Knowledge and Attitudes Towards Tuberculosis Among the People Living in Kudat District, Sabah
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10/A STUDY 01/11/2004 2:09pm Page 502 ORIGINAL ARTICLE Knowledge and Attitudes Towards Tuberculosis Among the People Living in Kudat District, Sabah T K Koay, MPH Kudat Health Office, Beg Berkunci No. 6, 89059, Kudat, Sabah Summary A multistage random sampling method was used to select the community sample in the district of Kudat, Sabah. A total of 205 respondents from 210 selected houses were interviewed using a standardised questionnaire to ascertain their knowledge and attitude towards tuberculosis. Generally the knowledge about tuberculosis was poor. The well known symptoms that the respondents knew were coughing blood (46.2%), cough (37.1%), loss of weight (34.5%), and loss of appetite (32.0%). Only 51% thought that the disease was caused by germs and it was transmitted by air. TB sufferers were thought to be dirty (22%) and the majority (51%) were not keen to mix with TB patients. Although more than 90% of the respondents considered TB as socially acceptable within their family and community, a large proportion (41%) expressed that getting TB was embarrassing, 4% said it was a disgrace to the family, and 16% said that it was too sensitive to discuss about it. These behaviours suggest that at the private level, the respondents were still perceived negative social attitudes towards tuberculosis. Key Words: Tuberculosis, Knowledge, Attitudes, Kudat Introduction Materials and Methods Tuberculosis still remains a major public health Study design and questionnaire problem in Sabah. It has been estimated that This is a descriptive cross sectional study carried out in approximately 4 per 1000 population in Sabah suffer Kudat district from 9 December 1996 to 24 December from active infectious tuberculosis based on the last 1996. The questionnaire was designed after literature prevalence survey done in Peninsula Malaysia in19701,2. review and preliminary discussions with the supervisor. More than 3,000 cases of tuberculosis were reported in The questionnaire was designed to capture the Sabah each year (Table I). In spite of the improvement demographic characteristics of the respondents (age, in the health care infrastructure, facilities and trained sex, ethnicity, marital status, education level, and health personnel in Sabah, the majority of cases came employment status), knowledge and attitudes of the for treatment only after the disease was well advanced respondents with regards to tuberculosis formed the (Table II). The finding from various studies indicate that major part of the questionnaire. The number of correct patient delayed may be influenced by several factors, responses to the question on TB symptoms was scored namely lack of knowledge, lack of awareness of the i.e. final score was given for knowledge on symptoms significance of symptoms, negative social attitudes or based on the total number of correct responses to the different combinations of these three factors. The question on TB symptoms3. Similarly scoring was done objective of this study was to measure the knowledge for general knowledge on TB (causation, transmission, and attitudes towards tuberculosis among the people prevention, and diagnosis). Three points were given if living in this region. the respondent knew that tuberculosis was caused by This article was accepted: 4 April 2004 Corresponding Author: T K Koay, Kudat Health Office, Beg Berkunci No. 6, 89059 Kudat, Sabah 502 Med J Malaysia Vol 59 No 4 October 2004 10/A STUDY 01/11/2004 2:09pm Page 503 Knowledge and Attitudes Towards Tuberculosis Among the People Living in Kudat District, Sabah germ, spread by air and could be prevented by BCG Tinangol i.e. every fourth number. Eventually a total of immunisation. A total of three points were given if the 210 houses were selected randomly for the study in the respondent mentioned X-ray, sputum and blood mainland of Kudat, 105 houses each from Tinangol and investigation for diagnosis of tuberculosis3. Here, the Sikuati. possible scores ranged between 0 to 6. Data Collection Pre-testing of questionnaire Two public health assistants from the vector-borne Pre-testing was carried out in Kuala Lumpur on fifteen disease unit carried out the fieldwork. They were respondents by the author. The aim was to rule out selected because they knew the local dialect and are ambiguity and to establish clarify of the questions. A familiar with the areas where the research was to be few modifications was made after the pre-testing and conducted. The two assistants approximately covered the questionnaire was finally sent for printing 20 houses daily interviewing the head of household selected for the study, if the head of household is not The training of interviewers available, the wives, parents or children above 19 years One day training section was organised by the author were interviewed according to the order. At the end of to brief the two public health assistants about the the day, the interviewers checked the questionnaire for research and interviewing technique needed for this completeness of information and it was re-checked by study and the questionnaire was used during this the author himself. Due to limited time factor the training section. author decided the maximum of two visits made to the selected houses, after which it was excluded from the Exclusion criteria study. The following households were excluded from the study if respondents had a past history of tuberculosis Data processing or aged below 19 years. The questionnaire was coded and the data was entered into computer using the Dbase 4+ programme. The Selection of sample data was checked and then analysed using Statistical A multistage random sampling method was used to Programme SPSS and Epi-info. Statistical comparisons select the community samples. District of Kudat is of the different groups were carried out using the χ2 divided into six operational areas namely Sikuati, test, Student’s t-test and F-test for analysis of variance Lotong, Kudat, Matunggong, Tinangol, and Banggi (ANOVA). All p-values are two tailed and the island. The population of each operation area ranges significance level α=0.05 from eight thousand to twelve thousand people. Two out of five operation areas were selected using simple random sampling methods. Banggi was excluded from Results selection because of unavoidable problems such as the transportation and the bad weather during the survey Out of 210 household selected randomly, 205 period. The two randomly selected areas were Sikuati households were interviewed i.e. 101 from Sikuati and and Tinangol. Each of the village in these two areas 104 from Tinangol, giving a total of 205 respondents. have a simple map that helped to identify the location Five (2.4%) household was not included because the of each houses, and all houses have a code number respondents were not available during the study period arranged in order. Tinangol has total of 24 villages inspite of two repeated visits made. (each village has 25 to 120 houses), out of these, 9 villages were selected using simple random sampling Sociodemographic Characteristics of respondents methods. These 9 villages have a total of 435 houses, Of the 205 respondents interviewed, 104 were males of which 105 houses were selected for the study by and 101 were females, the ratio of male to female was using systematic random sampling methods (every 1.03:1. The respondents age ranged between 19 and 72 fourth code number of the house). Sikuati has a total years (Mean age was 36.1, SD 9.8) and the majority of 30 villages (each village has 30 to 130 houses) and (79.5%) of the respondents were aged between 24 and 10 villages were selected using simple random 48 years. The majority (82%) of the respondents were sampling methods. These 10 villages consisted of 430 Rungus. 31.7%(65) of the respondents had no formal houses, of which 105 houses were selected for the education, 38.5% had primary education and 29.8% had study using systematic random sampling methods as in secondary education. 33.7% of the males and 29.7% of Med J Malaysia Vol 59 No 4 October 2004 503 10/A STUDY 01/11/2004 2:09pm Page 504 ORIGINAL ARTICLE the females had no formal education. Out of the total Table IV shows the respondents knowledge on of 120 respondents those aged below 39 years, 42.5% causation transmission, prevention, and diagnosis of had primary education, 48.3% had secondary education tuberculosis 50.8% of respondents thought that and 9.2% had no formal education. Whereas among tuberculosis were caused by germ, 34% of the the respondents aged 39 years and above, most of them respondents did not know the cause, 8.6% believed had no formal education (63.5%) or only had primary that it was caused by smoking, 3% thought it was education (32.9%). The majority of respondents (88%) inherited and 3.6% thought that it was due to bad food. were married, 3 respondents were widows and 21 were Seventy-five respondents (38.1%) knew that single. The majority of the respondents were tuberculosis was transmitted by air, 69 respondents housewives (37.6%) and farmers (38.5%). Only 108 (35%) thought that it was transmitted by infected (52.7%) out of the 205 respondents had a personal articles (e.g. foods, drinks, spoons, plates and cups) income. Ninety-two respondents (44.9%) had income and 31.0% of respondents did not know the method of below RM500 per month and 42 respondents (20.5%) transmission. 31.5% of the respondents said that TB had income below RM200. could be prevented by BCG, 11.7% said TB could be prevented by keeping house and environment clean, Knowledge about tuberculosis 13.2% said that it could be prevented by eating Of the 205 respondents, 197 respondents (96%) knew nutritious food and 76 respondents did not know how about tuberculosis.