Infectious Diseases Diagnosis & Treatment (ISSN: 2577-1515)

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Tuberculosis Awareness Among Nurses Working in Tertiary Care Hospital Peshawar

Muslim Shah*

Rehman College of Nursing, Rehman Medical Institute Peshawar, Pakistan

*Corresponding author: Muslim Shah, Assistant Professor, Rehman College of Nursing, Rehman Medical Institute Peshawar, Pakistan. Tel: +922542036626; Email: muslimshah266@gmail.com, Muslim.shah@rmi.edu.pk

Received Date: 06 March, 2018; Accepted Date: 07 June, 2018; Published Date: 18 June, 2018

1.                   Abstract

1.1.              Objective: The objective of the study was to assess tuberculosis awareness among nurses.

1.2.              Methodology: A descriptive cross-sectional study was conducted in tertiary care hospital Peshawar KPK. Participants were selected through random sampling technique. The data was collected through a self-developed structured questionnaire. The confidentiality and anonymity was maintained throughout the study.

1.3.              Result: The study consisted of 52 participants including 12(23.1%) males and 40(76.9%) females. Awareness of staff was calculated; result showed that 23.1% had high, 65.4% had moderate and 11.5% had low level of knowledge. Chi square test was applied to check the association between variables and awareness. There was no association found in the result.

1.4.              Conclusion: The study was conducted to assess the tuberculosis awareness among nurses in private tertiary care hospital. The majority of the participant ie 65.4% had moderate level of knowledge. General lack of knowledge was assessed regarding various aspects. Nurses need further training regarding TB.

2.                   Keywords: Infection; Knowledge; Nurses; Tuberculosis

1.       Background

Tuberculosis (TB) is a communicable disease that affects mostly the lungs but can also affect other parts of the body. It is caused by bacteria which are called Mycobacterium tuberculosis. The most common symptoms of tuberculosis are cough, fever, night sweat, weight loss. TB is air borne disease transmitted through air from one person to another [1].

According to World Health Organization (WHO), [2] report, TB is the ninth leading cause of death worldwide and the leading cause from a single infectious agent, ranking above HIV/AIDS. An estimated 10.4 million people (90% adults; 65% male; 10% people living with HIV) fell ill with TB in 2016.Most of the estimated number of incident cases in 2016 occurred in the WHO South-East Asia Region (45%). The top five countries, with 56% of estimated cases, were (in descending order) India, Indonesia, China, the Philippines and Pakistan [2].

A Cross-sectional study was conducted about healthcare provider knowledge, attitudes & practices regarding tuberculosis care. The result of study revealed that 56.13% had a good level of TB knowledge; and the remainder had a fair level. Providers’ knowledge levels were significantly linked to attendance at TB training, as well as their profession. There was strong association between knowledge and attendance at TB program [3].

Another Cross-sectional study about knowledge and practices regarding tuberculosis among nurses was conducted. The staff of medical college and peripheral health care unit was observed. The nursing staff posted in Medical College had less knowledge (mean score-12.8) as compared to the nursing staff of a peripheral health care unit (mean score- 15.3). Further they identified that Training under Revised National TB control program (RNTCP) should not be limited to peripheral health unit’s Nurses but also organize this program to nurses of medical colleges [4].

A study on Assessment of knowledge, attitudes and practices regarding T.B was conducted among medical students in Iran. The knowledge of the students was assessed and the mean score was 16.13±2.06. The majority of the students were fall in moderate to high level of knowledge. Around all of them had knowledge of T.B patients can’t be treated only on radiography. Two –thirds of them were no knowledge regarding distance which was kept from contagious patients. Most of the students were unaware of BCG vaccine that prevents T.B [5].

TB is one the major public health issues and nurses play a vital role in the prevention and treatment. Knowledge of nurses regarding TB is very important and should be addressed. The treatment and prevention of infection is the responsibility of nurses. Nursing staff is first level professional person and are responsible for direct patient care. They also impart health education to patient as well as his/her family members and other contacts [4].

1.1.  Purpose

The purpose of this study was to explore knowledge of nurses working in private tertiary care hospital in Peshawar, Pakistan.

1.2.  Research Questions

What do nurses working in private tertiary care hospital know about tuberculosis?

1.3.  Methodology

1.3.1.         Study Design

For this research project a quantitative, descriptive cross sectional study was used. Cross-sectional design is used when the researcher is concerned to gather the evidence at a given point and provide a picture of the population.

1.3.2.         Population and Setting

The population of the study was all nursing staff of private tertiary care hospital Peshawar, KP.

1.3.3.         Sampling technique

Simple random sampling technique was used to gather data from subjects. By using random sampling technique an unbiased sample was selected from population.

1.3.4.         Sample size

Sample size of the study was 52, as calculated by Raosoft software, using the population size 176 with 5% margin of error and 5% non-responsive rate.

1.3.5.         Data collection tools

Self-structured questionnaire was developed, which consisted of 18 questions about tuberculosis awareness among nurses. A criteria was developed; positive response to more than 14 questions was considered as high awareness, positive answer to more than 7and less than 14 questions was deliberated as moderate awareness and poor awareness was reflected when positive response was less than 7 questions.

1.3.6.         Ethical consideration

Approval was taken from Chief Nurse of the institute for data collection. Informed Consent was taken from each participant prior to participation in the study. Confidentiality and anonymity was maintained throughout the study.

1.3.7.         Pilot Study

Pilot study was conducted on 10% of the participants to evaluate the feasibility of the study. During the pilot study, there was no specific difficulty faced by participant.

1.3.8.         Inclusion criteria

All those Nurses who are working at the same hospital for at least one year.

1.3.9.         Exclusion criteria

All those nurses who are on the management posts.

1.3.10.      Data analysis

Analysis and presentation of the data was done using statistical Package for social sciences (SPSS) 20 version. Tables and flow charts were used for presentation of descriptive data, percentages and frequencies were calculated for nominal and ordinal data. Chi square test was used to check association among variables.

2.       Results

The study consisted of 52 participants, including 12 (23.1%) males and 40 (76.9%) females (shown in Figure 1). Numbers of the subjects from 18-25 years were 36 (69.2%), from 25-30 years were 8 (15.40%), from 30-35 years were 5 (9.6%), and above 35 were 3 (5.8%), (Shown in Figure 2). Concerning the educational level of the respondents, 48 (92.3%) were diploma holders and 4 (7.7%) were BSN degree holders (shown in Figure 3). Only 16 (30.8%) of the respondents were graduates of government nursing schools and 36 (69.2%) were graduates of private nursing schools (Table 1). Experience of the participants from 1-3 years =30 (57.7), 3-6 years = 12 (23.1%), 6-9 years = 5 (9.6%), and above 9 years 5 (9.6%) were calculated (Shown in Figure 4). Awareness of staff was calculated in percentage; result showed that among the participants 23.1% were high, 65.4% were moderate and 11.5% were low level of knowledge (Shown in Figure 5). Furthermore, chi-square test was applied to check the association among variables and awareness; there was no association found in the results (Table 2).

Awareness about Tuberculosis

S/No

Categories

Frequency

Percentage

1

high knowledge

12

23.10%

2

Moderate knowledge

34

65.40%

3

low knowledge

6

11.50%


Literature was searched thoroughly about tuberculosis awareness among nurses. A number of studies were found from different countries of the world. There were no specific studies found in KPK on the same topic.

Study consistent with findings of current study was conducted in Thailand by [3] found that 56.13% had Good and approximately 44% of the health care providers had a fair level of TB knowledge.

A study conducted by [6] in Russia. That was overall TB knowledge score were low among healthcare workers, especially laboratory technician and support staff. They further reported the percentage of correct responses of TB ‘causative agent’ was 87% and the response of ‘common symptoms’ of TB was 79%. Current study also showssame result; 86.5% and 80.8% was the correct response of causative agent and knowledge about common symptoms respectively.

A study in the Berea District of Lesotho, South Africa on occupational exposure to TB reported that the majority of healthcare workers (86.1%) have a ‘fair’ score for knowledge [7]. While the result of current study also showed lack of knowledge regarding various aspects of tuberculosis among nurses.

Study conducted in Iraq showed that overall, 98.4% health care workers had good knowledge about TB [8]. A study conducted in Iran by [5], identified knowledge level of the subjects was moderate to high in the majority of the students. These results reported high level of knowledge about tuberculosis. On other side current study highlights low level of knowledge among nurses.

The discrepancy might be due to the differences in the study set up and methods.

4.       Recommendations and Limitations

The health care organization should arrange continuous educational sessions and training programs to keep nurses updated regarding TB. Educational sessions and training programs regarding TB should be made compulsory for those health care professionals who work in pulmonary department.

A large scale study is needed to be conducted on this topic. A study is needed to conduct to find out the reasons behind inadequate knowledge among nurses regarding TB. Due to financial and time constrains study was limited only to private tertiary care, and hence result could not be generalized.

5.       Conclusion

It is concluded that majority of the participant i.e. 65.4% had moderate level of knowledge. However, tuberculosis is the common communicable disease and being healthcare professional nurses should have enough knowledge about each aspect of the disease. In this study a general lack of knowledge regarding various aspects of tuberculosis among nurseswere observed. Nurses need further education and training regarding TB.


Figure 1: Gender of the participants.



Figure 2: Age of the participant.



Figure 3: Qualification of participant.



Figure 4: Experiences of the participant.



Figure 5: Awareness about tuberculosis.

S/No

Categories

total

Percentage

1

government

16

30.80%

2

private

36

69.20%

3

total

32

100%

Table 1: Graduation from.


S/no

Questions

T/Participant

Yes

%age

No

%age

Don’t know

%age

1

have you heard about tuberculosis

52

52

100%

Nil

Nil

Nil

Nil

2

Do you know the causative agent of TB

52

45

86.50%

7

13.50%

Nil

Nil

3

Is tuberculosis a transmissible disease

52

47

90.40%

4

7.70%

1

1.90%

4

Do you know how people get TB

52

34

65.40%

13

25.00%

5

9.60%

5

Are the patient with HIV is at higher risk of developing tuberculosis

52

20

38.50%

22

42.30%

10

19.20%

6

Does TB affect only lungs

52

27

51.90%

20

38.50%

5

9.60%

7

Do you know about common symptoms of TB

52

42

80.80%

8

15.40%

2

3.80%

8

Does TB diagnose is in children is more difficult than in adult

52

18

34.60%

20

38.50%

14

26.90%

9

Does Sputum microscopy is the most effective tool for the diagnosis of TB

52

29

55.80%

14

26.90%

9

17.30%

10

Is tuberculosis a curable disease

52

14

84.60%

4

7.70%

4

7.70%

11

Do you know about DOTS therapy

52

 

21.20%

13

25.00%

28

53.80%

12

Is there a vaccine for TB

52

35

67.30%

11

21.20%

6

11.50%

13

Do you know the best time for BCG vaccination

52

39

75.00%

7

13.50%

6

11.50%

14

Do TB conformed patients should be kept separately

52

31

59.60%

11

21.20%

10

19.20%

15

Do you know how to protect from TB

52

42

80.80%

19

17.30%

1

1.90%

16

Do you know about N95 mask

52

24

46.20%

13

25.00%

15

28.80%

17

Is N95 mask protecting the health care worker from M. Tuberculosis

52

21

40.40%

12

23.10%

19

36.50%

18

Is ventilation necessary in the implementation of TB infection control

52

22

42.30%

16

30.80%

14

26.90%

Table 2: The overall percentage of questions about Tuberculosis Awareness is given in table-2.


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2.       World Health Organization (2017) Global tuberculosis report 2017.

3.       Lertkanokkun S, Okanurak K, Kaewkungwal J, Meksawasdichai N (2013) Healthcare providers’ knowledge, attitudes & practices regarding tuberculosis care. JItMM2012 Proceedings 2: 1-10.

4.       Gupta R, Sood A, Kaistha M, Bhardwaj A, Sharma T (2017) Comparative study of knowledge and practices regarding tuberculosis amongst the nursing staff of medical college and peripheral health care unit. International Journal of Community Medicine and Public Health 4: 3625-3629.

5.       Behnaz F, Mohammadzade G, Mohammadzadeh M (2014) Assessment of    knowledge, attitudes and practices regarding tuberculosis among final year   students in Yazd, central Iran. Journal of epidemiology and global health 4: 81-85.

6.       Woith WM, Volchenkov G, Larson JL (2010) Russian health care workers' knowledge of tuberculosis and infection control [Notes from the field]. The International Journal of Tuberculosis and Lung Disease 14:  1489-1492.

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8.       Hashim DS, Al Kubaisy W, Al Dulayme A (2003) Knowledge, attitudes and practices survey among health care workers and tuberculosis patients in Iraq. East Mediterr Health J 9: 718-731.


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