A Study on Awareness on Pulmonary Tuberculosis among Population Covered under Rural Health Training Centre at Mamandur in Tamilnadu

India has the highest number of Tuberculosis (TB) cases in the world. Community awareness on Tuberculosis in the general population is of foremost importance in combating tuberculosis in india. To assess the level of knowledge about symptoms, mode of transmission, causation, prevention and treatment relating to tuberculosis in a rural population of mamandur. To study the socio demographic factors associated with awareness about pulmonary tuberculosis Community based cross sectional study was conducted at Rural Field Practice Area of SRM at Mamandur in Tamilnadu. A total of 350 persons participated in the study. House to house interview was conducted using a predesigned, standardized semi structured questionnaire. Overall TB knowledge revealed adequate knowledge in 75.7%. There was significant association between the knowledge on TB among study population and the demographic variables of educational Nearly 2/3 of the population have adequate knowledge on tuberculosis. Factors like educational status, marital status and caste were significant association with inadequate knowledge on TB.


INTRODUCTION
India has the highest number of TB cases in the world 1 .Tuberculosis still remains a major public health problem despite the fact that the causative organism was discovered some 100 years back and highly effective drugs are available for its treatment.Worldwide 9.4 million cases are detected annually out of which half are sputum positive.India is 17 th among 22 high burden countries in terms of TB incidence rate 1 .
The global annual incidence estimate is 9.4 million cases out of which it is estimated that 1.98 million cases are from India.In India, every day more than 5000 people develop tuberculosis disease and nearly 1000 die due to tuberculosis i.e. 2 deaths every 3 minutes 2 .Deaths due to Tuberculosis exceed the combined deaths due to all other communicable disease and account for 26% of all avoidable deaths in adults.
Tuberculosis affects the most productive age group.Of all tuberculosis cases in India 2/3 rd are male and 70% of all patients are aged between 15 and 54 years 3 .It has been acknowledged though that TB control efforts worldwide, although impressive are not sufficient.The global TB targets -detecting 70% of TB cases and successfully treating 85% of them and halving the prevalence and mortality of the disease by 2015 as part of the Millennium Development Goals (MDGs) -are likely to be met only if current efforts are intensified.
The National Annual Risk of Tuberculosis Infection (ARTI) was estimated at 1.5% i.e. 75 new smear positive pulmonary TB cases are expected per 1, 00,000 population annually.TB primarily affects people in their most productive years with important Socio-economic consequences for the household when an individual falls sick with TB.Poor living conditions, debility and malnutrition predisposes population to disease.The disease is even more common among the poorest and marginalized section of the community 2 The present study is undertaken with the objectives of assessing the knowledge and Practice regarding Tuberculosis in a Rural Population of Mamandur Village.Tuberculosis has the dubious distinction of being the most persistent scourge of humankind .Worldwide statistics are staggering in 2001,the WHO estimated that 1.86 bilion persons were infected with TB.Each year 8.74 millon develop tuberculosis and nearly 2 millon die.This means that someone somewhere contracts TB every four seconds and one of them die every 10 seconds.

MATERIALS & METHODS
Community based cross sectional study was conducted at Rural Field Practice Area of SRM at Mamandur in Tamilnadu.A total of 350 persons participated in the study.House to house interview was conducted using a predesigned, standardized semi structured questionnaire.The sample of 327 individuals were selected on the assumption of prevalence of adequate knowledge of 55% from sampling on the study on rate of knowledge of pulmonary tuberculosis symptom among the rural population in Tamil Nadu as per the study by Malini Kar et al 4 .
After obtaining ethical committee approval, a house to house interview was conducted using a predesigned, pretested questionnaire Systematic random sampling was used to select the households from each village.First households selected by lot method.The next household was identified by adding the sampling interval with the first household.Head of family was selected for the study in his absence wife was selected for the study.The subsequent households were selected by same method till sample size is reached.

Data analysis
Data entry was made in excel spread sheets.The entered data was cleaned and validated for consistency.Analysis was done using SPSS21.0package and Epi info7.0.Prevalence was expressed in percentage and association with factors was tested for significance using Chi square test.P-value < 0.05 was considered significant.In the study relating to factors contributing to awareness the variable were dichotomized and two by two table were made.Test of ssociation chisquare test was done.Deriving the strength of association prevalence odds ratio was done.Subsequently logistic regression was performed choosing the factors which are significant.

Factors association between overall knownledge on tuberculosis
There was significant association between the knowledge on TB among study population and the demographic variables of educational status, marital status, and Caste.These three factors were part of the considered for the multiple logistic regressions.The regression model given in 4.3.12 and the adjusted odds ratio are given in illiterate people ,widows and the SC caste were associated with the adjusted odds ratio of 2.48(CI 1.46-4.22),2.23(CI 1.21-4.10)and2.22(CI 1.14-4.34)Respectively.So these are the population groups who need to be given priority to disseminate more knowledge about Tuberculosis Logistic regression model (Table 4), after controlling the effect of other variables showed that not having a education, a longer duration of the disease and having experienced surgery had a effect on disability and this was associated with statistical significance.few population based studies have highlighted the public awareness on Tuberculosis from different parts of India.One such study from Jaipur Rajasthan showed that 90% of illiterates were unaware about different aspects of Tuberculosis The present study clearly indicated that males have better knowledge when compared to females.A study from rural community of Delhi highlighted the age, sex and economic status did not have significant influence on TB knowledge A Cross sectional observational study done by Krishnadas Bhattacharyya et al Among 120 people Chest OPD of Calcutta National Medical College & Hospital, Kolkata during july -September 2001.Only 16.7% of the study subjects were aware of the cause of the disease 25.0% of them were not aware of the proper duration of treatment and 72.5% of patients' attitude towards domiciliary treatment was observed unfavourable.Safe method of sputum disposal was practiced by only 20.0% of study subjects and 21.7% of respondents did not take any precaution to prevent spread of the disease, while 46.7% practiced covering of face while coughing.
A descriptive cross-sectional study done by Philip Ifesinachi Anochie et al knowledge, attitude, behavioral and practice (KABP) survey on tuberculosis was carried out in a rural Nigerian community in Jun 2013 .We applied the questionnaire to 1186 people in designated rural households.Most of the participants, (1154, 97.3%) had prior knowledge and awareness about tuberculosis as a disease, 612 (51.6%) considered tuberculosis a result of HIV/AIDS epidemics or malnutrition, and 451 (38%) believed that it can be cured by Western medicine.The unwillingness of respondents to relate with TB patients was generally high (97%, 1150), even where levels of awareness and knowledge were high.Cough, the most common presentation of pulmonary TB was mentioned first in 68% (806) of the respondents' answers.Loss of weight was mentioned by 51.9% (615) of the respondents while hemoptysis was mentioned by 55.6% (660) of them.Only about 55% (652) of the respondents could list 3 or more symptoms or signs of the disease.Other responses regarding TB symptoms included: headache, body

Knowledge about Tuberculosis
The Present study showed that literates were more aware about the various aspects of Tuberculosis as compare to illiterates.Persons with literacy of higher secondary schooling and above had good TB knowledge compare to illiterates.A ache, joint-muscle pains and loss of appetite.The same questionnaire was used.
Present study revealed some lacunae in the knowledge about Tuberculosis.6% knew the tests for the diagnosis of Tuberculosis.(68.3%) were well aware that TB is a communicable disease, (93.1%) were aware lung was mainly affected by TB, (87.4%) knew the causes of TB, (78.9%) were well aware the mode of transmission and (81%) knew the common signs and symptoms of TB.These finding were comparable to similar studies conducted in a rural area in Delhi.27%were aware of the diet should be taken by TB patient.(66.8%) were aware of the preventive measure of TB. 3% had heard about DOTS centre.In general females, older population and individuals without schooling or with primary schooling were observed to be the groups with the significantly lower level of knowledge about the Symptoms, Transmission, Diagnosis, Treatment and prevention of TB.Over all TB knowledge was higher among males and respondents with higher schooling.In this study the adequate knowledge is only 2 so it was combined with moderate knowledge and bivariate analysis done.

CONCLUSION
A cross sectional study was carried out in rural population covered under Rural Health Training Centre at Mamandur to find out the knowledge towards Pulmonary Tuberculosis.Among 350 individuals, (93.1%) had heard about TB. (68.3%), were well aware that TB is a communicable disease.(92.3%) were well aware about the mode of transmission.81%knewcough as a symptoms.(72.3%)respondents perceived Tuberculosis to be a preventable disease, citing the treatment of patients as the main-stay of preventing spread of the disease.Only 6% knew the test for the diagnosis of TB.Overall TB knowledge revealed inadequate knowledge in 23.3%, and adequate knowledge in 75.7%.The study concludes that females, older population and individuals without schooling or with primary schooling were observed to be the groups with a significantly lower level of knowledge about symptoms, transmission, diagnosis, treatment and prevention of TB.
Overall TB knowledge towards pulmonary TB was higher among males, younger age and higher schooling respondents.Concerted efforts should be taken to create awareness.There was significant association between the knowledge on TB among study population and the demographic variables of educational status, marital status, and Caste.These three factors were part of the considered for the multiple logistic regressions.The adjusted odds ratio are given in illiterate people , widows and the SC caste.So these are the population groups who need to be given priority to disseminate more knowledge about Tuberculosis.
Nearly 2/3 of the population have adequate knowledge on tuberculosis.Factors like educational status, marital status and caste were significant association with inadequate knowledge on TB.So these are the population groups who need to be given priority to disseminate more knowledge about tuberculosis.

Fig. 1 :
Fig. 1: Shows the Overall knowledge Distribution DISCUSSION

Table 3 : Shows association between Overall knowledge on tuberculosis Among study population and study variables
* Pearson chi square, ** statistically significant