Knowledge about Tuberculosis and its Complication among the Patients in a Teaching Hospital

Tuberculosis (TB) is an infectious disease which is transmitted by air. This disease damages the lungs and other organs in the human body. It is one of the leading causes of morbidity and mortality despite the fact that it can be cured with adequate treatment. The entry of multidrug resistant tuberculosis (MDR-TB) or extensively drug resistant (XDRTB) is biggest challenges in our effort to control the disease complications. A cross-sectional study was conducted to assess TB related knowledge, its complications and control among the patients from the outpatient Pulmonology department of Owaisi Hospital and Research CenterHYD. The research shows that maximum number of patients (59%) was unsure about the severe complication of TB whereas patients did not adhere to the treatment and discontinue it half-way, this become the prime reasons for the gap between treatment and control, thereby non-adherent treatment could have severe consequences of diseases and might lead to death. Knowledge about pulmonary complication and duration of treatment has to be emphasized.


Introduction
After human immunodeficiency virus (HIV) [1][2][3], Tuberculosis (TB) is one of the leading causes of the disease worldwide [4,5]. The Latest World Health Organization (WHO) Report shows that there were 9.0 Million new TB cases and 1.5 Million tuberculosis deaths [6][7][8][9][10]. The Transmission of the TB disease by Mycobacterium tuberculosis takes place by air in the form of sneeze, talk, cough, spit etc. Transmission of the disease occurs only after continues exposure patients with active TB [11][12][13]. In some patients, the sign and symptoms of the disease do not appear for many years and TB bacteria remains dormant. The disease gets effect only if the immune system becomes weakened by Diabetes, HIV infection, Malignancy, Kidney disease and immunosuppressive agent [14][15][16][17][18][19].
Active or pulmonary tuberculosis (TB) can cause permanent lung damage when it is not diagnosed and treated early [12]. Untreated active disease can also spread to other organs of the body where it leads to serious or life-threatening complications. Complications of TB arise due to late detection, identification and irregular treatment. These complications can vary from mild to severe health problems that may also cause death [20][21][22][23][24][25][26]. Few complications of the disease are listed like permanent lung damage, Meningitis, bone and joint complications, cardiac problems and liver or renal inflammation [27][28][29][30][31][32].
Due to Multidrug resistance, some of the TB programs were not successful. Drug [9] resistance in MDR-TB or XDR-TB is a human-made problem [33][34][35]. Lack of awareness, incomplete [9] or inappropriate treatment and bad quality of medicines has led to the present situation of TB prevalence [36,37]. The early detection and proper treatment of TB using combination of drug therapies for 6-9 months can make the patient non-infectious and finally cure the disease [38,39]. However, in countries like India proper assessment of the TB has not been done. This study is done to assess the patient's perception on TB complication and drug regimen [40][41][42][43][44].

Method
A cross-sectional survey was done to assess TB-related knowledge, its complications, and control among the participants from the outpatient Pulmonology Department of Owaisi Hospital and Research Center, Hyderabad, India.

Participants
The data collection is done with help of a questionnaire which contains two different parts that is 1) Knowledge on TB disease, 2) Complication and control of TB. The study includes 1006 patients from the out-patients from Pulmonology department which were previously diagnosed for tuberculosis. The patient's response in the survey study was assessed on perception of TB disease, its complication and control.

Result
• The above statistical analysis shows that, maximum (59%) were unsure that the severe complication of Tuberculosis. Participants both (male and female) were unaware about treatment and side effects of the given medicine.
• 90% of total participants scared when they had cough with blood and sought immediate treatment. 45% of total participants did not adhere to the treatment and discontinue it half way. This becomes the prime reason for the gap between the treatment and its adherence.
• 58% of total participants' belief was that TB is a short lived infectious disease and curable. In Contrast to this 28% total of participant had opposite negative thought; they told that TB is not at all curable completely. 30% of total participant thought that 1 or 2 months treatment are sufficient is enough to control TB disease (Tables 1-9). minor ocular and gastrointestinal complications were reported, Rifampicin and isoniazid was the most causative agent of hepatotoxicity. Of all the participants 62% of the patients stated that they didn't have idea of properly maintain the medical records for their treatment of the disease, this is the main root cause, where TB not under controls.
It was very concerning that there is a tendency to show discrimination towards TB patients, which was shown by this study. A good number of patients told that they are unaware that TB causes

Discussion
The study shows significant variations in the genders male and female. Male are better informed the causes, transmission of TB, its complication and Control. Maximum patients were unsure about the sever complication of TB and drugs. The result of this study also indicates that intolerance of Anti-tuberculosis drugs due to side effect is still a serious problem in patients. The incidence rate of hepatic dysfunction was found to be the most frequent side effect. Whereas       severe complications and patients do not maintain any medical history/ records of the disease. In addition, the most alarming event was that patients are unaware of the Multi-drug resistance Tuberculosis (MDR-TB) besides. These results, in lack of awareness of drug therapy and its regimen after getting a positive test for MDR-TB test. It was very encouraging as we expect individuals to seek health care as early as possible. However, the patients are very well aware of the side effects of drugs and consequences of incomplete or inappropriate treatment. An attempt could be made in future to improve an awareness and knowledge among TB patients to decrease TB complications and misconceptions, to allay the social stigma attached with it to decrease TB transmission. TB complications includes spinal pain, joint pain in knees and hips, swelling of the membrane of the brain i.e., meningitis, impairment of liver and kidney functions and rarely Heart disorder called cardiac Tamponade. These complications can be overcome by minimizing the drug side effects. This can be done by increasing the awareness for proper usage of medications to prevent MDR-TB. Drug complications can be diminished by increasing immunity of the patients with the help of diet and increasing pulmonary health.

Conclusion
According to this study analysis, it is clear that a patient does not have clear knowledge regarding the TB, its complication and control. Perfect management of active tuberculosis treatment includes the initiation and the completion of anti-tuberculosis therapy with minimal complication and reduce side effect of anti-tuberculosis drug by closer monitoring of Adverse Drug Reaction (ADR). MDR-TB can be diminished by identifying the drug resistance and by treating the disease with the second line anti-tuberculosis drugs in proper regiment in relapse cases. Thereby inappropriate or incomplete treatment could lead to severe consequences and may leads to death of the patient. Knowledge about pulmonary complication and duration of treatment has to be focused.