|Year : 2020 | Volume
| Issue : 4 | Page : 79-83
Impact of National Tuberculosis Elimination Program sensitization workshop on health-care workers in a Medical College and Hospital in Karnataka, India
V Narayana Holla1, Sagar Atmaram Borker2, Saroj Swapnil Salelkar3, N Shashikala1
1 Department of Community Medicine, KVG Medical College, Sullia, Karnataka, India
2 Department of PSM ABVIMS and Dr RML Hospital, Delhi, India
3 ESI Dispensary, Goa, India
|Date of Submission||17-Oct-2020|
|Date of Decision||29-Oct-2020|
|Date of Acceptance||01-Nov-2020|
|Date of Web Publication||25-Dec-2020|
Dr. Saroj Swapnil Salelkar
H. No 45, Kothiwada, Karapur, Sanquelim, Goa - 403 505
Source of Support: None, Conflict of Interest: None
Introduction: Tuberculosis (TB) has been haunting humanity for decades. Even with the existing treatment modalities and preventive measures, it continues to be among the top 10 killers in the world. India had 2.69 million cases in the year 2018, with 440,000 deaths due to TB alone. Hence, in this scenario, the knowledge of the health-care providers play a crucial role in the efforts of the Stop TB strategy of the National TB Elimination Program. This study aims to assess baseline knowledge and impact of TB sensitization program among nurses, interns, and postgraduate students in a Medical College Hospital in Karnataka.
Materials and Methods: The methodology involved a questionnaire to assess the baseline knowledge of the participants of the RNTCP sensitization program. The same was repeated after completion of the program.
Analysis: Data were entered into excel spreadsheets and analyzed using SPSS software. Proportions and paired t-test were used to assess the impact of the training on the participants.
Results: The mean baseline knowledge among nurses, interns, and postgraduate students was 38.02%, 30.61%, and 34.04%, which improved by 40%, 57%, and 60%, respectively, after the training program.
Conclusions: A highly significant (P < 0.001) difference was found in the pretest and posttest scores of the nurses, interns, and postgraduate students, indicating that training increased the knowledge scores of the Health Care Workers (HCW's) significantly. Hence, regular trainings are recommended to keep the HCWs updated on TB facts and strategies in the country.
Keywords: Health-care workers, knowledge, revised national tuberculosis control program training, tuberculosis
|How to cite this article:|
Holla V N, Borker SA, Salelkar SS, Shashikala N. Impact of National Tuberculosis Elimination Program sensitization workshop on health-care workers in a Medical College and Hospital in Karnataka, India. MRIMS J Health Sci 2020;8:79-83
|How to cite this URL:|
Holla V N, Borker SA, Salelkar SS, Shashikala N. Impact of National Tuberculosis Elimination Program sensitization workshop on health-care workers in a Medical College and Hospital in Karnataka, India. MRIMS J Health Sci [serial online] 2020 [cited 2021 Apr 14];8:79-83. Available from: http://www.mrimsjournal.com/text.asp?2020/8/4/79/304929
| Introduction|| |
Tuberculosis (TB) has been a challenging infection for decades. Despite existing treatment and preventive strategies, the world saw 10 million active cases in 2018, of which 27% were in India. It continues to be a top leading cause of death with a toll of 1.2 million in 2018. India witnessed 2.69 million cases in 2018, with 440,000 deaths due to TB alone. India started the Revised National TB Control Programme program in a phased manner in 1997 to improve case detection and treatment rate in the country. In 2020, it was modified to the National Tuberculosis Elimination Program (NTEP) with an aim to End TB in the country by 2025.
The Central TB Division is supported by the National Task Force Committee. This, in turn, collaborates Medical College activities in the country through Zonal Task Force/State Task Force (STF) Committees. These committees engage Medical Colleges to support patient care, training, and research. Medical Colleges may be involved in various capacities as peripheral health institutions, microscopy centers, peripheral laboratories, imaging, and testing facilities, Cartridge-Based Nucleic Acid Amplification Test sites, Designated Microscopy Centers, and Drug-Resistant TB (DR-TB) centers.
Health-care workers work are at the frontline for TB prevention and delivery of TB care services. Hence, it is of utmost importance that they possess the adequate and latest knowledge regarding treatment, prevention, and other programmatic aspects related to the infection. The addition of HIV/TB coinfection along with the COVID-19 pandemic has made the role of health-care workers (HCW's) challenging. Moreover, with the rollout of the END TB Strategy with detect, treat, prevent and build approach, knowledge and training of HCWs is imperative. Various studies,,,,,,,, have found the knowledge among HCW's to be lacking, which could stagger the aim to stop TB in the country.
In view of the above factors and in accordance with the instructions from the STF Committee, this study was conducted with the aim to assess baseline knowledge and impact of TB sensitization program among nurses, interns, and postgraduate students in a Medical College Hospital in Karnataka.
| Materials and Methods|| |
As per instructions received from the STF Committee (dated: 1/1/2018) a sensitization program on NTEP was conducted for staff nurses, interns, and postgraduate students in KVG Medical College Hospital at Sullia-Karnataka.
The study is a hospital-based cross sectional study involving a total of 184 staff nurses that were sensitized in 3 batches over a period of 3 days, 123 interns sensitized in 4 batches over a period of 4 days, and 44 postgraduate students trained in 2 batches in 2 days. The study was conducted from February 2018 to March 2018 in ½-day sessions so as not to disturb the hospital routine. Informed consent was obtained from all the participants before the conduction of the study.
Each program consisted of 3–4 sessions on different thematic areas to orient the participants on Technical and Operational Guidelines–2016. All the participants attending the program were provided with a questionnaire to assess the knowledge before the training session to grossly identify the gaps, for reinforcement in the training program for practical benefits. The same questionnaire was repeated on completion of the training program to assess the impact of the training program on the participants.
The questionnaire was prestructured, self-administered consisting of open-ended questions related to knowledge, diagnosis, and treatment aspects of TB. The questions were centered mainly on six major aspects, i.e., basic epidemiology (7–11 questions), TB Program (6–10 questions), sputum samples (3–4 questions), tuberculin test (1–5 questions) anti-TB treatment, and adverse drug reactions (ADR) (3–12 questions) and TB notification and prevention (3 questions). The questions were structured according to the professional competency and qualifications of the participants with a total of 24 questions for nurses and 45 questions for interns and postgraduate students. Confidentiality of the participants was maintained during data collection, data entry, and analysis.
The data were entered in Microsoft Excel spreadsheets, and rechecked for errors or missed entries. The analysis was done using Statistical Package for Social Sciences IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, N.Y., USA). Proportions were calculated for the respective questions at the baseline as well as post-training level. Paired t-test was done to determine any significant change in the level of knowledge among participants before and after the sensitization program. Results were presented in tabular and diagrammatic format.
Calculation of the percentage for correct answers was done by obtaining the proportion of correct answers from total answers received for a particular question from all participants, i.e.,
Percentage for correct answers = Number of correct answers/N (Total number of participants in the group) × number of questions in the section.
The mean value was calculated based on the average correct score for the group. Percentage and mean values were obtained for pretest as well as posttest in all the three groups.
| Results|| |
The participants included 184 nurses, 123 interns, and 44 postgraduate students. All participants had attempted all the questions and there was no missing data.
The baseline mean knowledge percentages for nurses was 38.02%, with the lowest being for knowledge regarding notification of TB case (3.26%) and the highest being for the mode of spread of TB infection (85.33%).
Regarding interns, the mean percentage was 30.61%, with the lowest being for new TB cases in India (0.8%) and highest for causative agent of TB (95.93%). In postgraduate students, mean percentage was 34.04% with the lowest being for estimated prevalence and deaths of TB patients in India (2.27%) and the highest being for “is Mantoux test a confirmatory test?” (97.73%).
Overall knowledge regarding the section on preventive measures was the least amongst all the groups (<17%). On detailed comparison, it was observed that the baseline knowledge of all HCW's regarding infectivity rates, case definitions, intensified case finding and notification of TB was <10–12%, thus suggesting knowledge gaps in various aspects of the TB Control program.
The percentages in all sections were found to have improved significantly following the sensitization program, wherein the mean percentages for nurses, interns, and postgraduate students were 78.01%, 87.76%, and 94.30%, respectively [Table 1]. The paired t-test values were highly significant for all groups indicating that the training increased the knowledge of all the participants significantly [Table 2].
|Table 1: Pre- and post-test percentages of answers attempted correctly for various sections among nurses, interns, and postgraduate students|
Click here to view
On comparison between groups, it was seen that nurses had a higher baseline knowledge than interns and postgraduate students. This could be due to different aspects of knowledge parameters being explored in all the categories. However, improvement in percentages was best among postgraduate students (60%) compared to nurses (40%). Interns showed an improvement of around 57% after the sensitization session [Figure 1].
|Figure 1: Comparative percentage for nurses, interns, and postgraduate students|
Click here to view
| Discussion|| |
This study is aimed to assess the impact of TB sensitization program. It was observed that various gaps were present in the baseline mean knowledge for nurses, interns, and postgraduate students (38.02%, 30.61%, and 34.04%, respectively), which increased significantly following the training program. These findings were similar to another study where a significant improvement in knowledge parameters was obtained after the training of medical interns.
Similar to our observations, most studies found baseline knowledge to be less than satisfactory among HCW's.,,,,,,, However, some other studies found good to satisfactory level of knowledge in HCW's.,,
Most Indian and international studies found knowledge parameters amongdoctors to be higher than nurses,,,,, which was in contrast to our findings wherein nurses were found to have slightly better baseline knowledge than interns and postgraduate students. A study amongst Health Professionals in China, India, Iran, and Mexico showed that very few respondents correctly answered all knowledge questions regarding TB care; China (5%), India (5%), Iran (19%), or Mexico (22%).
Various studies among nursing staff in India have shown significant knowledge gaps. In Haryana, 62.2% had satisfactory knowledge, whereas in Punjab, 64% had knowledge below average. In Delhi, mean knowledge was found to be 63.08%, whereas another study showed only 40.2% of TB related and 10.7% of general hospital nurses to have a satisfactory level of awareness. In this study, mean knowledge among nurses was 38.02%.
Various cross-sectional studies among nurses in Kanchipuram, Delhi, and Solan showed that knowledge regarding the causative agent of TB was 71.80%, 56.5%, and 85.6%, whereas mode of transmission was correctly stated by 87.60%, 78.6%, and 60%, respectively. The baseline values for similar questions in our study were 77.17% (causative agent) and 85.33% (mode of transmission), which increased to 97.28% and 91.85%, respectively.
One study found the lowest knowledge concerning programmatic aspects to be 49.4%, in our study the baseline knowledge for program-related parameters was 31.95%. Comparative values for similar questions in the study in Haryana like the meaning of positive tuberculin test (66.6%), mode of transmission (95.1%), case definition (40.7%), and most appropriate test for diagnosis (68.8%), were higher than those obtained in baseline data of our study.
Another study conducted among medical interns, showed that baseline knowledge on general facts (92.7%), natural history of disease (15.3%), number of sputum samples (71.7%), treatment regimen (50%), safety of treatment during pregnancy (14.5%) and was comparatively lower than our study among interns, whereas, clinical suspect (16.9%), definition of multidrug-resistant TB (67.7%), extensively drug-resistant-TB (37.1%), and isoniazid prophylaxis (55.6%) findings were higher than our study. All the values increased significantly after the intervention in both the studies.
A study in Iraq among HCW's showed that 95.5% had good knowledge about TB. However, not all HCW's (87.4%) knew that TB is caused by a bacterium. The mode of TB transmission was answered correctly (via the respiratory tract) by 98.2% of respondents.
While a study in Nepal, showed that the level of knowledge on TB infection control among almost half (45.8%) of the HCWs was poor.
As this study is conducted in the Medical College Hospital of Karnataka, findings cannot be generalized to the HCW's of other areas, other hospitals, and other settings. In addition, findings are based on particular aspects explored in the study and cannot be extrapolated to other aspects of the program. As questions were based on the profession and qualifications of the participants findings cannot be compared with other groups.
| Conclusion and Recommendation|| |
A significant 40–60% improvement in knowledge of HCWs is suggestive of a positive impact of the sensitization program among HCW's. In the long-standing history of the TB program in India and the numerous workshops on the sensitization of HCW's, this study shows that despite all the efforts the knowledge gaps in TB still exist and still a lot needs to be done in this direction. Hence periodically updating of the knowledge through well-designed questionnaire covering the thematic areas and evaluation of effectiveness of the training program helps to identify gaps and meet the demands generated. The baseline knowledge gap among the health-care providers is very large. however, regular training sessions will help improve the knowledge and practices of the HCW's, leading to improved case detection, reduced transmission, control of DR-TB, treatment adherence, identification of ADR etc., thus contributing to the goal of “End TB initiative.” Further, a session of retraining for HCW's on the aspects of NTEP is highly recommended to fulfil the vision of “zero deaths, disease, and suffering due to TB.”
We would like to thank the KVG Medical College and Hospital for providing an opportunity for conducting the study. Further, we are highly obliged to the participants of the study without whom the study would not have been possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
National TB Elimination Programme, Training Modules (1-4) For Programme Managers & Medical Officers, Central TB Division, MoHFW, Government of India; July, 2020.
Ancy AV, Thangaraj P, Hemalatha K, Bethubarani M. Effect of an e-learning tool on knowledge of recent Revised National Tuberculosis Control Programme guidelines among Medical Interns. J Edu Health Promot 2020;9:257. [Full text]
Aggarwal R., Sahu D, Manuja, Aditya K, Mehera S. Awareness about Tuberculosis and RNTCP-DOTS guidelines among nurses working in a rural medical college in Haryana Int J Res Health Sci 2017;5:8-12.
Kaur K, Kaur M. A study to assess the knowledge of staff nurses regarding DOTS therapy inview of the preparation of informational booklet at tertiarycare hospital, amritsar, Punjab, India. Curr Trends Diagn Treat 2018;2:22-7.
Singla N, Sharma PP, Jain RC. Awareness about tuberculosis among nurses working in a tuberculosis hospital and in a general hospital in Delhi. India Int J Tuberc Lung Dis 1998;2:1005-10.
Gizaw GD, Alemu ZA, Kibret KT. Assessment of knowledge and practice of health workers towards tuberculosis infection control and associated factors in public health facilities of Addis Ababa, Ethiopia: A cross-sectional study, Demissie Gizaw et al
. Arch Public Health 2015;73:15.
Mohammed H, Jaber F, Jassim H. Nurses awareness regarding detection of tuberculosis cases in babylon hospitals. J Global Pharm Technol 2018;10:179-83.
Jaiswal KM, Vaishnao LS, Dudhgaonkar S, Raghute L, Kewalramani MS, Jawade AS, et al
. Knowledge, attitude and preventive practices regarding tuberculosis care and control among health care professionals at TB centres: Implications for TB control efforts. Int J Community Med Public Health 2020;7:2318-25.
Chavan PV, Datta D, Patil RS, Daniel AJ. Awareness about RNTCPand DOTSGuidelines among health care professionals of a tertiary care hospital of South India. Natl J Community Med 2014;5:77-8.
Shrestha A, Bhattarai D, Thapa B, Basel P, Wagle RR. Health care workers' knowledge, attitudes and practices on tuberculosis infection control, Nepal. BMC Infect Dis 2017;17:724.
Kansal AR, Mahal R, Behera D, Sarin R. A study to assess learning need, knowledge and attitude of nurses regarding tuberculosis care under RNTCP in two tertiary care tuberculosis institutions of Delhi, India. Asian J Nur Edu Res 2014;4;30-4.
Hashim DS, Kubaisy WA, Dulayme AA. Knowledge, attitudes and practices: Survey among health care workers and tuberculosis patients in Iraq. Eastern Mediterranean Health J 2003;9:718-31.
Ekuma AE, Oridota SE. Knowledge, attitude and tuberculosisinfection control practice among healthcare workers in DOTS centres in Lagos, Nigeria Int J Infect Control 2016;12:7-15.
Bhandari SR, Bande R. Knowledge, attitude and practice against tuberculosis infectioncontrol among medical students and nursing staff. J Cont Med A Dent 2016;4:29-32.
Noé A, Ribeiro RM, Anselmo R, Maixenchs M, Sitole L, Munguambe K, et al.
Knowledge, attitudes and practices regarding tuberculosis care among health workers in Southern Mozambique. BMC Pulmonary Med 2017;17:1-8.
Alotaibi B, Yassin Y, Mushi A, Maashi F , Thomas A, Mohamed G, et al
. Tuberculosisknowledge, attitude and practice among healthcareworkers during the 2016 Hajj. PLoS ONE 2019;14:1-15.
Hoffman SJ, Guindon GE, Lavis JN, Randhawa H, Posada FB, Dejman M, et al
. Surveying the knowledge and practices of health professionals in China, India, Iran, and Mexico on treating tuberculosis. Am J Trop Med Hyg 2016;94:959-70.
Krithika SA, Jayanthi NN, Subramanian S. Awareness of tuberculosis among nurses. IAIM 2018;5:153-60.
Singh K, Dikshita, Panya, Aditi, Pabla H, Chawla S. Awareness about tuberculosis among nurses working in a tertiary care hospital in Solan, Himachal Pradesh. Int J Community Med Public Health 2019;6:3081-6.
[Table 1], [Table 2]