Allama Iqbal Medical College, Lahore, Pakistan.
Int J Equity Health. 2011 Feb 4;10:8. doi: 10.1186/1475-9276-10-8.
The aim of this study was to explore inequities in knowledge, attitudes and practices regarding tuberculosis (TB) among the urban and rural populations.
A cross-sectional study was conducted in two districts of Pakistan's Punjab province. The 1080 subjects aged 20 years and above, including 432 urban and 648 rural respondents, were randomly selected using multistage cluster sampling and interviewed after taking verbal informed consent. Logistic regression was used to calculate the crude odds ratio (OR) with 95% confidence interval (CI) for the urban area. The differences in knowledge, attitudes, practices and information sources between the urban and rural respondents were highlighted using Pearson chi-square test and Fisher's exact test.
The study revealed poor knowledge regarding TB. The deficit was greater in the rural areas in all aspects. The knowledge regarding symptoms (OR 2.03, 95% CI 1.59-2.61), transmission (OR 1.93, 95% CI 1.44-2.59), prevention (OR 2.24, 95% CI 1.70-2.96), duration of standard treatment (OR 1.88, 95% 1.41-2.49) and DOTS (OR 1.84, 95% CI 1.43-2.38) was significantly higher in the urban areas (all P < 0.001). Although a majority of the subjects (urban 83.8%, rural 81.2%) were aware of the correct treatment for TB, less than half (urban 48.1%, rural 49.2%) were aware of the availability of the diagnostic facility and treatment free of cost. The practice of seeking treatment at a health facility (P = 0.030; OR 2.01, 95% CI 1.06-3.82), as soon as they realized that they had TB symptoms (P < 0.001; OR 1.72, 95% CI 1.26-2.35), was significantly higher in the urban areas. People in the urban areas were more likely to feel ashamed and embarrassed being a TB patient (P < 0.001; OR 2.03, 95% CI 1.50-2.76); however, they seem to be supportive in case their family member suffered from TB (P = 0.005; OR 1.53, 95% CI 1.13-2.06). Nearly half of the respondents, irrespective of the area of residence, believed that the community rejects the TB patient (urban 49.8%, rural 46.4%). Television (urban 80.1%, rural 68.1%) and health workers (urban 30.6%, rural 41.4%) were the main sources for people to acquire the TB related information.
Respondents' knowledge regarding TB was deficient in all aspects, particularly in the rural areas. Intended health seeking behavior was better in the urban areas. Television and health workers were the main sources for TB related information in both the urban as well as the rural areas. Therefore, the area of residence should be considered in tailoring communication strategies and designing future interventions for TB prevention and control.
本研究旨在探讨城乡人群对结核病（TB）的知识、态度和实践方面的不平等。
在巴基斯坦旁遮普省的两个地区进行了一项横断面研究。1080 名年龄在 20 岁及以上的受试者，包括 432 名城市和 648 名农村应答者，采用多阶段聚类抽样随机选择，并在获得口头知情同意后进行访谈。使用 logistic 回归计算城市地区的粗比值比（OR）和 95%置信区间（CI）。使用 Pearson 卡方检验和 Fisher 确切检验突出了城市和农村应答者在知识、态度、实践和信息来源方面的差异。
研究显示，对结核病的知识较差。在所有方面，农村地区的缺陷更大。对症状（OR 2.03，95%CI 1.59-2.61）、传播（OR 1.93，95%CI 1.44-2.59）、预防（OR 2.24，95%CI 1.70-2.96）、标准治疗持续时间（OR 1.88，95%CI 1.41-2.49）和 DOTS（OR 1.84，95%CI 1.43-2.38）的了解明显更高（均 P<0.001）。尽管大多数受试者（城市 83.8%，农村 81.2%）都知道结核病的正确治疗方法，但只有不到一半（城市 48.1%，农村 49.2%）知道可以获得诊断设施和免费治疗。一旦意识到自己有结核病症状，就到医疗机构（P=0.030；OR 2.01，95%CI 1.06-3.82）接受治疗的做法在城市地区明显更高。城市地区的人更有可能因为是结核病患者而感到羞耻和尴尬（P<0.001；OR 2.03，95%CI 1.50-2.76）；然而，他们似乎在家人患有结核病时会提供支持（P=0.005；OR 1.53，95%CI 1.13-2.06）。近一半的应答者，无论居住地区如何，都认为社区会排斥结核病患者（城市 49.8%，农村 46.4%）。电视（城市 80.1%，农村 68.1%）和卫生工作者（城市 30.6%，农村 41.4%）是人们获取结核病相关信息的主要来源。
在各个方面，尤其是在农村地区，应答者对结核病的知识都不足。城市地区的预期寻医行为更好。电视和卫生工作者是城乡地区结核病相关信息的主要来源。因此，在制定结核病预防和控制的沟通策略和设计未来干预措施时，应考虑居住地区。
