An estimated 10.0 million (range: 8.9-11.0 million) individuals worldwide contracted Tuberculosis (TB) in 2019, a figure that has been slowly dropping in previous years. HIV-negative individuals died from TB at a rate of 1.2 million (1.1-1.3 million) in 2019. (A reduction from 1.7 million in 2000). However, India still contributes to being the highest TB burden country in the world, with an estimated incidence of 26.9 lakh cases in 2019 (WHO), and has one of the most significant shares (27%) of drug-resistant TB in the world [1-3].

TB also has a substantial socioeconomic impact as it commonly affects the most productive age group and rural high-risk populations. An estimated 100 million people fall below the poverty line each year because of the financial burden related to TB disease [4-5].

Although India accounts for a large portion of the global TB burden, the illness has declined for the past few years. The therapy is accessible under the National Tuberculosis Elimination Program, and the patient will receive financial aid to maintain optimal nutrition. Along with treating those who are afflicted, the program also emphasizes early case detection through active case discovery and awareness-raising, as delaying access to medical care might delay diagnosis and treatment, which will hinder our efforts to realize the goal of a TB-free India by 2025 [6-7].

Early detection and treatment of TB can significantly reduce the spread of the disease from an infected person to others in the family and community. To stop continuous transmission, it is crucial to check the level of awareness in the community regularly. Raising awareness encourages behavioral change and better health-seeking habits [8-9].

The community may help our nation achieve its aim of eradicating TB from India by 2025 by raising awareness about the disease. As a result, the current study was conducted to gauge community awareness of and attitudes regarding TB in Punjab.        

Objectives of the Study

To evaluate the Awareness and Perception of Tuberculosis among the general population of Punjab.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area:  Whole state of Punjab

• Study Duration: Between April 2022 and May 2022

• Study Population: All adults above 18 years old who stayed in Punjab for 12 months or more. 

• Sample Size: 400 Adults assuming 50%   have adequate knowledge regarding Tuberculosis, 5% absolute error, 95% confidence level, and 5% non-response rate.

• Sampling Technique: Convenience and snowball Sampling technique

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography, Awareness, and Perception of Tuberculosis was created. The questionnaire was initially pre-tested on a small number of people to identify any difficulty in understanding by the respondents

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants' backgrounds: age, gender, marital status, religion, employment, education, and many more

• Questionnaire: The questionnaire contains 40 structured questions regarding Awareness and Perception of Tuberculosis, having three options, i.e., Yes, No & Don't Know. The participants have to choose the right one. One mark was given for each correct answer and zero for the incorrect answer. The maximum score was 40 and minimum score was zero.

 Scoring was done on the basis of marks as >80%(32-40) = very good,60-79%(24-31) = PGood,41-59% ( 16-23) = Fair,<40% (< 16) = poor

• Validity of Tool: by the experts in this field

• Inclusive Criteria: who were willing to participate in the study

• Exclusion Criteria: who were not willing to participate in the study

• Data Collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like email and social media platforms like WhatsApp groups, Facebook, Instagram, and LinkedIn in both rural and urban areas of Punjab till the 400 responses were collected. Responses were then recorded in a Google Excel spreadsheet

• Data Analysis: Data was collected and entered in a Microsoft Excel spreadsheet, cleaned for errors, and analyzed with Epi Info V7 Software with the appropriate statistical test for frequencies and percentages

• Ethical Considerations: Participants' confidentiality and anonymity were maintained

The The present study was a cross-sectional descriptive study to evaluate awareness and Perception of Tuberculosis among the general population of Punjab.

A total of 400 respondents, including 165(41.25%) from an urban area and 235(58.75%) from rural areas, participated in the study. Among the participants, the majority, 262(65.5%), were males, 174(43.5%) were between 18-30 years, 159(39.75%) were graduates, 259(64.75%) were employees, 248(62.0%) were married, and 384 (96.0%) were Hindu.

In the present study, 36 (9.0%) participants had very good (32-40 marks) awareness and Perception about Tuberculosis,122 (30.5%) had good (24-31 marks),

Table 2: Awareness about TB Disease Characteristics among Participants

Table 3: Awareness Regarding Tuberculosis among Study Participants

147 (36.75%) had fair (16-23 marks) and 95 (23.75%) had poor (<16 marks) awareness and Perception about Tuberculosis.

Our study's findings show that the general Punjabi population lacks appropriate information and awareness about TB. Similarly, in the study done by Shashikantha SK et al., 1, more than three‑fourth of the subjects (76.1%) had heard about TB disease. More than 50% of the subjects mentioned "coughing" by a diseased person as the main reason for spread, forty percent of the subjects opined as recovery would be complete after treatment, and more than 60% of the subjects knew that TB diagnosis and treatment is accessible in any government health center.

In the study done by Sreeharshika Dumpeti et al., 4, although the awareness of symptoms, causative agents, and mode of spread was reasonably good, knowledge of the availability of DOTS centers and services offered through RNTCP is still poor among the population. The study by P. Kulkarni et al., 10 showed poor knowledge about TB symptoms, causes, and modes of transmission and moderate awareness of government TB services. 

The results mentioned above in our study underline that the population lacks or is dissatisfied with knowledge about TB and its control in many areas. The general public's access to health education has to be increased. Additionally, this study reaffirms the necessity of extensive community-based TB awareness studies in all of Punjab's districts to support our efforts to eradicate TB from India by 2025. The need for a coordinated effort by the community with the accurate and required information and the health care professionals is necessary for strengthening our efforts toward TB-free India by 2025. Multi-sectoral approach by various stakeholders involved in TB care, with people having the correct information related to TB, is the need of the hour.

Limitations

The sample size and duration of the study are restricted to 400 respondents and two months in time; thus, the scope and extent of the conducted research might be minimized. This survey was conducted only in one state of India; hence, these findings cannot be generalized all over India.

It is determined that participants' knowledge and views of TB were not sufficiently based on the assessment of awareness and perception surrounding the disease. The study's conclusions can be used to develop a thorough health education program for raising awareness of TB throughout Punjab. It can support early tuberculosis detection and treatment. Health initiatives based on these findings may potentially assist in lessening TB stigma in the local community.

1. Shashikantha, S.K. and M.P. Sheethal. “Awareness about tuberculosis in a rural area of Mandya district: A cross-sectional study in southern Karnataka.” Journal of Family Medicine and Primary Care, vol. 11, 2022, pp. 587–592.

2. Central TB Division. India TB Report 2020. Ministry of Health and Family Welfare, New Delhi, 2020.

3. World Health Organization. Global Tuberculosis Report 2020. World Health Organization, Geneva, 2020. Licence: CC BY-NC-SA 3.0 IGO.

4. Dumpeti, S. et al. “Awareness about tuberculosis and RNTCP services among rural people in Nalgonda district, Telangana.” Journal of Family Medicine and Primary Care, vol. 9, 2020, pp. 3281–3287.

5. Tanimura, T. et al. “Financial burden for tuberculosis patients in low- and middle-income countries: A systematic review.” European Respiratory Journal, vol. 43, 2014, pp. 1763–1775.

6. Central TB Division. India TB Report 2021. Ministry of Health and Family Welfare, New Delhi, 2021.

7. Potty, R.S. et al. “Community health workers augment the cascade of TB detection to care in urban slums of two metro cities in India.” Journal of Global Health, vol. 11, 2021, p. 04042.

8. Rami, K. et al. “Awareness and knowledge about tuberculosis in patients of tuberculosis at GMERS Medical College and Hospital Dharpur, Patan, Gujarat.” International Journal of Medical Science and Public Health, vol. 4, 2015, pp. 906–909.

9. Koneru, K.S. et al. “Awareness of tuberculosis among patients attending Saveetha Medical College.” International Journal of Scientific Research, vol. 7, 2018, pp. 44–47.

10. Kulkarni, P. et al. “Tuberculosis knowledge and awareness in tribal-dominant districts of Jharkhand, India: Implications for ACSM.” Public Health Action, vol. 4, no. 3, September 2014, pp. 189–194.

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