Date Published: June 6, 2019
Publisher: Public Library of Science
Author(s): Simukai Shamu, Locadiah Kuwanda, Thato Farirai, Geoffrey Guloba, Jean Slabbert, Nkhensani Nkhwashu, Sphiwe Madiba.
South Africa ranks third among 22 high burden countries in the world. TB which remains a leading cause of death causes one in five adult deaths in South Africa. An in-depth understanding of knowledge, attitudes and practices of young people towards TB is required to implement meaningful interventions. We analysed young men and women (18–24 years)’s TB knowledge including TB/HIV coinfections, testing rates and factors associated with them. A cross sectional cluster-based household survey was conducted in two provinces. Participants completed computer-assisted self-interviews on TB knowledge, testing history and TB/HIV coinfections. A participant was regarded as knowledgeable of TB if s/he correctly answered the WHO-adopted TB knowledge questions. We built three multivariate regression models in Stata 13.0 to assess factors associated with knowing TB alone, testing alone and both knowing and testing for TB. 1955 participants were interviewed (89.9% response rate). Their median age was 20 years (IQR19-22). Sixteen percent (16.2%) of the participants were social grant recipients, 55% were enrolled in a school/college and 5% lived in substandard houses. A total of 72% had knowledge of TB, 21% underwent screening tests for TB and 14.7% knew and tested for TB. Factors associated with TB knowledge were being female, younger, a student, social grant recipient, not transacting sex and having positive attitudes towards people living with HIV (PLWH). Factors associated with TB testing were being a student, receiving a social grant, living in OR Tambo district, HIV knowledge and having a family member with TB history. Factors associated with both TB knowledge and testing were being female, a student, using the print media, living in OR Tambo district and having a family member with a TB history. The study demonstrates the importance of demographic factors (gender, economic status, family TB history, and location) and HIV factors in explaining TB knowledge and testing. We recommend extending community TB testing services to increase testing.
About 10 million individuals developed Mycobacterium tuberculosis bacillus (TB) disease globally and 1.6 million died in 2017. Eighty percent of the world’s burden of tuberculosis (TB) is carried by twenty-two countries defined as high burden countries by the World Health Organization (WHO) and South Africa is one of them. In South Africa 692 individuals per 100 000 people are diagnosed with TB.
A total of 1955 participants were recruited and interviewed (response rate of 89.9%) in Mpumalanga (n = 973) and Eastern Cape (n = 982) provinces. Overall 50.2% of the sample were female. Median age of the participants was 20 years (IQR19-22). A total of 16.2% participants were social grant recipients. Fifty-five percent of the participants were enrolled in school. Of the 45% out of school 82.3% were unemployed. Thirteen percent were either married or partnered. One in 20 participants (5%) lived in substandard housing including Wendy house or shack. The radio (56.4%) was the most preferred media channel for TB information dissemination followed by the television (52.1%). Overall 72.1% were knowledgeable of TB. Slightly over 1 in five (22.1%) participants reported ever testing for TB. Fifteen percent (14.7%) had correct knowledge of TB and had ever tested for TB. Table 1 shows levels of TBknowledge per question asked and as a combined variable. Participants answered most of the symptoms and transmission questions correctly compared to the questions on co-infections.
In this paper we sought to identify rates of and associated factors for TB knowledge and testing among young people in two districts of South Africa. We found almost three quarters of the participants knowledgeable of TB (72%) and one in five having ever tested for TB. Only 14.7% knew and tested for TB. Demographic factors were associated with both TB knowledge and testing while HIV-related factors were associated with TB knowledge alone or TB testing alone. Demographic factors related to TB knowledge and testing were being female, a student, living in OR Tambo district, having a household member who had TB before and using the print media for health messages. HIV-related factors such as high HIV knowledge, PrEP knowledge, transactional sex, having positive attitudes towards PLWH and towards HIV testing were associated with either TB knowledge alone or TB testing alone in different ways as shall be discussed. This study contributes to our knowledge of the importance of demographic factors and TB/HIV connections as communicable diseases in the prevention of TB as a leading killer disease.
The study found high levels of TB knowledge amongst youth overall but low levels of knowledge of TB/HIV coinfections. Demographic factors (age, gender, place of residence, occupation) and socio-economic status were associated with TB knowledge or testing while HIV-related factors (accepting attitudes towards HIV testing or PLWH, knowledge of PrEP and high HIV prevention knowledge score) were associated with TB knowledge alone or TB testing alone. Interventions on TB should consider strengthening the education of the people about TB/HIV coinfections in the communities towards a comprehensive programme of TB prevention including testing. Holistic interventions that target altering socio-economic characteristics of the communities remain key in ensuring that high levels of TB knowledge and testing are achieved. In a nutshell, this paper contributes to our knowledge of the importance of demographic factors and TB/HIV integration when planning TB control programmes.