|Year : 2017 | Volume
| Issue : 3 | Page : 274-280
Knowledge on tuberculosis among the members of a rural community in Myanmar
Kyaw San Lin, Chit Sandy Kyaw, Ye Pyae Sone, Su Yi Win
Community Field Training Centre, Hlegu, and University of Medicine 1, Yangon, Myanmar
|Date of Web Publication||31-Jul-2017|
Kyaw San Lin
No. 40, Room 12, Bahosi Housing, Lanmadaw Township, Yangon
Source of Support: None, Conflict of Interest: None
Background: Myanmar, one of the high tuberculosis (TB) burden countries, is in serious need of research work to develop strategies aiming to tackle the problem. Conducting a study on the knowledge of the population will help understand the flaws in the National TB Control Program (NTP), and how to correct them, and further strategic planning to reach the goals of Sustainable Development Goals. Aims: The aim of the study was to access sociodemographic characteristics, knowledge, and behavioral practice of TB among the community members in Ngar Syu Taung Village, Hlegu Township. This is a cross-sectional descriptive study. The number of defined person was 200. Methods: Nonprobability convenience sampling method was used. Data collection method used was face-to-face interviewing method using questionnaires. They were collected by house officers as a part of the community medicine training program. Results: Less than half of the respondents were not aware of TB meningitis (41%) and TB osteomyelitis (49%) and they are not aware that diabetic patients are one of the commonly infected people (41.5%). Furthermore, less than one-third of the patients know that TB can infect the gut (23%) and cause bowel obstruction (30.5%). Conclusions: Wrong ideas should be tackled, and lacking knowledge should be enlightened. Nationwide studies using stronger study designs are also urgently needed. Implementing these evidence into NTP is necessary for Myanmar, to escape from being a TB high-burden country.
Keywords: Knowledge, Myanmar, survey, tuberculosis
|How to cite this article:|
Lin KS, Kyaw CS, Sone YP, Win SY. Knowledge on tuberculosis among the members of a rural community in Myanmar. Int J Mycobacteriol 2017;6:274-80
|How to cite this URL:|
Lin KS, Kyaw CS, Sone YP, Win SY. Knowledge on tuberculosis among the members of a rural community in Myanmar. Int J Mycobacteriol [serial online] 2017 [cited 2019 Mar 21];6:274-80. Available from: http://www.ijmyco.org/text.asp?2017/6/3/274/211938
| Introduction|| |
Tuberculosis (TB) is a common disease in Myanmar. The causal organisms are various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. Due to its air-born transmission as the primary mode of transmission, TB has become the disease of community concern for Myanmar. Proper research is needed to explore the knowledge of the community members on TB.
In 2015, World Health Organization (WHO) estimated 10.4 million new (incident) TB cases worldwide, of which 5.9 million (56%) were among men, 3.5 million (34%) among women, and 1.0 million (10%) among children. People living with human immunodeficiency virus (HIV) accounted for 1.2 million (11%) of all new TB cases.
According to WHO TB Report 2016, Myanmar is included in all three categories of TB high-burden countries in the world: TB, multidrug-resistant TB (MDR-TB), and TB/HIV. In 2015, mortality (excludes HIV + TB) is 49 per 100,000 population. Estimated percentage of new TB cases with MDR/rifampicin-resistant TB (RR-TB) was 5.1%, of previously treated TB cases 27%. Estimated number of MDR/RR-TB cases among notified pulmonary TB cases was 9000. There were 43 MDR/RR-TB cases tested for resistance to second-line drugs.
According to Myanmar Demographic and Health Survey (MDHS) 2015–16, more than 9 in 10 women and men aged 15–49 have heard of TB. The lowest level of knowledge about TB is among women and men in Shan State, where only two-thirds have heard of TB. Knowledge of TB is also relatively low among those with no education, with only about seven in ten have heard of TB.
We have done a survey on knowledge on TB at the Ngar Syu Taung village during our training period to Hlegu Township for the community medicine field training as part of the house officer training. The training period was from May 8, 2017, to May 19, 2017.
| Methods|| |
This is a cross-sectional descriptive study. The number of defined persons was 200.
Selection and description of participants
Study area assigned was Ngar Syu Taung village, Hlegu Township. The village is located within Yangon Division of Myanmar. In 2016, there were 69 old cases of TB per 100,000 population and 69 new cases of TB per 100,000 population. Nonprobability convenience sampling method was used for the selection of participants with an age of ≥18 years of both sexes.
Questionnaire development and data collection
The questionnaire was developed by 11 house officers, and a brief pilot study was conducted among the other 34 house officers and reviewed by a supervisor.
The survey program was conducted by 33 house officers. Data collection method used was face-to-face interviewing method using questionnaires.
The data were analyzed by computer processing using Statistical Package for the Social Sciences (SPSS) 16.0 (SPSS Inc, Chicago, USA).
The objectives of the study were explained before asking the questionnaires. It was made sure that there was absolute confidentiality of the information during and after conducting the study. However, permission from the Ethics Committee was not obtained because this study is not an interventional study.
| Results|| |
Sociodemographic characteristics of respondents
In [Figure 1.1], out of 200 respondents, 54% were males and 46% were females.
In [Figure 1.2], regarding the age group distribution, this graph shows that 26.5% of the population were between ages of 35 and 44 years, 20% were between 45 and 55 years, 19.5% between 25 and 34 years, 18.5% were 55 years and above, and only 15.5% between 18 and 24 years.
In [Figure 1.3], as for the educational status, most of the studied population, 33% had basic middle school level. Moreover, 24% had basic high school level, 16.5% had basic primary school level, 12% can only read and write, 11% are graduates, but 3.5% were illiterate.
|Figure 1.3: Educational status (BHS -basic high school, BMS -basic middle school, BPS -basic primary school)|
Click here to view
In [Figure 1.4], among respondents, most (42%) of the studied population were vendors. Moreover, there were dependents (17.5%), farmers (13%), manual workers (12%), homemakers (8%), government officers (3.5%), retired (2.5%), and company staffs (1.5%).
In [Figure 1.5], according to the survey, 74.5% of the studied population were married, 20% were single, 1.5% divorced, and 4% were widows or widowers.
In [Figure 1.6], among respondents, about 28% of the studied population had 200,000 Kyats and above family income per month, 24% had a monthly income of 150,000–200,000 Kyats, 21% had 100,000–150,000, 18% had 50,000–100,000 Kyats, and 9% had less than 50,000 Kyats.
In [Figure 1.7], 38% of the population lived in wooden houses, 20% in bamboo house, 18% in semi-pucca, 15.5% in buildings built with reinforced concrete, and 8.5% had to rent.
Therefore, out of 200 respondents, the majority of the respondents were between 35 and 44 years old (26.5%), married (74.5%), vendors (42%), and finishing only middle school (33%). They had a monthly income of 200,000 Kyats and above (28%) and living in the wooden house (38%).
Knowledge of tuberculosis
In [Figure 2.1], regarding the mode of transmission of TB, 95.50% of the studied population believed that TB was transmitted by coughing, but 36.5% believed that TB is hereditary.
In [Figure 2.2], regarding the signs and symptoms of TB, 81.50% thought that coughing for more than 3 weeks was one of the symptoms of TB, 79.5% about loss of weight as a symptom, 75% about blood-stained sputum, 74.5% about being easily tired, fatigue, and lassitude, 70% about loss of appetite, but only 70% knew that evening rise in temperature was one of the symptoms of TB.
In [Figure 2.3], regarding the commonly infected person for TB, 86% of the studied population knew that TB can occur at any age. About commonly infected person, 80% knew that elderlies were included, 79% knew about immunodeficient person and children, 71% about malnourished, but only 41.5% about diabetic patients.
In [Figure 2.4], 92.50% of the studied population knew that TB can infect lungs, but 42.5% knew that TB can infect bone, 28% about the brain, and 23% about the intestines.
In [Figure 2.5], regarding the complications of TB, 86.50% of the population knew that TB can lead to death if untreated, 60.5% about pleural effusion, 50.5% about pneumothorax, 49% about TB osteomyelitis, 41% about TB meningitis, but only 30.50% of the population knew that TB can cause intestinal obstruction.
In [Figure 2.6], regarding the diagnostic tests for TB, 95.50% of the population knew that TB can be diagnosed by taking sputum examination, 77.5% about taking chest X-rays, 51.5% wrongly thought that TB can be diagnosed by blood sampling, and 35.5% wrongly thought that TB can be diagnosed by taking urine sample.
In [Figure 2.7], regarding the types of treatment, 93.50% of the studied population thought TB patient should be consulted with a doctor. Nearly 75% knew about directly observed treatment, short course (DOTS) treatment. However, 34.5% thought that TB can be treated with traditional medicine and 27.50% of the population believed that TB can be treated by self-medication.
In [Figure 2.8], about 91.50% of the studied population knew that taking healthy diets is important during taking treatment of TB. Almost 87% knew that TB is a curative disease and 85% knew about taking anti-TB regularly at least 6 months. Nearly 80% knew to recheck sputum after 6 months of anti-TB and only 21% wrongly thought to withdraw anti-TB by him/herself when he/she feels better.
In [Figure 2.9], regarding the methods of prevention, about 87.5% of the population knew that proper disposal of TB patient's sputum can prevent the spread of TB, 86.6% knew about staying away from TB patients, and 59.5% were aware of Bacillus Calmette–Guérin vaccine.
Hence, almost all the respondents were aware that TB is infected by coughing (95.5%), can infect the lungs (91.5%), can be diagnosed by taking sputum (95.5%), and should be consulted with a doctor (93.5%).
More than two-third of the patients were aware of all the signs and symptoms of TB (minimum 70%), all the commonly infected persons for TB (minimum 71%) except diabetic patients (41.5%), can cause death if untreated (86.50%), can be diagnosed by taking chest X-ray (77.5%), DOTS treatment (75%), about TB treatment (80%), and prevention (86.5%).
Less than half of the respondents were not aware of TB meningitis (41%) and TB osteomyelitis (49%) and they are not aware that diabetic patients are a commonly infected person (41.5%). Furthermore, less than one-third of the patients know that TB can infect the gut (23%) and cause bowel obstruction (30.5%).
In [Figure 2.10], within our survey area, 90% of the population got information regarding TB from radio and TV, 84% from health workers, 81.5% from health education programs, 80% from pamphlets, and 73.5% from newspapers, journals, and magazines.
In [Figure 2.11], 54% of the studied population had good knowledge about TB, but 46% had poor knowledge.
Behavioral practice of respondents
In [Figure 3.1], according to the study, 68% of the studied population were nonsmokers. Nearly 7% were ex-smokers, but 25% were still smoking.
In [Figure 3.2], 82.5% of the population had a good habit of not smoking in public, but 17.5% were still smoking in public.
In [Figure 3.3], 63% of population covered the mouth with a handkerchief when they cough, but 37% did not.
In [Figure 3.4], 70.5% of the population did not usually use a mask when they are ill. Only 29.5% usually used a mask when they are ill.
In [Figure 3.5], 52% of the studied population discarded the sputum in a bowl, but 48% of the population claimed that they discard anywhere convenient.
In [Figure 3.6], 94% of population opened the windows during the daytime. Only 6% did not open the windows during the daytime.
In [Figure 3.7], only 34% of the population went to crowded places, 66% did not.
| Discussion|| |
This survey has revealed important information regarding the knowledge and behavioral practice of the Ngar Syu Taung village population. Using this information, appropriate intervention plans should be done to tackle the problems regarding TB.
Only 54% (n = 200) of the respondents have good knowledge, which is a really low value, as Myanmar is a country with very high TB burden. Intervention is required urgently to increase the knowledge of the rest (46%) (n = 200) of the respondents. A survey conducted on 2016 at the same village yielded 61% of high knowledge and 39% of low knowledge. (paper submitted to the University of Medicine 1, Yangon; unpublished private collection; unreferenced). Compared to that study, the knowledge level has slightly declined this year. One intervention recommended should be health education as a study conducted in Vietnam, a South-east Asian country like Myanmar has found that receiving health education can increase the knowledge on TB. Health education through radios and television is urgently suggested as they are the major source of information (90%) (n = 200) and the knowledge level will continue to decline if there is no further intervention.
However, in a nationwide study, MDHS 2015–16, 71% of women and 63% of men know that TB spreads through coughing, compared to 95.5% (n = 200) in this study. This means that there are many regions in Myanmar that have far worse knowledge on TB than this studied village.
Regarding the topics, tuberculous meningitis, tuberculous osteomyelitis, and tuberculous intestinal obstruction should also be emphasized with the same level as the another topic as they are usually not included in most health education programs in Myanmar. Awareness should also be raised regarding the association between diabetes and TB. Surveys conducted last year in the same village, as well as the nearby Phaung Gyi Village, yielded a similar result. (paper submitted to the University of Medicine 1, Yangon; unpublished private collection; unreferenced).
Another important fact is that 27.50% (n = 200) of the respondents agreed to self-medication, which is a dangerous problem, as drug resistance may arise. Almost 34.5% (n = 200) agreed to traditional medicine, which is also harmful to the individual as well as for the public. A similar finding was found from a study conducted at Ethiopia where 45.3% (n = 422) of the study population prefer traditional healers for treatment. Surveys conducted in the same village, as well as the nearby Phaung Gyi Village, yielded a similar result. (paper submitted to the University of Medicine 1, Yangon; unpublished private collection; unreferenced). Local traditional practitioners and drug stores should be informed and given information not to give traditional treatment and drugs to people suspected of suffering from TB.
Regarding the behavioral practice of the respondents, 25% (n = 200) were still smoking, so health education programs aimed at smoking cessation are highly recommended. Furthermore, their behavioral practices were mostly wrong, not covering the mouth with a handkerchief when they cough (37%) (n = 200), not using a mask when they are ill (70.5%) (n = 200), and discarding the sputum anywhere (48%) (n = 200). This could lead to high risk of transmission among the population. Health education intervention is urgently needed to correct these wrong practices. A study conducted at three main industrial zones of Yangon, Myanmar, revealed a similar result.
| Conclusion|| |
Our study has revealed some wrong idea and lack of knowledge in certain areas regarding TB. These wrong ideas should be tackled, and lacking knowledge should be enlightened. For doing so, we have found out the most effective way as television and radio. Cooperation between Ministry of Health and Sports and Ministry of Information is needed for broadcasting health education programs on television and radio.
Moreover, nationwide studies using stronger study designs are also urgently needed. Interventional studies, preferably randomized control trials, are also recommended to have a high-quality evidence. A systematic review of all these studies would be the next step recommended. Implementing these evidence into NTP as included in the Strategic Direction III: Intensified Research and Innovation of the 2016-2020 National Strategic Plan for TB Control, with a strong advocacy, communication, and social mobilization strategy, is absolutely necessary for our country, Myanmar, to escape from being a TB high-burden country.
We would like to express our deep sense of gratitude to the Rector of University of Medicine 1, Yangon, Prof Zaw Wai Soe and the Professor & Head of Department of Pediatrics, Prof Ye Myint Kyaw, for letting us learn about community medicine and get trained for research work. We are also grateful to our respected Associate Prof Chaw Su Maung, Assistant Lecturer Daw Than Win, Senior Tutor Daw Mya Mya Win, Tutors Daw Khin Mar Cho, Daw Oo Than Nu, U Sai Min Min Oo and Daw San Ou from the Community Field Training Center, Hlegu for their close supervision and valuable guidance during our training periods. We are also thankful to Township Medical Officer, Medical Officers and all the other staff members from Hlegu General Hospital and Health Assistant from Ngar Syu Taung Rural Health Center for their kind co-operation and help. We would like to give special thanks to our colleagues, Su Lei Yee, Khin Zar Thwe, Khin Chit Zin, Su Kyi Lin, Khin Gonyi Lin, Soe Ei Ei The, Su Sandar Tun, Hsu Sandi Oo, Cho Thet Zin, Khine Khine Zaw, Kyaw Zin Oo, Kyaw Khan Zaw, Khant Kyaw Swar, Kyaw Zaw Hein, Khin Ma Ma Soe, Khin Pyae Sone Thu, Cynthia Cheng, Kay Yu San, Kaung Htet Tun, Khin Cherry Mon, Khine Mon Yee Hlaing, Sein Lei Lei Thazin Aye, Khine Zin, Cho Cho Khine, Kyaw Htet Tun, Khin Thuzar Kyaw, Kyaw Zin Aung, Khin Thandar Oo, Kaung Htet, Su Su Pyae Sone Myint, Soe Nyein Nyein Thu, Chu Chu Naing Lin, Khin Thiri Lwin, Khin Myo Thet, Chan Nyein Su, Chit Hsu Lub, Khin Sabai Sint, Khin Su Nandar, Su Myat Than Hman, Su Myat Mon, and The The Khine for their kind participation in questionnaire development and data collection.
Financial support and sponsorship
This study was self-financed, and general support was received from Community Field Training Center, Hlegu, and University of Medicine 1, Yangon.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1.4], [Figure 1.5], [Figure 1.6], [Figure 1.7], [Figure 2.1], [Figure 2.2], [Figure 2.3], [Figure 2.4], [Figure 2.5], [Figure 2.6], [Figure 2.7], [Figure 2.8], [Figure 2.9], [Figure 2.10], [Figure 2.11], [Figure 3.1], [Figure 3.2], [Figure 3.3], [Figure 3.4], [Figure 1.1], [Figure 1.2], [Figure 1.3], [Figure 1.1], [Figure 1.2], [Figure 1.3], [Figure 3.5], [Figure 3.6], [Figure 3.7]