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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 72-76

Awareness about new guidelines of national tuberculosis elimination program among medical college faculty


Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India

Date of Submission28-Sep-2020
Date of Decision17-Nov-2020
Date of Acceptance14-Dec-2020
Date of Web Publication11-Jun-2021

Correspondence Address:
Dr. Prashant R Kokiwar
Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_1_20

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  Abstract 


Background: Physicians and faculty working in Medical Colleges play a major role in tuberculosis (TB) control. Their knowledge, attitude, and practices can affect the treatment and care of TB patients significantly.
Objectives: The objectives were to assess the awareness about new guidelines of National TB Elimination Program (NTEP) among medical college faculty.
Methods: A cross-sectional study was carried out among 95 faculties. They were given anonymous self-administered questionnaire with 23 questions. One mark was given for each correct answer. We classified correct knowledge as score >10 and poor knowledge as score <10. Yates-corrected Chi-square was used to study the association between variables and outcomes. P 0.05 was considered as statistically significant.
Results: Questions about case detection rate, cure rate, incentives to private practitioner, bedaquiline, and follow-up of patients after completion of treatment were very poorly answered (<10 persons had correct knowledge). Only 17 could answer about the fixed-dose combinations, 10 about 99 Directly Observed Treatment Short-Course (DOTS) chemotherapy, and 13 about the choice of treatment in HIV-TB. Best answered questions were about the drugs used in each DOTS category, categories of DOTS, what are multidrug-resistant TB, extensive drug-resistant TB, and definition of presumptive case of TB. Overall, 58 faculties (61.1%) had poor knowledge with a score <11. The remaining 37 (38.9%) had correct knowledge with a score 11 or more. Correct knowledge was not found to be associated with age, sex, and designation but was associated with professional experience, with higher experience being associated with poor knowledge (P < 0.05).
Conclusion: Majority of the faculty in the studied medical colleges had poor knowledge about new updates/guidelines in the NTEP. Professional experience was found to be significantly associated with the correct knowledge on recent updates in NTEP.

Keywords: Faculty, guidelines, knowledge, national tuberculosis elimination program


How to cite this article:
Kokiwar PR, Asritha N, Ganesh N, Reddy N N, Dakshayani N U, Nikitha N, Naresh P, Snigdha K, Naila B, Vyshnavi N, Nikhil P, Saikrishna P, Sukanya P, Mounika P. Awareness about new guidelines of national tuberculosis elimination program among medical college faculty. MRIMS J Health Sci 2021;9:72-6

How to cite this URL:
Kokiwar PR, Asritha N, Ganesh N, Reddy N N, Dakshayani N U, Nikitha N, Naresh P, Snigdha K, Naila B, Vyshnavi N, Nikhil P, Saikrishna P, Sukanya P, Mounika P. Awareness about new guidelines of national tuberculosis elimination program among medical college faculty. MRIMS J Health Sci [serial online] 2021 [cited 2021 Oct 21];9:72-6. Available from: http://www.mrimsjournal.com/text.asp?2021/9/2/72/318149




  Introduction Top


The death rate and incidence due to tuberculosis (TB) have fallen significantly in 22 countries which were a high burden of TB. Even then, TB is the second most common cause of mortality globally after HIV-AIDS among all the infectious diseases. Multidrug-resistant TB (MDR-TB) incidence has increased globally.[1]

Twenty-five percent of global cases of TB are seen in India. In absolute number, it is 28 lakh which were reported in 2016.[2] For effective prevention and control of TB in the community, it is important to limit the transmission of TB.[3]

In the present scenario in India, secondary prevention (early diagnosis and treatment) is the mainstay of prevention of TB. Although BGC vaccination is available and is a part of National Immunization Schedule of India; due to large variation in the effectiveness of BCG (0%–80%) against TB, it cannot totally rely upon. Hence, the National TB Elimination Program of India as per the World Health Organization guidelines has implemented the Directly Observed Treatment Short-Course (DOTS) Chemotherapy strategy which mainly aims at early detection and prompt treatment of TB cases to prevent further transmission of TB in the community. The TB control program in India has undergone major revisions since 1996. In a recent couple of years, many new guidelines have come up with a major revision of change in the name from Revised National TB Program (RNTCP) to NTEP. With rapidly changing guidelines in treatment, nomenclature, drug regimen, and technological advancement, it becomes necessary to test the knowledge of faculty in medical colleges from time to time to formulate training programs to help the NTEP and the community at large.

Hence, physicians and faculty working in medical colleges (both government and private) play a major role in the NTEP. Their knowledge, attitude, and practices can affect the treatment and care of TB patients significantly. With this background, the present study was carried out to assess awareness about new guidelines of NTEP among medical college faculty.


  Methods Top


Study design

This was a cross-sectional study.

Settings

This study was done at two private medical colleges' faculties.

Sample size

A total of 95 faculties could be contacted during the study period in the present study.

Study period

The study was conducted from May 28, 2019 to July 27, 2019.

Ethical consideration

Institution Ethics Committee permission was obtained. Informed consent was obtained from all participants.

Methodology

The present study was questionnaire-based study. Based on review of literature and latest changes in the NTEP, a pre-designed, pre-tested, semi-structured study questionnaire was prepared. It was a self-administered questionnaire.

The faculty was contacted and explained briefly about the study protocol. With prior appointment, they were given the study questionnaire. Identifying details like name, and institution name was not included in the study questionnaire. The anonymous forms were taken back.

All questions were open-ended questions with expected specific answers. All forms were mixed up to avoid any identity. The answers were analyzed specific to each question and were ticked as correct answer or incorrect answer. There were total 23 questions. One mark for each question was given. Out of 23 questions, the scores were given. One mark was given for each correct answer. Out of 23, the maximum score was 15 and the minimum score was 2. Hence, we classified correct knowledge as score >10 and poor knowledge as score <10

Statistical analysis

The data were entered into a Microsoft Excel worksheet and analyzed using proportions. Yates-corrected Chi-square was used to study the association between variables and outcomes. P < 0.05 was considered as statistically significant.


  Results Top


Majority (44.2%) of the study subjects belonged to the age group of 31–40 years followed by 26.3% in 21–30 years, 21% in 41–50 years, and 8.4% in above 50 years. Males (69.5%) were more than females (30.5%). Forty percent were senior residents, 27.3% were assistant professors, 22.1% were associate professors, and 10.6% were professors. About 48.4% had profession experience of more than 10 years followed by 31.6% having professional experience of 6–10 years and 20% having from 1 to 5 years.

[Table 1] shows distribution of study subjects as per the correct knowledge to various questions. There were a total of 23 questions. Questions about case detection rate, cure rate, incentives to private practitioner, bedaquiline, and follow-up of patients after completion of treatment were very poorly answered (<10 persons had correct knowledge). Only 17 could answer about the fixed-dose combinations (FDCs), 10 about 99 DOTS, and 13 about the choice of treatment in HIV-TB. The best answered questions were about the drugs used in each DOTS category, categories of DOTS, what are MDR-TB, extensive drug-resistant TB (XDR-TB), and definition of presumptive case of TB. Overall, 58 faculties (61.1%) had poor knowledge with score <11. The remaining 37 (38.9%) had correct knowledge with score 11 or more.
Table 1: Distribution of study subjects as per correct knowledge to various questions

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About 52% in 21–30 years of age had correct knowledge. As the age increased, the knowledge decreased till 50 years of age and then increased in the next age category. However, this trend was not found to be statistically significant (P > 0.05) [Table 2].
Table 2: Association between age and knowledge

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Females were found to have better (45%) knowledge compared to males (36.4%), but this difference was not found to be statistically significant [Table 3].
Table 3: Association between sex and knowledge

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Senior residents (42.1%) and assistant professors (42.3%) cadre were found to have correct knowledge compared to associate professors (38.2%) and professors with only 20% having correct knowledge [Table 4].
Table 4: Association between designation and knowledge

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It is seen that as the professional experience increased from 1 to 5 years to more than 10 years, the correct knowledge decreased from 57.9% to 24%. Similarly, poor knowledge increased from 20% to 48.4%. This trend was found to be statistically significant [Table 5].
Table 5: Association between professional experience and knowledge

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  Discussion Top


Questions about case detection rate, cure rate, incentives to private practitioner, bedaquiline, and follow-up of patients after completion of treatment were very poorly answered (<10 persons had correct knowledge). Only 17 could answer about the FDCs, 10 about 99 DOTS, and 13 about the choice of treatment in HIV-TB. Best answered questions were about the drugs used in each DOTS category, categories of DOTS, what are MDR-TB, XDR-TB, and definition of presumptive case of TB. Overall, 58 faculties (61.1%) had poor knowledge with a score <11. The remaining 37 (38.9%) had correct knowledge with a score 11 or more. Correct knowledge was not found to be associated with age, sex, and designation but was associated with professional experience, with higher experience being associated with poor knowledge (P < 0.05).

Khan et al.[4] studied knowledge of TB among 460 interns from Pakistan. Ninety-six percent had correct knowledge of mode of transmission. The use of sputum smears was endorsed by only 38% for diagnosis and 43.5% for follow-up. Nearly 56.3% of interns correctly named four drugs used in DOTS. Eighty-two percent could not identify all components of DOTS. The author concluded that awareness about TB was poor among these interns.

Vandan et al.[5] carried out a study to assess the practices related to TB among 141 doctors. They found that sputum sampling skill was present in 66% and 39% of public sector and private sector doctors, respectively. Knowledge about the drug regime of TB was better among public sector doctors compared to the doctors from the private sector (odds ratio = 2.1; P = 0.05).

Dasgupta and Chattopadhyay[6] observed knowledge of general practitioners. RNTCP and DOTS full form was correctly told by general practitioners in 63.9% and 27%, respectively. Only 21% could answer about the most common symptom of TB and 39% only could answer about the RNTCP treatment categories. Only 60% could answer contraindicated drugs in pregnancy. Finally, they found that only 24% had good knowledge and only 19.7% had proper practices related to TB.

Rajpal et al.[7] studied knowledge of 287 interns. Almost 92.7% of interns stated that DOTS is the best strategy for control of TB and self-administered or self-decided drugs should not be given. However, only 4.2% correctly told about the modes of transmission. Nearly 65.9% correctly told that a sputum test should be done for the diagnosis of TB.

Rizvi and Hussain[8] found that out of 150 family physicians, 21.3% opined that TB should not be considered as a serious public health problem. Twenty-nine percent were not in favor of giving BGC vaccination. Only 38% admitted that sputum smear microscopy should be done for the diagnosis of TB. Only 39% used all four drugs mentioned in DOTS. Nonrecommended drugs were being used by majority of the family physicians.

Ramos et al.[9] included 55 physicians and 46 nurses in their study. Out of them, 58% were recently trained in TB. However, the author found that satisfactory answers to 16 questions were seen only to seven questions given by less than half of the participants. Fifty-one percent had no knowledge on prevention of latent TB infection (LTBI) among contacts, 32% had no knowledge on how the progression to disease could be prevented, 43% had no knowledge on diagnosis of LTBI, 62% had no knowledge on treatment of LTBI, 44% had no knowledge on the duration of isoniazid treatment, 84% had no knowledge on dose of isoniazid, and 70% had no knowledge on how to manage the adverse events.

Vandan et al.[10] study included 141 medical physicians. Sixty percent were already trained in RNTCP. However when asked about the recommended drugs for TB, only two-third were able to answer it correctly. It was observed that private sector physicians had inadequate knowledge of gold standard drug regimens. The author concluded that doctors should be adequately trained in treatment regimens.

Aadnanes et al.[11] studied 195 general practitioners for awareness and knowledge on TB. They noted that 69% of the general practitioners do not think that TB is a serious health issue. About 49.7% of them had good knowledge about TB and it was significantly associated with experience and training on TB.

Zhao et al.[12] assessed knowledge on TB among 1486 medical students in China. Knowledge on hemoptysis was seen only in 24.1% of students. Knowledge on the presence of TB clinics was observed only among 27.2% of students. Only 34.1% answered correctly that TB treatment is free of cost. Only 14.5% of students told that they heard about DOTS. Only 54% of students told that they had access to the information on TB. The author also reported that good knowledge was directly proportional to exposure to health education.


  Conclusion Top


Majority of the faculty in the studied medical colleges had poor knowledge about new updates/guidelines in the NTEP. Professional experience was found to be significantly associated with the correct knowledge on recent updates in NTEP.

Recommendations

In the light of the present study findings, it becomes necessary that sensitization programs should be conducted by the medical colleges in recent updates/guidelines at regular intervals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization 2012. Global Tuberculosis. Report. Available from: http://apps.who.int/iris/bitstream/10665/75938/1/9789241564502_eng.pdf. [Last accessed on 2019 Apr 22].  Back to cited text no. 1
    
2.
Otero L, Shah L, Verdonck K, Battaglioli T, Brewer T, Gotuzzo E, et al. A prospective longitudinal study of tuberculosis among household contacts of smear-positive tuberculosis cases in Lima, Peru. BMC Infect Dis 2016;16:259.  Back to cited text no. 2
    
3.
Verver S, Warren RM, Munch Z, Richardson M, van der Spuy GD, Borgdorff MW, et al. Proportion of tuberculosis transmission that takes place in households in a high-incidence area. Lancet 2004;363:212-4.  Back to cited text no. 3
    
4.
Khan JA, Zahid S, Khan R, Hussain SF, Rizvi N, Rab A, et al. Medical interns knowledge of TB in Pakistan. Trop Doct 2005;35:144-7.  Back to cited text no. 4
    
5.
Vandan N, Ali M, Prasad R, Kuroiwa C. Assessment of doctors' knowledge regarding tuberculosis management in Lucknow, India: A public-private sector comparison. Public Health 2009;123:484-9.  Back to cited text no. 5
    
6.
Dasgupta A, Chattopadhyay A. A study on the perception of general practitioners of a locality in Kolkata regarding RNTCP and DOTS. Indian J Community Med 2010;35:344-6.  Back to cited text no. 6
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7.
Rajpal S, Mittal A, Dhingra VK, Malhotra R, Gupta R, Malhotra C, et al. Knowledge, attitude and practices regarding tuberculosis and dots among interns in Delhi, India. J Coll Physicians Surg Pak 2007;17:457-61.  Back to cited text no. 7
    
8.
Rizvi N, Hussain M. Survey of knowledge about tuberculosis amongst family physicians. J Pak Med Assoc 2001;51:333-7.  Back to cited text no. 8
    
9.
Ramos J, Wakoff-Pereira MF, Cordeiro-Santos M, Albuquerque MF, Hill PC, Menzies D, et al. Knowledge and perceptions of tuberculosis transmission and prevention among physicians and nurses in three Brazilian capitals with high incidence of tuberculosis. J Bras Pneumol 2018;44:168-70.  Back to cited text no. 9
    
10.
Vandan N, Ali M, Prasad R, Kuroiwa C. Physicians' knowledge regarding the recommended anti-tuberculosis prescribed medication regimen: A cross-sectional survey from Lucknow, India. Southeast Asian J Trop Med Public Health 2008;39:1072-5.  Back to cited text no. 10
    
11.
Aadnanes O, Wallis S, Harstad I. A cross-sectional survey of the knowledge, attitudes and practices regarding tuberculosis among general practitioners working in municipalities with and without asylum centres in eastern Norway. BMC Health Serv Res 2018;18:987.  Back to cited text no. 11
    
12.
Zhao Y, Ehiri J, Li D, Luo X, Li Y. A survey of TB knowledge among medical students in Southwest China: Is the information reaching the target? BMJ Open 2013;3:e003454.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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