Globally, an estimated 10.0 million (range: 8.9–11.0 million) people fell ill with tuberculosis (TB) in 2019, a number that has been declining very slowly in recent years. There were an estimated 1.2 million (range: 1.1–1.3 million) TB deaths among HIV‑negative people in 2019 (a reduction from 1.7 million in 2000). However, India still contributes to be the highest TB burden country in the world with an estimated incidence of 26.9 lakh cases in 2019 (WHO), and also, it has one of the largest shares (27%) of drug‑resistant TB in the world.^1-3

TB also has huge socioeconomic impact as it commonly affects the most productive age group and rural high‑risk population. An estimated 100 million people fall below the poverty line each year because of the financial burden related to TB disease.^4,5

Even though India’s share in TB burden is high, the disease is in declining trend since past few years. Under the National Tuberculosis Elimination Program, the treatment is completely free and also the patient will be given financial assistance as well to maintain a better nutrition. Apart from the treatment of the affected, the program also focuses on the early identification of cases through active case finding and by spreading awareness, as delay in approaching health care can lead to delay in diagnosis and treatment, which will hamper our attempts in reaching the target of TB‑free India by 2025.^6,7

Huge reduction in TB disease transmission from infected person to others in the family and community can be achieved by early diagnosis and treatment of TB. Therefore, it is important to assess the awareness level at regular intervals in the community as creating awareness helps in behavioral change and thereby improved health‑seeking behavior which halts the ongoing transmission.^8-9

When there is a better awareness about TB in the community, our country’s goal of eliminating TB from India by 2025 can be made possible. Hence, the present study was carried out to estimate the community awareness and their perception toward TB in the state of Himachal Pradesh.

Objectives of the Study

To evaluate the Awareness and Perception about Tuberculosis among the general population of Himachal Pradesh.

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: Hilly state of Himachal Pradesh

• Study duration- between October 2021 to December 2021

• Study population: All adults above 18 years of age who were staying in the Himachal Pradesh   for 12 months or more.

• Sample size- 400 Adults assuming 50%   have adequate knowledge regarding Tuberculosis, 5% absolute error, 95% confidence level, and 5% non response rate.

• Sampling Technique- convenience & snowball Sampling technique

• Study tool: A google form questionnaire consisting of questions regarding socio-demography, Awareness and Perception about Tuberculosis was created. The questionnaire was initially pre-tested on a small number of people to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 40 structured questions regarding Awareness and Perception about Tuberculosis having three options i.e. Yes, No & Don’t Know. The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 40 and minimum score was zero. Scoring was done on the basis of marks as >80%(32-40)=very good,60-79%(24-31) =Good,41-59% ( 16-23)=Fair,<40% (< 16)=poor

• Validity of tool - by the experts in this field

• Inclusive Criteria- who were willing to participate in the study.

• Exclusion Criteria: who were not willing to participate in the study

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin in both rural and urban area of Himachal Pradesh till the 400 responses were collected.  Responses were then recorded in a Google Excel spreadsheet.

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained. 

The present study was cross sectional descriptive study carried out to evaluate awareness and Perception about Tuberculosis among the general population of Himachal Pradesh.

A total of 400 respondents took part in the study, with 237 (59.25%) coming from rural areas and 163 (40.75%) from urban areas. The majority's participants included 387 (96.75 percent) Hindus, 269 (67.25 percent) males, 173 (43.25 percent) people in their 18 to 30s, 155 (38.75 percent) graduates, 266 (66.5 percent) working people, and 238 (59.5 percent) married people.

Table-1: Socio-demographic characteristics of study participants

Table-2: Awareness about TB disease characteristics among participants

Table 3: Awareness and Perception about Tuberculosis among study participants

In the present study 76 (19.0%) study participants had very good (32-40 marks) awareness and Perception about Tuberculosis, 169 (42.25%) had good (24-31 marks), 132 (33.0%) had fair (16-23 marks) and 23(5.75%) had poor (<16 marks) awareness and Perception about Tuberculosis. 

Our study findings indicate poor TB-related knowledge and moderate awareness among the general population residing in Himachal Pradesh. Similarly, in the study done by Shashikantha SK et al.,¹, more than three‑fourth of the subjects (76.1%) had heard about TB disease, more than 50% of the subjects mentioned “coughing” by a diseased person as the main reason for spread, forty percent of the subjects, opined as recovery, will be complete after treatment and more than 60% of the subjects knew that TB diagnosis and treatment is free in any government health center.

In the study done by Sreeharshika Dumpeti et al.,⁴, although the awareness of symptoms, causative agent, mode of spread was reasonably good, knowledge on availability of DOTS centres, services offered through RNTCP is still poor among population.The study done by P. Kulkarni et al.,¹⁰ showed poor knowledge about TB symptoms, causes, modes of transmission and moderate awareness about government TB services. 

The above findings from our study highlight the fact that knowledge regarding TB and its control in many of the aspects is either insufficient or not satisfactory in the community. Health education of the members of the community at large needs to be improved. And also, this study reiterates the need of large‑scale community‑based TB awareness studies  in all 12 districts of Himachal Pradesh to help our effort toward TB elimination from India by 2025. Strengthening our attempts toward TB‑free India by 2025 necessitates the need for a coordinated effort by the community members with the accurate and necessary information and the health‑care professionals. Multi‑sectoral approach by various stakeholders involved in TB care, with people having the right information related to TB, is the need of the hour.

Limitations

The sample size and duration of the study are restricted to 400 respondents and 3 months in time; thus, the scope and extent of the conducted research might be minimized.This survey was conducted only in one state of India, and hence, these findings cannot be generalized all over India.

Conclusion

The assessment of awareness and perception regarding TB provides valuable information, it is concluded that participants' knowledge and perceptions regarding TB was not satisfactory. The findings of the study can be used to plan for in-depth health education programme for spreading more awareness regarding TB in the whole state Himachal Pradesh. It can help to promote early diagnosis and treatment for Tuberculosis. Health programmes based on these findings can  also be helpful to reduce stigma associated with TB at community level.

1. Shashikantha SK, Sheethal MP. Awareness about tuberculosis in a rural area of Mandya district: A cross-sectional study in southern Karnataka. Journal of Family Medicine and Primary Care. 2022 Feb;11(2):587.

2. Central TB Division. India TB Report 2020. New Delhi: Ministry of Health and Family Welfare; 2020.

3. World Health Organization. Global Tuberculosis Report 2020. Geneva: World Health Organization; 2020. Licence: CC BY‑NC‑SA 3.0 IGO.

4. Dumpeti S, Jothula KY, Naidu NK. Awareness about tuberculosis and RNTCP services among rural people in Nalgonda district, Telangana. Journal of Family Medicine and Primary Care. 2020 Jul;9(7):3281.

5. Tanimura T, Jaramillo E, Weil D, Raviglione M, Lönnroth K. Financial burden for tuberculosis patients in low-and middle-income countries: a systematic review. European Respiratory Journal. 2014 Jun 1;43(6):1763-75.

6. Central TB Division. India TB Report 2021. New Delhi: Ministry of Health and Family Welfare; 2021.

7. Potty RS, Kumarasamy K, Adepu R, Reddy RC, Singarajipura A, Siddappa PB, Sreenivasa PB, Thalinja R, Lakkappa MH, Swamickan R, Shah A. Community health workers augment the cascade of TB detection to care in urban slums of two metro cities in India. Journal of Global Health. 2021;11.

8. Rami K, Thakor N, Patel A. Awareness and knowledge about tuberculosis in patient of tuberculosis at GMERS Medical College and Hospital Dharpur, Patan, Gujarat. Int J Med Sci Public Health. 2015 Jul 1;4(7):906-9.

9. Ramya R. A Study to assess the knowledge of Breast Cancer and awareness of Mammography among women (30-50) in Saveetha Medical College and Hospital. Research Journal of Pharmacy and Technology. 2018 Oct 1;11(10):4219-21.

10. Kulkarni P, Kudale A, Arasu K, Lab M, Darby W, Rangan S. Tuberculosis knowledge and awareness in tribal-dominant districts of Jharkhand, India: implications for ACSM. Public Health Action. 2014 Sep 21;4(3):189-94.