Identifying misconceptions about tuberculosis: A step forward in developing effective awareness campaigns

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South Africa carries a particularly high burden of cases of tuberculosis (TB) with 3% of all cases reported worldwide occurring here.  Of even more concern is the fact that the country also has a high number of cases of drug-resistant TB. Reasons cited for the high prevalence of the disease often include poverty and poor, overcrowded housing conditions.
However, lack of knowledge about the disease itself in a country where levels of education are generally low is undoubtedly also a factor. The need to be more conscious of the way TB is understood and how understandings relate to behaviour led to a study conducted by Nurse Peggy Onyango,  Professor Daniel Ter Goon and Nurse Ntombana Rala.
The research project focused on 327 patients suffering from TB attending three community health centres in the Nelson Mandela Bay Health District. The three researchers used a close-ended questionnaire to collect information for the study and used descriptive and multivariate logistic regression analyses to work with data.
Findings from the study indicate widespread misconceptions about causes of the disease. For example, 76.5% of respondents expressed the belief that TB was caused by cold air, 85.9% claimed that it was due to a dusty environment and 84.7% indicated smoking as a cause with many (60.6%) claiming that people who smoke and drink are responsible for its spread.
Nonetheless, the largest proportion of participants in the study (88.4%) did identify correctly the presence of TB bacteria in the air as a cause.
Importantly, participants in the study shared misconceptions about the relationship of TB to HIV, with 77.4% claiming that TB could develop into HIV and that HIV infects those suffering from TB. 
According to the researchers, these misconceptions could be related to the fact that South Africa has a high incidence of HIV and TB is a major cause of death for those infected with both TB and HIV. 
The belief that TB develops into HIV was also identified as an explanation for some patients choosing to hide symptoms, resulting in a delay in getting medical advice. 
In addition, the threat of stigma associated with HIV also adds to a failure to seek a diagnosis and get treatment. Treatment for TB can be lengthy and requires repeated visits to health facilities for testing and check-ups. The majority of respondents (87.2%) were aware that treatment took six months or longer, with 70.6% noting that they thought follow-up sputum tests were an important part of treatment. 
However, more than half said they thought treatment for TB was unpleasant and interfered with work or marriage, with the majority indicating stigmatisation as the main reason for avoiding follow-up visits at clinics. Given these results, it is not difficult to see why many patients fail to follow up on their treatment.
Although 53.5% of those who completed the questionnaire did not associate TB with poverty, the multivariate logistic regression analysis conducted by the researchers showed that place of residence was a factor that was statistically significant, with identifying misconceptions about tuberculosis: A step
forward in developing effective awareness campaigns residence in formal housing emerging as a predictor of correct knowledge.
A lack of knowledge about TB along with people’s attitudes towards the disease and delays in seeking health advice are all factors linked to mortality from the disease. Because of this, the three researchers identify the need to scale up TB programmes and focus on stigma-related perceptions and attitudes.
This important study thus contributes to ways South Africa could begin to lessen the burden of TB on its population by developing research-based campaigns that ensure misconceptions about the disease are challenged and people are provided with the information that will encourage healthy behaviour.