Three “women only” focus group discussions contained a total of 30 women, and three “men only” focus group discussions included a total of 31 men. Male participants in the focus group discussions were slightly older (mean 34 years, median 28 years, range 18–78 years) than female participants (mean 30 years, median 26 years, and range 18–58 years). Two focus group discussions were conducted in an urban area (one male, one female). Urban participants were younger (mean 26 years, median 25 years, range 18–64 years) than rural participants (mean 36 years, median 31 years, and range 18–78 years).
TB knowledge
Overall TB knowledge was limited. Three hundred forty three participants (95.3%) mentioned that cough is one of the main signs and symptoms of TB, but of the other two classic TB symptoms weight loss and night sweats, only 91 people (25.3%) mentioned weight loss, and only 10 people mentioned anything that could be interpreted as “night sweats” (responses included fever, sweating, evening fevers, evening sweats, and “evening malaria”). When asked how someone can get TB (as an open ended question allowing multiple responses), 49 people (13.7%) mentioned that it was an airborne disease, and 62 (17.3%) people said that you can get it from being near a patient. The most common form of transmission mentioned was through saliva, usually by sharing cups (263 participants, 73.3%). Fifty eight people (16.2%) mentioned that someone could get TB from smoking and/or drinking, 35 people (9.8%) stated that TB was hereditary, 35 (9.8%) mentioned other ways of getting TB (for example from uncooked milk or meat, from working in factories, from hard labour), and 21 (5.9%) were unsure how TB is transmitted. Two hundred eighty nine people (80.5%) knew that TB can be cured.
The mean TB knowledge summary percentage score was 34 (SD 15, range 0–79). Univariate and multiple linear regression analysis of TB knowledge considered age, education, type of house, sex, marital status, place of residence, and knowing someone who has had TB as independent variables. For both univariate and multivariate regression, older age (≥45 years) was statistically significantly associated with higher TB knowledge, and urban residence was statistically significantly associated with lower TB knowledge (see Table
3).
Table 3
Univariate and multivariate linear regression analysis of TB knowledge score
Age | 18-24 | 1.0 | | 1.0 | |
| 25-44 | 1.33 (−4.47, 7.12) | 0.582 | 1.88 (−3.43, 7.19) | 0.404 |
| > = 45 | 6.76 (0.27, 13.26) |
0.044
| 7.45 (0.30, 14.60) |
0.044
|
Education | Primary or less | 1.0 | | 1.0 | |
| Secondary or higher | 1.08 (−3.63, 5.80) | 0.580 | 3.07 (−2.03, 8.18) | 0.183 |
House** | Mud walled | 1.0 | | - | |
| Concrete walled | −1.75 (−7.69, 4.18) | 0.482 | - | |
Sex | Male | 1.0 | | 1.0 | |
| Female | −0.43 (−6.34, 5.51) | 0.859 | −0.31 (−6.08,5.45) | 0.894 |
Marital status | Single | 1.0 | | 1.0 | |
| Ever married | 1.17 (−5.27,7.62) | 0.660 | −0.49 (−6.77, 5.79) | 0.850 |
Residence | Rural | 1.0 | | 1.0 | |
| Urban | −6.02 (−11.37, -0.68) |
0.034
| −6.27 (−11.73,-0.81) |
0.032
|
Has a friend who has had TB | No | 1.0 | | 1.0 | |
Yes | 1.04 (−4.59,6.67) | 0.654 | 0.63 (−4.47, 5.74) | 0.762 |
Focus group participants discussed general population knowledge about TB, different types of TB symptoms, and transmission. Respondents reported a general lack of knowledge about TB amongst their village members. A lack of awareness was linked to delays in seeking treatment due to not recognizing the symptoms of TB. When asked why people were dying of TB despite treatment being available, one respondent stated:
"“
For me I think our people lack information. You find someone coughing without knowing that it’s TB.” (urban male)
"
There was an expressed perception that TB isn’t curable. Participants mentioned either directly that TB doesn’t have a cure, or that their fellow villagers believed that TB has no cure. One respondent stated:
"
“The government announced that there is no complete cure for TB, that one we know.” (rural male)
"
Distinctions were also made between types of TB that are not curable, for example “inherited” TB cannot be cured, or TB that has progressed very far cannot be cured. It was also believed that TB cannot be cured in HIV patients. One explanation given was because HIV destroys all the white blood cells so even with the help of strong drugs the body cannot fight TB.
People believed that TB is transmitted through saliva by sharing utensils, cups, plates, and food stuffs. For example, one respondent noted that:
"
“When a TB patient spits and another comes close to it [he/she] gets TB. Then sharing things like cups, forks you also get it.” (urban female)
"
The idea of TB being transmitted through sharing cups is especially mentioned in the context of sharing cups when drinking alcohol. The situation of passing around a common cup at a local bar is associated with TB transmission. For example, one respondent stated:
"
“TB spreads easily to those people who drink local booze because they share straws among themselves.” (rural male).
"
In addition to alcohol, smoking was also understood as a way how TB is transmitted.
TB was also associated by respondents with being an environmental air pollutant. TB can be contracted from smoky fires in local houses that don’t have good chimneys and where the kitchen and bedrooms are together.
"
“Most especially we have kitchens in the same house where people sleep, so the smoke is too much. [The] lungs develop something like feathers which causes that person to cough, cough and cough.” (urban male)
"
"
“People who work mostly in industries and factories are vulnerable.” (urban male)
"
There was also an understanding of TB being inherited from one’s parent through blood, that it runs in a family, as one respondent explained:
"“S
ome diseases we inherit from the blood of our parents like TB, that TB can be inherited.” (rural male)
"
TB was correctly associated by respondents with a very serious set of symptoms including very severe and prolonged cough, often associated with coughing up or vomiting blood. Less severe symptoms were assumed to be a “normal cough”, and so people didn’t seek medical attention. As one participant explained:
"
“Yes, asthma and other things, regular coughs. I see that the reason leading to many people dying of TB [is that] they assume it’s a normal cough yet it’s TB.” (rural female)
"
Abnormal weight loss was also understood as a symptom of TB, but not independent of cough. There was almost no mention of night sweats (the only person who mentioned it was a nurse) and no discussion of having weight loss/ night sweats without the cough.