Research Article: Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 Hajj

Date Published: January 25, 2019

Publisher: Public Library of Science

Author(s): Badriah Alotaibi, Yara Yassin, Abdulaziz Mushi, Fuad Maashi, Abin Thomas, Gamal Mohamed, Amir Hassan, Saber Yezli, Frederick Quinn.


Given the inherent characteristics of the Hajj pilgrimage, the event is a risk for tuberculosis (TB) infection. Early diagnosis and appropriate management of TB cases by knowledgeable and skilled healthcare workers (HCWs) are key in improving patients’ outcome and preventing transmission during the Hajj mass gathering and globally.

We conducted a cross-sectional study to assess knowledge, attitude and practice (KAP) of HCWs deployed during the 2016 Hajj regarding TB and its management using an anonymous self-administered questionnaire.

Data was collected from 540 HCWs from 13 hospitals. HCWs originated from 17 countries and included physicians, nurses and other non-administrative HCWs. Nearly half of HCWs declared having experience dealing with TB patients. In general, HCWs had average knowledge (mean knowledge score of 52%), above average attitude (mean attitude score of 73%) and good practice (mean practice score of 85%) regarding TB, based on our scoring system and cut-off points. Knowledge gaps were identified in relation to the definition of MDR-/XDR-TB and LTBI, smear microscopy results, length of standard TB treatment for drug-sensitive TB, 2nd line anti-TB drugs, BCG vaccination, and appropriate PPE to be used with active PTB patients. Poor attitudes were found in relation to willingness to work in TB clinic/ward and to the management and treatment of TB patients. Poor practices were reported for commencing anti-TB treatment on suspected TB cases before laboratory confirmation and not increasing natural ventilation in TB patients’ rooms. Age, gender, nationality, occupation, length of work experience and experience dealing with TB patients were associated with knowledge scores. Age and occupation were associated with attitude scores while length of work experience and occupation were associated with practice scores. There was a weak but statistically significant positive correlation between score for knowledge and attitude (rs = 0.11, p = 0.009) and attitude and practice (rs = 0.13, p = 0.002).

While the results of the study are encouraging, important knowledge gaps and some poor attitudes and practices regarding TB were identified among HCWs during Hajj. This calls for multifaceted interventions to improve HCWs KAP regarding TB including tailored, periodic TB education and training aimed at boosting knowledge and improving behaviour.

Partial Text

Early diagnosis and appropriate management of tuberculosis (TB) cases by knowledgeable and skilled healthcare workers (HCWs) are key in addressing this global health issue [1]. The Hajj religious mass gathering in the Kingdom of Saudi Arabia (KSA) attracts over 2 million pilgrims from around 180 different countries [2]. Many pilgrims come from TB endemic areas and worship under conditions that increase the risk of TB transmission [3]. The event has been linked to increased risk of TB infection and both diagnosed and undiagnosed TB have been reported at the pilgrimage [3, 4]. During Hajj 1000s of HCWs are deployed from across the Kingdom to ensure healthcare for pilgrims. HCWs serving during Hajj come from different nationalities; cultural, educational and occupational backgrounds; and work in different specialities. Many are deployed to temporary healthcare facilities attending large numbers of patients in a limited period of time.[5] While this workforce receives various trainings in preparation for Hajj work, including relating to infection prevention and control [6], it is unclear whether this is adequate to improve their collective knowledge, attitude and practice (KAP) regarding TB and its management during or after the event.

Knowledge deficit regarding TB among HCWs may result in substandard care, ineffective service provision, inefficient resource use, and impact on health outcomes as well as increasing the risk of TB transmission and development of resistance. In addition, the knowledge and attitude of HCWs towards TB will determine the type and quality of information passed on to the patients during health education. Inadequate or incomplete information passed on to the patients create wrong perceptions in them or strengthen the patients’ negative perceptions which are often times based on cultural beliefs and misconceptions [26, 27]. These negative perceptions are mostly inimical to appropriate health seeking behaviour, hence reducing the likelihood of completing treatment and achieving cure and increasing the risk of spread of the disease [26]. As such, the knowledge of health professionals related to TB affects not only themselves and their individual patients, but also the global population as a whole. A number of studies from around the world investigated knowledge of HCWs regarding TB and found varying results [7]. Some reported poor knowledge [13, 28], others found adequate [17, 29–31] or good knowledge [14, 32]. For example studies among HCWs from Peru [29], Mozambique [13], Russia [28], Ethiopia [33] and Lesotho [10] reported average TB knowledge scores of 51.7–74%, which are close to what we found among HCWs working in Hajj (52%). However, while we deemed TB knowledge in the current study to be average, a number of these studies reported that their scores were poor, unsatisfactory or low given their higher score cut off points for good knowledge [10, 13, 28].




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