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Indian Journal of Community Medicine

Knowledge about Tuberculosis in Senior School Students of Punjab

Author(s): U.P. Singh1, A. Bala2, R.K.D. Goel2

Vol. 31, No. 2 (2006-04 - 2006-06)

Introduction

Tuberculosis continues to rank among the World's most serious health problems despite the remarkable achievements of discovering effective diagnostic and treatment measures. In India, tuberculosis case finding under National Tuberculosis Programme (NTP) is a passive process limited to chest symptomatics in the community who attend the Government health institutions on their own for relief of symptoms. It is, therefore essential that the community at large, and younger generations in particular, are aware about the basic facts about tuberculosis. Unless they possess basic knowledge about tuberculosis and its management, they are not likely to make the best use of the available facilities.

We have hardly any data from our country, both rural and urban areas, as to how knowledgeable are our senior school students about different aspects of tuberculosis. The present study was planned with an idea to collect such information.

Material and Methods

In the present study, a total of 1893 students of both sexes studying in 9th to 12th class belonging to 3 urban and 4 rural schools were interviewed. The personnel data as well as information provided by them about different aspects of tuberculosis, like its aetiology, symptomatology, diagnosis, treatment and prevention etc. were recorded on a specially prepared performa. Every effort was made to avoid asking leading questions.

The data was analyzed statistically using Chi-square test to see any differences in awareness levels of males and. females from rural and urban community.

Results

A total of 1893 students including 1068 males comprising 620 male students from the urban area and 448 male students from schools in the rural area and 825 females comprising 425 girls from schools in the urban area and 400 female students from schools in the rural areas of the district were interviewed for the present study. It was planned to include only those students for further analysis who had replied to the question, "Have you ever heard of tuberculosis?" in affirmative.

809 male students (75.9%) and 621 female students (75.2%) i.e. a total of 1430 (75.54%) who answered in the affirmative were eligible for further analysis in this study. The differences between rural and urban students as a whole and between rural urban males as well as between rural and urban females about having heard about tuberculosis was statistically significant. (P< 0.05).

Though nearly 70% of all four groups i.e. urban and rural males and females were aware that tuberculosis is caused by germs, almost equal numbers also held unhygienic food, unclean water, smoking and over crowding directly responsible for causing tuberculosis. However, very small percentage of the interviewed children held evil spirits and demons responsible for causing tuberculosis. The differences in awareness about aetiology of tuberculosis was not statistically significant both between urban and rural students as well as between male and female students.

Whereas fever and weight loss were main complaints of tuberculosis patients, according to replies given by about 65% and 80% students respectively, prolonged cough, chest pain and haemoptysis were described by less than half of all students who had heard about tuberculosis. The differences between urban and rural male and female students were not statistically significant.

Table - I: Knowledge About Aetiology of TB*

  Males Females
Urban Rural Urban Rural
Total 523 286 365 256
Germs 292 (73.54%) 203 (70.98%) 257 (70.41%) 177 (69.14%)
Over crowding
and unhygienic food
358 (61.16%) 180 (62.93%) 225 (61.64%) 154 (60.15%)
Smoking 371 (69.61%) 196 (58.53%) 252 (69.04%) 171 (66.7%)
Spirits/ Demons /Evils 74 (13.88%) 43 (15.03%) 55 (15.06%) 43 (17.06%)
*Many gave more than one reasons

Knowledge about sputum examination and chest skiagram as diagnostic tools was present in 42-48% and 31-35% students respectively. Though more male students, both urban and rural, gave positive replies than female students, the difference was not significant statistically. A very small percentage (4-6%) knew about mantoux test, and its role as a diagnostic tool in children.

Role of BCG as a preentive tool was known to 57%-60% of the students of both rural as well as urban scchools. 31.62%- 35.65% students new that tuberculosis was the urable disease and differene between rural and urban students was not signifiant. In response to the question whether hospitalization is needed ot treat tuberculosis 358 urban males out of 523 (67.55%) answered in the affirmative whereas 194 rural males out of 286 rural students (67.85%) said yes. 69.04% - 71.84% of the female students both rural as well as urban thought that hospitalization is must for treating tuberculosis.

Table II: Knowledge About Symptomatology & Diagnostic Means

  Males Females
Urban Rural Urban Rural
TOTAL 523 286 365 256
Fever 356 (66.79%) 185 (64.68%) 236 (64.66%) 162 (63.28%)
Weight Loss 435 (81.61%) 228 (79.72%) 292 (80.01%) 201 (78.51%)
Prolonged cough 223 (41.83%) 122 (42.65%) 159 (43.56%) 104 (40.62%)
Chest pain 231 (43.34%) 118 (41.26%) 152 (41.64%) 99 (38.67%)
Haemoptysis 229 (42.96%) 118 (41.25%) 145 (39.73%) 99 (38.36%)
Chest X-ray 261 (48.95%) 131 (45.81%) 164 (44.93%) 108 (42.19%)
Sputum 191 (35.65%) 98 (34.26%) 121 (33.15%) 81 (31.62%)
* Mantoux test 35 (6.56%) 17 (5.94%) 21 (5.75%) 11 (4.28%)

Regarding disposal of sputum overall knowledge among the students was poor. Maximum number of students i.e. 29.83%- 36.71% of the students both male as well female were of the view that sputum should be thrown in the drains and disposed of in gutters. Burning as a method of disposal of sputum did not seen to be a popular mode as just 8% of the students opted for it. 18.35%-26.27% of the students of both rural as well as urban area were of the view that sputum should be boiled before dispoal. The difference in percentage among male and females of both rural and urban area in significant. About 32.86%-37.10% of the students among all categories were of the view that the sputum should be buried in ground after digging a hole. The difference in all the groups was insignificant.

Discussion

The present study revelas that the urban and rural higher secondary school students of Punjab, both boys and girls, by and large possess very limited and at times wrong knowledge about various aspects of tuberculosis. The osbservation that only 75.54 percent of total of 1893 students had ever heard of tuberculosis reflects rather poor awareness about tuberculosis at secondary school level. In contrast in a study among tribes of Andhra. Pradesh, only 44% had heard of tuberculosis1. A high level of ignorance, wrong knowledge, wrong attitudes and wrong practices was demonstrated among senior secondary students in a study by Tanimowa from Zambia2. In this study 81.4% students had heard of tuberculosis. Urban students were significantly better informaed about tuberculosis and male students were better informed that girls underlines the need for creating awareness about tuberculosis in all study groups, especially in rural students particularly the females.

Though over 70 percent students knew that tuberculosis is caused by germs, yet a large percentage of students were also of the view that tuberculosis is caused by over crowding, unclean water, unhygienic food and smoking. In Zambian study, 72.3% students were of the opinion that tuberculosis can be due to drinking unclear water or eating unhygienic food. In Andhra tribal area study, 38% cases attributed the disease to tubercle bacilli. Though these factors may contribute the toward progression of ailment, such factors can not be described as aetiological agent. One assuring aspect from this analysis emerged that a very small percent of Punjab students (about 15%) held evil spirits and demons to be responsible for causing tuberculosis. Similar figures (16.2%) were reported by Zambian students2. In contrast, the tribal study from Andhra 24% attributed tuberculosis to be due to superstitious beliefs. About symptoms of tuberculosis, a large number of students knew fever and weight loss as main symptom of tuberculosis. However, awareness about prolonged cough, the main symptom on which tuberculosis case finding and control is based in developing countries, was miserably low (about 40%). In Andhra tribal study1, Uplekar et al reported cough, haemptysis and fever as symptoms of tuberculosis by 66%, 13% and 6% respectively3. In East African study too, only 43.6% students reported cough as main symptom of Tuberculosis. This lack of awareness about prolonged cough can have immense impact on results of passive case finding. In diagnostic measures, only one third students replied that Tuberculosis is diagnosed by sputum examination. Sputum examination is main basis of case finding in tuberculosis control programme and especially RNTCP. There is urgent need to create awareness among students about this important factor.

Though over half of total students knew about BCG vaccinaition as a preventive tool against tuberculosis, only about forty percent cases knew that tuberculosis is now a fully curable disease knoledge about BCG vaccination was peresent in only 14% rural population in a study from Tamilandu4. At the same time nearly 70 percent students were of the view that hospitalization is must for cure of disease. This misconception about poor cure rate and need for hospitalizaiton also needs to be clarified.

There was hardly any knowledge about proper disposal of sputum. This is another important aspect about which there is need for imparting knowledge to students, because by proper disposal of sputum, the chances of disease spread can be minimized. To conclude, the results of present study indicate that students of Punjab, by and large, have rather poor knowledge about various aspects of tuberculosis and a high level of ignorance, wrong knowledge and wrong attitudes is demonstrated. there is urgent need to plan sincere and sutstained effort to educate our studetns about Tuberculosis. It is therefore necessary that different aspects of Tuberculois education should be included in the syllabi of senior school students. By increasing knowledge of school students we can play an important role in tuberculosis control.

References

  1. Rajamma KJ, Rao DV, Narayana ASL, Rameachandran R, Prabhakar R. Health seeking behaviour, acceptability of available health facilities and knowledge about Tuberculosis in a rural area. Ind J Tub 1996, 43:195.
  2. Tanimowo MO. Knowledge, attitudes and practices regarding senior secondary school students. East Afr Med J 1999, 76:47.
  3. Upleakar MW and Sheela Rangan. Tackling TB : The Search for Solutions. The Foundation for Research in Community Health, 1996.
  4. Subramaniam T Charles N, Balasubramaniam R Balambal R. Knowlede about Tuberculosis in a South Indian Rural Community, Initially and after Health Education Ind J Tub 1999, 46:251.

1. Deptt. TB & Chest Hospital, Patiala.
2. SPM Deptt., Govt. Medical College, Patiala.
e-mail: s[email protected], [email protected] Received: 17.11.2004

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