuberculosis Control Programme (RNTCP). To create the awareness in the public, it has to get advertised in cinema theaters, local channels, and newspapers. For awareness among HCWs, scientific updates should be advertised frequently in the journals and symposiums/seminars should be organized regularly by RNTCP.

Keywords: Health-care workers, Revised National Tuberculosis Control Programme, tuberculosis


How to cite this article:
Gadde S, Chandra T J. Awareness of tuberculosis control program among health-care workers in a tertiary hospital, South India. J Datta Meghe Inst Med Sci Univ 2019;14:36-8

How to cite this URL:
Gadde S, Chandra T J. Awareness of tuberculosis control program among health-care workers in a tertiary hospital, South India. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2019 Oct 18];14:36-8. Available from: http://www.journaldmims.com/text.asp?2019/14/1/36/258662




  Introduction Top


Tuberculosis (TB) is a worldwide pandemic, a bacterial disease caused by Mycobacterium tuberculosis complex (M. tuberculosis, Mycobacterium bovis, and Mycobacterium africanum).[1] Nearly 90% of TB cases occur in middle- and low-income countries such as India and Pakistan and Sub-Saharan African countries.[2] Due to a large number of cases and deaths, the World Health Organization (WHO) declared TB a global public health emergency in 1993.[3]

In India, the National Tuberculosis Control Programme (NTCP) was established in 1962. The NTCP had <30% treatment completion. On the basis of an in-depth review of the program by a high-level committee, in 1992, a Revised National Tuberculosis Control Programme (RNTCP) was envisaged with a view to achieve a cure rate of at least 85% among newly detected sputum-positive cases.[4],[5] The RNTCP is based on internationally recommended, WHO-devised, directly observed treatment, short-course (DOTS) strategy.[6]

With progress in achieving objectives of RNTCP, a National Strategic Plan 2012–2017 was developed.[7] The vision under this plan is “TB-free India.” Active involvement of health-care workers (HCWs) and the public is essential for the success of RNTCP, as well as to create TB-free India. With this, we conducted the study to evaluate the awareness of TB control program (TCP) among the HCWs by an interview method. The objectives of this study were (i) to access the awareness of TCP among the HCWs in a tertiary hospital and (ii) to compare the knowledge on TCP between the HCW and the public.


  Materials and Methods Top


This study was conducted in GSL Medical College, Rajahmundry, Andhra Pradesh, India, from January 2015 to October 2015. The study protocol was approved by the research and ethics committee of the institution.

The study participants were selected randomly and divided into two groups: test and control. The test group consisted of undergraduates, interns, postgraduates (PGs), and the faculty. The control group consisted of the public and the employees of GSL Medical College who do not have patient exposure. The administrators and RNTCP core committee members were excluded. The faculty and PGs of chest medicine, microbiology, and social preventive medicine departments and the interns who completed their posting in social preventive medicine and chest medicine departments were also excluded.

After getting informed written consent, the participants were provided with printed, multiple-choice questionnaire. The questionnaire comprised 28 questions and options to mark the correct answer. All the questions were provided with a “not aware” option as well. If required, the questionnaire was also given in local language. The results were tabulated and analyzed by giving 1 for correct answer, −1 for wrong answer, and 0 for not aware option.

Statistical analysis

Data were analyzed using SPSS software, version 16 (SPSS, Inc., Chicago, IL, USA), with participant as the unit of analysis. The Mann–ANOVA test was used to find the statistical difference. A P< 0.05 was found to be statistically significant.


  Results Top


Of total 125 volunteers, 100 were included in the test group and another 25 in the control group. Maximum was scored by the test group and minimum by the control group. The scores ranged from 6 to 28. The mean average of scores was 18.52 in the test group and −0.12 in the control group [Table 1]. The mean difference between the groups was found to be statistically significant (P< 0.05).
Table 1: Scores and mean difference of the study participants

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  Discussion Top


The first seven questions of the questionnaire were to test the knowledge of the HCWs on this white plague (causative agent of TB, route of transmission, etc.). All the HCWs answered correctly. As per the RNTCP 2016 Annual Report, an increased amount of INR 4500 crore under the 12th Five-Year Plan was allocated for this global killer through RNTCP.[8] This money is being utilized not only to diagnose and treat TB but also to create awareness in the public and for further research on TB. However, in this study, 60% of HCWs were not aware of the name of the TCP organized by the Government of India and 50% of HCWs were not aware of the existence of this program in the teaching hospitals. Most of the HCWs opined that TCP exists in government hospitals. The difference between test and control group scores was not statistically significant (P > 0.05).

In this institution, Chief of Chest Medicine is the coordinator and principal, is the chairman of the RNTCP core committee. About 75% of HCWs were not aware of this. The difference between test and control group scores was not statistically significant (P > 0.05).

Case detection by sputum smear examination among patients with symptomatic TB is one of the key elements of DOTS.[9] Currently, in India, fluorescent staining technique by light-emitting diode fluorescence microscope (LED-FM) is being applied for screening the sputum smears.[3] In 2012, the LED-FMs were installed in all the medical colleges throughout the country under RNTCP in partnership with the International Union against TB and Lung Diseases.[10] However, 75% of HCWs were not aware of the current diagnostic technique under RNTCP and 83% were not aware of installation of LED-FMs in medical colleges. The difference between test and control group scores was not statistically significant (P > 0.05).

For the diagnosis of TB, three sputum samples were collected by spot morning spot approach. However, significant numbers of smear-positive cases are diagnosed in the first two samples of sputum, and the diagnostic utility of the third sample is limited.[11],[12] Hence, RNTCP reduced minimum number of samples to two. SM approach, i. e. spot (S) sample at the time of the first visit, followed by the morning (M) sample.[13],[14] However, 63% of HCWs were not aware of the current RNTCP specimen collection approach. The difference between test and control group scores was not statistically significant (P > 0.05).

Culture and drug susceptibility testing (DST) is also free of cost in RNTCP-accredited laboratories. In South India, one of such laboratories is located at Visakhapatnam, Andhra Pradesh. However, 90% of the faculty and 93% of the HCWs were not aware of the existence of RNTCP-accredited DST laboratory at Visakhapatnam. The difference between test and control groups was not statistically significant (P > 0.05).

Distribution of anti-TB drugs (ATDs) to patients under direct observation of health-care/DOT provider is another element of DOTS. About 80% of HCWs were not aware of this and 70% of faculty opined that ATDs were given by the faculty of chest medicine. Treatment for drug-resistant TB is given under DOTS-plus. Seventy percent of HCWs were not aware that RNTCP provided medication for drug-resistant TB. The difference between test and control groups was not statistically significant (P > 0.05).

Interestingly, most of the public answered that diagnosis and treatment of TB are free of cost under RNTCP, but most of the HCWs opined that either diagnosis or treatment, but not both; 60% opined that diagnosis is free and 71% answered that treatment is free. The difference between test and control groups was statistically significant (P< 0.05).

Research is one of the thematic areas of RNTCP. However, 98% of HCWs were not aware that the program provides financial support for research on TB and 95% of HCWs were not aware that the Indian Journal of Tuberculosis is an RNTCP journal. The difference between test and control groups was not statistically significant (P > 0.05). Surprisingly, 90% and 92% of the faculty were not aware regarding RNTCP financial support to TB research and name of the RNTCP official journal, respectively.

Although statistically there was mean significant difference [Table 1] between the groups, a significant number of HCWs were not aware of important RNTCP guidelines.


  Conclusion Top


So awareness in HCWs on TCP is essential for the success of the RNTCP. To create awareness in public, it has to get advertised not only in cinema theaters but also in local channels and newspapers. The scientific updates should be advertised frequently in the journals, and symposiums/seminars should be organized regularly by the RNTCP. This will surely create awareness among the HCWs. Political commitment is another key element of DOTS. However, there is a significant gap in this area. Hence, the government should take proper steps because politicians are in regular contact with public. This will be an important measure for the success of the RNTCP so that TB-free India can be seen shortly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chandra TJ, Raj RS, Sharma YV. Same day sputum smear microscopy approach with modified ZN staining for the diagnosis of pulmonary tuberculosis in a microscopy centre at Rajahmundry. Indian J Med Microbiol 2014;32:153-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
World Health Organization. Global Tuberculosis Control: Epidemiology, Strategy, Financing. WHO/HTM/TB/2009. Geneva, Switzerland: World Health Organization; 2009. p. 411.  Back to cited text no. 2
    
3.
Chandra TJ, Selvaraj R, Sharma YV. Same-day sputum smear microscopy for the diagnosis of pulmonary tuberculosis: Direct vs. concentrated smear. Int J Tuberc Lung Dis 2016;20:247-51.  Back to cited text no. 3
    
4.
Annual Report of the Revised National Tuberculosis Control Programme. New Delhi: Central Tuberculosis Division Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; 2010. Available from: http://tbcindia.nic.in/showfile.php?lid=2922. [Last accessed on 16 Oct 20].  Back to cited text no. 4
    
5.
Technical and Operational Guidelines for Tuberculosis Control, Revised National Tuberculosis Control Programme. New Delhi: Central Tuberculosis Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; 2005.  Back to cited text no. 5
    
6.
Sachdeva KS, Kumar A, Dewan P, Kumar A, Satyanarayana S. New vision for Revised National Tuberculosis Control Programme (RNTCP): Universal access – Reaching the un-reached. Indian J Med Res 2012;135:690-4.  Back to cited text no. 6
  [Full text]  
7.
Central TB Division, Directorate General of Health Services Ministry of Health and Family Welfare. Manual for Sputum Smear Fluorescence Microscopy. New Delhi, India: Ministry of Health and Family Welfare; 2012. p. 12-6. Available from: http://www.tbfacts.org/wp-content/uploads/2016/01/NSP-2012-2017.pdf. [Last accessed on 16 November 20]  Back to cited text no. 7
    
8.
Annual Report of the Revised National Tuberculosis Control Programme. New Delhi: Central Tuberculosis Division Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; 2016. Available from: http://tbcindia.nic.in/showfile.php?lid=3181. [Last accessed on 16 Oct 20].  Back to cited text no. 8
    
9.
World Health Organization. The Five Elements of DOTS. Geneva, Switzerland: World Health Organization; Available from: http://www.who.int/tb/dots/whatisdots/en/. [Last accessed on 16 Nov 20].  Back to cited text no. 9
    
10.
Reza LW, Satyanarayna S, Enarson DA, Kumar AM, Sagili K, Kumar S, et al. LED-fluorescence microscopy for diagnosis of pulmonary tuberculosis under programmatic conditions in India. PLoS One 2013;8:e75566.  Back to cited text no. 10
    
11.
Bonnet M, Ramsay A, Gagnidze L, Githui W, Guerin PJ, Varaine F. Reducing the number of sputum samples examined and thresholds for positivity: An opportunity to optimise smear microscopy. Int J Tuberc Lung Dis 2007;11:953-8.  Back to cited text no. 11
    
12.
Mase SR, Ramsay A, Ng V, Henry M, Hopewell PC, Cunningham J, et al. Yield of serial sputum specimen examinations in the diagnosis of pulmonary tuberculosis: A systematic review. Int J Tuberc Lung Dis 2007;11:485-95.  Back to cited text no. 12
    
13.
Chandra TJ. Same day sputum smear microscopy approach for the diagnosis of pulmonary tuberculosis in a microscopy centre at Rajahmundry. Indian J Tuberc 2012;59:141-4.  Back to cited text no. 13
    
14.
World Health Organization. New WHO Policies. World Health Organization; December, 2007. Available from: http://who.int/tb/dots/laboratory/policy/en/index.html. [Last accessed on 2015 Nov 14].  Back to cited text no. 14
    



 
 
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