Tuberculosis (TB) represents a serious global health problem and the second leading cause of death due to infectious disease worldwide. Despite the fact that TB is curable with six months of chemotherapy, incidence and prevalence rates remain high – particularly in developing countries – due in part to insufficient case detection rates. Increasing case detection and reducing delay to treatment is especially important in regions – like The Gambia – that have a low prevalence of HIV co-infection and thus an extended transmission period for TB. Enhanced Case Finding (ECF) methods that utilize public education about TB symptoms, diagnosis, testing, and treatment coupled with publicity of local testing methods have been successful in increasing case detection and treatment rates. However, there is a dearth of evidence that ECF interventions are effective in improving community knowledge of TB.This study sought to evaluate the effect of the community sensitization component of an ECF intervention on community knowledge of TB and TB treatment. This study was nested in a parent ECF study being conducted by MRC Gambia in the West Coast Region of the country. The parent study is a cluster randomized controlled trial in which communities (in the form of neighbourhood or villages defined by census data) are randomly assigned to either an intervention group or a control group. The intervention groups receive a community sensitization intervention that consists of an educational video about TB in a local language, followed by a question and answer session and the distribution of sputum sample cups. Sputum samples are collected in the village the following day and tested. Follow up and GPS mapping of dwellings is done for all smear-positive cases found. Control communities receive no intervention or information about the study.The sub-study described in this thesis sought to evaluate the level of TB knowledge in communities both before and after the sensitization meeting (in the intervention communities), as well as in the control communities. An interview-administered, modified knowledge, attitude, and practice (KAP) questionnaire was designed based on information presented in the movie (used for sensitization) and piloted with patients in a government health centre. The final questionnaire was given to 527 randomly selected participants from four intervention and four control communities between July and September 2012.Number of correct answers was calculated by participant and by question. Participant scores were very similar across the three groups (;;before”, ;;after”, and ;;control”) and, due to random sampling, the three groups did not differ in terms of age structure, sex ratio, level of education, or history of TB. Poisson regression analysis revealed that being aged 45-64 and/or having completed secondary school or higher were associated with better overall scores. When the number of correct answers was analysed by question using Pearson’s chi-square test with Bonferroni correction, there were no significant differences found between the ;;before” and ;;after” groups. Although several questions showed a significant difference between the ;;before” and ;;control” group, this is likely due to a difference in courtesy bias rather than knowledge level.Overall, there appears to be no large scale or systematic difference in the level of TB knowledge associated with the community sensitization intervention. This result provides process evaluation for the parent study and will also be important when considered in the context of the (on-going) parent study. It also underlines the importance of specifically evaluating educational components of ECF interventions in terms of knowledge gain as well as case detection rate.
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The Effect of a Community Sensitization Intervention on Knowledge of TB in The Gambia
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