Paul Sukanta, Akter Rahima, Aftab Afzal, Khan Antora M, Barua Mrittika, Islam Shayla, Islam Akramul, Husain Ashaque, Sarker Malabika
James P Grant School of Public Health, BRAC Institute of Global Health, BRAC University, 68 Mohakhali, Dhaka, 1212, Bangladesh.
Health Nutrition and Population Programme, BRAC, 75 Mohakhali, Dhaka, 1212, Bangladesh.
BMC Public Health. 2015 Jan 31;15:52. doi: 10.1186/s12889-015-1390-5.
Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas.
This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part.
Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB.
This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
孟加拉国国家结核病控制规划采用了多种策略来促进结核病的诊断和治疗。“倡导、沟通与社会动员”（ACSM）是孟加拉农村进步委员会（BRAC，一个非政府发展组织）结核病控制项目实施的关键策略之一。本研究的目的是评估参与BRAC结核病控制地区ACSM的关键社区成员（KCMs）的知识和态度。
本研究采用混合方法，结合定量和定性方法。以结核病病例发现率低的三个地区的关键社区成员为目标，评估ACSM项目。采用多阶段随机抽样策略对432名参与者进行了定量调查。定性研究包括对48名受访者子样本的深入访谈（IDI）。定量分析采用频率、百分比和卡方检验报告描述性统计数据，而定性部分则采用主题分析。
大多数（99%）参与者听说过结核病，几乎所有人都知道结核病是一种具有传染性但可治愈的疾病。超过一半（53%）的关键社区成员对结核病有良好的了解，但与其他关键社区成员相比，BRAC工作人员的知识更丰富。然而，在BRAC社区卫生工作者中观察到相当大的知识差距。定性结果显示，大多数关键社区成员了解结核病的体征、症状和传播途径，并认为吸烟和成瘾是结核病传播的主要原因。即使在BRAC卫生工作者中，关于儿童结核病的知识也很匮乏。与结核病相关的耻辱感并不罕见。几乎所有受访者都表示，被诊断患有结核病的年轻女孩。
本研究结果揭示了关键社区成员对结核病的知识水平参差不齐，态度不一。它还提供了关于儿童结核病知识匮乏的见解，并表明尽管结核病项目取得了重大成功，但耻辱感在社区中仍然普遍存在。未来的ACSM活动应让社区成员消除耻辱感，并推广与儿童结核病相关的信息，以进一步改进BRAC结核病控制项目。
