Punchak_IJTLD_2013
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Correspondence 1245 References 1 World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis. Emergency update 2008. WHO/HTM/TB/2008.402. Geneva, Switzerland: WHO, 2008. http://whqlibdoc.who.int/publications/2008/9789241547 581_eng.pdf Accessed June 2013. 2 Caminero J A, ed. Guidelines for clinical and operational man- agement of drug-resistant tuberculosis. Paris, France: Interna- tional Union Against Tuberculosis and Lung Disease, 2013. 3 World Health Organization. Treatment of tuberculosis: guide- lines. 4th ed. WHO/HTM/TB/2009.420. Geneva, Switzerland: WHO, 2009. http://whqlibdoc.who.int/publications/2010/9789 241547833_eng.pdf Accessed June 2013. 4 Bojorquez-Chapela I, Bäcker C E, Orejel I, et al. Drug resistance in Mexico: results from the National Survey on Drug-Resistant Tuberculosis. Int J Tuberc Lung Dis 2013; 17: 514–519. 5 Granich R M, Balandrano S, Santaella A J, et al. Survey of drug resistance of Mycobacterium tuberculosis in 3 Mexican states, 1997. Arch Intern Med 2000; 160: 639–644. 6 Blumberg H M, Burman W J, Chaisson R E, et al. American Thoracic Society/Centers for Disease Control and Prevention/ Infectious Diseases Society of America: treatment of tuberculo- sis. Am J Respir Crit Care Med 2003; 167: 603–662. Sociodemographic basis of tuberculosis knowledge in Bolivia Tuberculosis (TB) is a disease that disproportionally affects the poor. Bolivia has an estimated population of 10 million, mostly mestizo and indigenous Aymara and Quechua people, 51.3% of whom live in pov- erty. 1 In South America, Bolivia ranks highest in the incidence of TB, with a rate of 131 cases per 100 000 population. 2 Lack of knowledge about TB may play an instrumental role in preventing symptomatic indi- viduals from seeking medical attention. In this pre- liminary study (approved by the Tuberculosis De- partmental Laboratory SEDES in La Paz and the Research Ethics Committee of the London School of Hygiene & Tropical Medicine), we assessed factors associated with health-seeking behaviour and knowl- edge of TB among persons presenting to health cen- tres. Face-to-face interviews with 20 adult patients from each of the three participating health facilities located in three geographically distinct regions of Bolivia (El Alto, Achacachi and Caranavi) were con- ducted from 18 June to 26 July 2012. Interview data were coded and analysed using Stata 12.1 (Stata Corp, College Station, TX, USA). The mean age of the patients interviewed was 26.9 years (18–44); the majority (90%) were women. The majority had completed either primary (43.3%) or secondary (45%) school. Patients who lived less than 30 minutes away from a health centre were more likely to go there or visit a pharmacy if sick, while those who lived 1 to 3 hours away practised home remedies (P = 0.045). The most commonly identified symptom of TB was persistent cough (60%). Overall, 61.7% of the interviewees knew that TB is a curable disease, and 60% knew that it is an infectious dis- ease. Adjusting for schooling, the data suggested a statistically significant association between location and ability to identify cough as a symptom of TB (P = 0.02) as well as with knowing that TB is curable (P < 0.01). In addition, there was a statistically significant association between completing secondary school and knowing about the curability of TB, when adjusting for location and age (adjusted odds ratio 8.27; 95% confidence interval 1.15–59.50). This study represents the first time that health- seeking behaviour and understanding of TB has been assessed in a Bolivian population. The association be- tween education and knowledge about the disease has been reported in other countries. 3,4 In those set- tings, patients who knew about TB symptoms and its curability and perceived diagnosis and treatment as being free were more likely to seek medical attention in the formal health sector. 5 The association between location and knowledge may be partly explained by the activities of public health campaigns in El Alto. Caranavi patients were less knowledgeable about TB than those in El Alto, but more knowledgeable than patients in Achacachi. This is possibly because Ca- ranavi is highly endemic for TB. This study had several limitations, including the small sample size, the cross-sectional survey design, and the use of convenience sampling, which prevents us from generalising the findings to the general Boliv- ian population. Further studies exploring the socio- demographic determinants of TB knowledge across all of Bolivia are needed to build on the findings of this study and to assist with effective targeting of fu- ture public health campaigns. Mary Punchak* Pilar Hernandez † Christian Bottomley* Carla Jemio ‡ Mirtha Camacho § Ruth McNerney* *London School of Hygiene & Tropical Medicine London UK † Pro Mundi Share Salut Romualdo Herrera 770 La Paz ‡ Laboratorio Departamental de Tuberculosis SEDES La Paz La Paz § Instituto Nacional de Laboratorios de Salud La Paz, Bolivia e-mail: [email protected] http://dx.doi.org/10.5588/ijtld.13.0432 Acknowledgements The authors acknowledge the assistance of N Nina, Licenciada R Casillo and J Melgarejo and other staff at the collaborating centres and the patients who took part in this study. They also thank the London School of Hygiene & Tropical Medicine Trust Funds for fi- nancing travel to Bolivia to carry out field research for this project.
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Sociodemographic Determinants of TB Knowledge
Transcript of Punchak_IJTLD_2013
Correspondence 1245
References1 World Health Organization. Guidelines for the programmatic
management of drug-resistant tuberculosis. Emergency update 2008. WHO/HTM/TB/2008.402. Geneva, Switzerland: WHO, 2008. http://whqlibdoc.who.int/publications/2008/9789241547 581_eng.pdf Accessed June 2013.
2 Caminero J A, ed. Guidelines for clinical and operational man-agement of drug-resistant tuberculosis. Paris, France: Interna-tional Union Against Tuberculosis and Lung Disease, 2013.
3 World Health Organization. Treatment of tuberculosis: guide-lines. 4th ed. WHO/HTM/TB/2009.420. Geneva, Switzerland: WHO, 2009. http://whqlibdoc.who.int/publications/2010/9789 241547833_eng.pdf Accessed June 2013.
4 Bojorquez-Chapela I, Bäcker C E, Orejel I, et al. Drug resistance in Mexico: results from the National Survey on Drug-Resistant Tuberculosis. Int J Tuberc Lung Dis 2013; 17: 514–519.
5 Granich R M, Balandrano S, Santaella A J, et al. Survey of drug resistance of Mycobacterium tuberculosis in 3 Mexican states, 1997. Arch Intern Med 2000; 160: 639–644.
6 Blumberg H M, Burman W J, Chaisson R E, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculo-sis. Am J Respir Crit Care Med 2003; 167: 603–662.
Sociodemographic basis of tuberculosis knowledge in Bolivia
Tuberculosis (TB) is a disease that disproportionally affects the poor. Bolivia has an estimated population of 10 million, mostly mestizo and indigenous Aymara and Quechua people, 51.3% of whom live in pov-erty.1 In South America, Bolivia ranks highest in the incidence of TB, with a rate of 131 cases per 100 000 population.2 Lack of knowledge about TB may play an instrumental role in preventing symptomatic indi-viduals from seeking medical attention. In this pre-liminary study (approved by the Tuberculosis De-partmental Laboratory SEDES in La Paz and the Research Ethics Committee of the London School of Hygiene & Tropical Medicine), we assessed factors associated with health-seeking behaviour and knowl-edge of TB among persons presenting to health cen-tres. Face-to-face interviews with 20 adult patients from each of the three participating health facilities located in three geographically distinct regions of Bolivia (El Alto, Acha cachi and Caranavi) were con-ducted from 18 June to 26 July 2012. Interview data were coded and analysed using Stata 12.1 (Stata Corp, College Station, TX, USA).
The mean age of the patients interviewed was 26.9 years (18–44); the majority (90%) were women. The majority had completed either primary (43.3%) or secondary (45%) school. Patients who lived less than 30 minutes away from a health centre were more likely to go there or visit a pharmacy if sick, while those who lived 1 to 3 hours away practised home remedies (P = 0.045). The most commonly identifi ed symptom of TB was persistent cough (60%). Overall, 61.7% of the interviewees knew that TB is a curable disease, and 60% knew that it is an infectious dis-ease. Adjusting for schooling, the data suggested a
statistically signifi cant association between location and ability to identify cough as a symptom of TB (P = 0.02) as well as with knowing that TB is curable (P < 0.01). In addition, there was a statistically signifi cant association between completing secondary school and knowing about the curability of TB, when adjusting for location and age (adjusted odds ratio 8.27; 95% confi dence interval 1.15–59.50).
This study represents the fi rst time that health-seeking behaviour and understanding of TB has been assessed in a Bolivian population. The association be-tween education and knowledge about the disease has been reported in other countries.3,4 In those set-tings, patients who knew about TB symptoms and its curability and perceived diagnosis and treatment as being free were more likely to seek medical attention in the formal health sector.5 The association between location and knowledge may be partly explained by the activities of public health campaigns in El Alto. Caranavi patients were less knowledgeable about TB than those in El Alto, but more knowledgeable than patients in Achacachi. This is possibly because Ca-ranavi is highly endemic for TB.
This study had several limitations, including the small sample size, the cross-sectional survey design, and the use of convenience sampling, which prevents us from generalising the fi ndings to the general Boliv-ian population. Further studies exploring the socio-demographic determinants of TB knowledge across all of Bolivia are needed to build on the fi ndings of this study and to assist with effective targeting of fu-ture public health campaigns.
Mary Punchak*Pilar Hernandez†
Christian Bottomley*Carla Jemio‡
Mirtha Camacho§
Ruth McNerney**London School of Hygiene & Tropical Medicine
LondonUK
† Pro Mundi Share SalutRomualdo Herrera 770
La Paz ‡ Laboratorio Departamental de
Tuberculosis SEDES La Paz La Paz
§ Instituto Nacional de Laboratorios de Salud La Paz, Bolivia
e-mail: [email protected]://dx.doi.org/10.5588/ijtld.13.0432
AcknowledgementsThe authors acknowledge the assistance of N Nina, Licenciada R Casillo and J Melgarejo and other staff at the collaborating centres and the patients who took part in this study. They also thank the London School of Hygiene & Tropical Medicine Trust Funds for fi -nancing travel to Bolivia to carry out fi eld research for this project.
1246 The International Journal of Tuberculosis and Lung Disease
References
1 World Bank. World development indicators—Bolivia, 2012. Washington, DC, USA: World Bank. http://www.worldbank.org/en/country/bolivia Accessed June 2013.
2 World Health Organization. Global tuberculosis control, 2012. WHO/HTM/TB/2012.6. Geneva, Switzerland: WHO, 2012.
3 Salaniponi F M L, Harries A D, Banda H T, et al. Care seeking behaviour and diagnostic processes in patients with smear-positive
pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis 2000; 4: 327–332.
4 Storla D G, Yimer S, Bjune G A. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health 2008; 8: 15.
5 Cuevas L E, Yassin M A, Al-Sonboli N, et al. A multi-country non-inferiority cluster randomized trial of frontloaded smear microscopy for the diagnosis of pulmonary tuberculosis. PLoS Med 2011; 8(7): e1000443.
ERRATUM
IN THE ARTICLE entitled ‘Waterpipe smoking: prevalence and attitudes among medical students in London’ by M. Jawad, J. Abass, A. Hariri, K. G. Rajasooriar, H. Salmasi, C. Millett, F. L. Hamilton (Int J Tuberc Lung Dis 2013; 17(1): 137–140; http://dx.doi.org/10.5588/ijtld.12.0175), an error occurred in the labelling of the last three lines of Table 2. It should have read as follows:
Ever smoker (n = 253) Prevalence: ever %
Current smoker (n = 54) Prevalence: current
%OR (95%CI) P value OR (95%CI) P value
Smoking status Never Former Current
1.0 6.90 (2.92–16.30)14.85 (3.35–65.89)
<0.01<0.01
4.484.393.5
1.00.76 (0.22–2.67)5.16 (1.92–13.87)
<0.67<0.01
9.6 9.832.3
[http://dx.doi.org/10.5588/ijtld.12.0175-e]
