Knowledge, Attitude, and Practices Toward Tuberculosis Among Hospital Outpatients in Kabul, Afghanistan

Abstract

BackgroundTuberculosis (TB) is a high-burden respiratory infectious disease. There was a sharp decline in the number of confirmed TB cases during the pandemic; this is likely to be influenced by the COVID-19 pandemic response, with under-reporting due to resource diversion. There are typically 13,000 tuberculosis-associated deaths in Afghanistan annually, with significant problems posed by drug-resistant TB.MethodA cross-sectional descriptive study was conducted in Afghanistan on Kabul residents who visited the adult outpatient departments of public hospitals for any health-related reason from 1st January to 20th March 2022. The study scored their knowledge, attitude, and practices (KAP) toward tuberculosis. The sample size was calculated using Epi-Info, and the minimum sample size was 385. The sampling method is chosen the non-probability convenient sampling for data gathering. Data were analyzed using SPSS version 28, and we used the Mann-Whitney test, Chi-square or fisher extract test, spearman correlations, and binary logistic regression model.ResultsOf 829 participants, 450 (54.3%) were males and 379 (45.7) females. The median age was 28 years, and 63.3% were married. Most participants were unemployed (75.5%), but 54% had a monthly income >3,000 Afghanis, indicating the reliance on family. By TB knowledge score, 727 (87.7%) participants had good knowledge, and 800 (96.5%) participants had a positive attitude toward treatment and control. Only 2 participants reported poor practices regarding prevention. Regarding the binary logistic regression, young age, being a male, belonging to the “1,000–3,000” Afghani monthly income category, and having a positive attitude were significant predictors of good TB knowledge (P-value = 0.009, 0.000, 0.003, and 0.009), respectively. A positive attitude was expected to have good knowledge 6.035 times more than a negative attitude (95% CI: 1.572–23.167).ConclusionThe study findings highlighted that outpatients in Kabul had good knowledge, attitude, and practice toward TB. More studies are needed to highlight KAP in different Afghan populations, including in other parts of the country.

Assessing the knowledge, attitude and practice (KAP) measures against tuberculosis in patients in the ambulatory department facilities in Pakistan: a cross-sectional analysis

“…In contrast to a study conducted in Ethiopia, which found that 46% of respondents had a low level of knowledge about TB [12], the current study found that total knowledge about TB was 64% lower. The current finding, however, was superior to a study conducted in Afghanistan [13], where nearly 88% of individuals had a good awareness of TB. The latter study's score was substantially correlated with attitude assessment, age, and gender.…”

“…This result is consistent with that of a different study carried out in Tepi General Hospital in Ethiopia, where the majority of participants (70%) said that the spread of the illness could not be stopped, while 92 (22.4%) said that covering the mouth and nose while coughing or sneezing could help stop the spread [18]. The results, however, contrast with those from Kabul, where 98 percent of participants indicated that TB transmission could be prevented [13]. Cough was the primary symptom mentioned by the majority of individuals (90.4%), followed by fever (80.8%) and loss of appetite (62.3%).…”

“…Age, marital status, and employment position were reliable indicators of participants' general attitudes regarding tuberculosis (TB). It is distinct from studies of a similar nature conducted in Ethiopia [15] and Afghanistan [13], where the individuals' gender simply predicted higher scores; 44% of participants in another study in Ethiopia's North Mecha area were judged to have good practice, while 68% of the participants reported having a good attitude [16]. Similar findings were seen in a Thai study, where 47.9% of subjects were classified as having a high level of attitude towards TB [17].…”

“…There was great variability in the monthly income of participants ranging from 0 to 300000 (mean 30000) (Table 1). The results of the area under the ROC curve (AUC) were deemed to be successful for AUC values between 0.9 and 1, excellent for AUC values between 0.8 and 0.9, good for AUC values between 0.7 and 0.8, fair for AUC values between 0.7 and 0.8, poor for AUC values between 0.6 and 0.7, and failed for AUC values between 0.5 and 0.6 [13].…”

Exploring Sex Differences in Risk Factors and Quality of Life Among Tuberculosis Patients in Herat, Afghanistan: A Case-Control Study

“…A hospital review of extrapulmonary TB cases in Kabul found a majority were women, indicating potential gender differences [ 13 ]. Studies in Kabul revealed knowledge gaps and stigmatizing attitudes about TB among Afghans in Pakistan [ 17 , 18 ].…”