Knowledge and attitude of key community members towards Tuberculosis: Mixed method study from BRAC TB control areas in Bangladesh

The Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. Advocacy, communication and social mobilisation (ACSM) was one of the key strategies implemented by BRAC’s tuberculosis control programme. The purpose of this study was to assess the knowledge and attitudes of the key community members who participated in the ACSM programme in three of BRAC’s TB control programme areas in Bangladesh.

This study combined quantitative and qualitative methods, leading to a mixed method approach funded by BRAC’s TB control programme. It was conducted in three districts of Bangladesh which have a low case detection rate of tuberculosis compared to other districts based on the MIS report from BRAC’s tuberculosis control programme.

The findings of this study revealed that the majority of the participants (99 per cent) had heard about TB, and almost all knew TB to be a contagious yet curable disease. A significant portion of the key informants (53 per cent) had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable. BRAC staffs (21 per cent) were found to be the major source of information although considerable knowledge gaps were also observed among BRAC community health workers or shasthya shebikas.

Qualitative results revealed that the majority of the key informants were aware of the signs, symptoms and transmission pathways of tuberculosis and believed that smoking and addiction were the prime causes of transmission of the disease. Knowledge relating to TB in children was found to be poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that it would be difficult for girls to get married if they were diagnosed with tuberculosis.

The study was carried out from May - July 2013. It provided an insight on the limited knowledge surrounding TB in children simultaneously adding credence to the fact that despite the significant success of the TB programme, stigma remained prevalent in the community. Further ACSM activities in the future should engage community members against stigma and promote information related to childhood TB for further improvement of BRAC’s current TB programme.

• A quantitative survey questionnaire was undertaken by a total of 36 enumerators under the guidance of six research assistants supervised by a research team.
• Prior to data collection, an extensive training session was conducted which included a background briefing on the project and its objective. The training also disseminated information on ACSM activities undertaken by BRAC’s TB control programme.
• The questionnaire was prepared in English and translated into Bengali. After pre-testing, the Bengali version of the questionnaire was modified and back translated into English with feedback from the pre testing duly incorporated.
• All of the instructions, including skipping and probing had been documented as a field protocol to assist the field workers.
• For quantitative analysis, descriptive statistics were reported using frequencies and percentages, and Chi square test; thematic analysis was used for qualitative part.

• BRAC TB control programme
• GFATM TB Global Fund to Fight AIDS, Tuberculosis and Malaria

• The study findings 2013 were submitted to BRAC’s TB control programme.
• An article was published in BMC Public Health in 2014.