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Year 2019

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Archana B.R and Sangeetha S: Tuberculosis, RNTCP, DOTS and Multidrug resistant tuberculosis: Do our Medical students know enough?


Introduction

Tuberculosis (TB) is one of the most common infectious diseases worldwide. As per the Global TB report 2017, India has approximately 2.8 Million TB patients, accounting for about a quarter of the world’s TB cases. Of these cases 1, 47,000 cases are MDR TB cases, resistant to the first line TB drugs rifampicin and isoniazid.1 The treatment success rate among MDR-TB patients in India is consistently about 46% and the death rate is around 20%, as against the global level of treatment success rate of 52% and death rate of 17%. High rates of treatment failure and deaths are associated with fluoroquinolone resistance in the Indian cohort of MDR-TB patients. India is also the country with the second highest number of estimated HIV associated TB cases.2

RNTCP has released a ‘National strategic plan for tuberculosis 2017-2025’ (NSP) for the control and elimination of TB in India by 2025. According to the NSP TB elimination have been integrated into the four strategic pillars of “Detect, Treat, Prevent, Build”.2 The goal of NSP 2017-2025 is to achieve rapid decline in the burden of TB, mortality and morbidity, while working towards elimination of TB in India by 2025.1

TB trends are influenced by control programmes as well as by biological, social and economic factors. A lack of knowledge regarding TB among health care workers may contribute to an increased risk of developing the disease. Control & elimination of TB is more likely to be achieved if the level of knowledge regarding the disease, its diagnosis, management and development of resistance, is increased among medical students in order to make excellent doctors, as they play a vital role in diagnosis, management of TB. Medical colleges play an important role in training the future generations of medical practitioners who will manage TB patients. So this study was undertaken to assess the knowledge of Tuberculosis, drug resistance among medical students and their awareness about DOTS, RNTCP guidelines.

Material and Methods

A cross sectional study was carried out in a tertiary care, medical college and hospital, Bangalore. Total of 150 medical students of 5th semester M.B.B.S. were included in the study. The Knowledge of participants about TB signs/symptoms, transmission, diagnosis and their knowledge about drug resistance, DOTS and RNTCP guidelines were assessed using a questionnaire.

Self-administered questionnaires were distributed to all participants and allowed 60 minutes to complete the questionnaire under supervision. The questionnaire had multiple choice questions with single correct response. The participants were instructed to mark a single appropriate answer for each of the questions. The data was analysed using descriptive statistics, proportions and mean.

Results

Out of 150 medical students assessed, more than 80-90% had knowledge about causative agent, disease symptoms, transmission and diagnosis (Table 1). First line drugs were known to 62% of students. Only 30% answered correctly about side effects of drugs, 20% know about drugs used in pregnancy and also TB-HIV co infection, 36% were aware about gene responsible for drug resistance in tuberculosis (Table 2).

About 80% were aware of DOTS, availability of free drugs. But poor knowledge was observed about various categories, drug resistance and drugs used for different categories under DOTS treatment regimen and RNTCP guidelines. Only 35% answered correctly about different categories of TB, 30% were aware of drugs used in the treatment of different categories (Table 3).

Table 1
Question Percentage of correct answers
Causative agent 92%
Mode of spread 88%
Symptoms of TB 87%
Diagnostic tests 80%
No. of samples collected 85%
Available treatment for TB 80%

Knowledge about Tuberculosis

Table 2
Question Percentage of correct answers
First line drugs of TB 62%
Side effects of drugs 30%
Drugs used in TB & HIV coinfection 22%
Drugs used for TB in pregnancy 20%
Definition of MDR 71%
Different types drug resistance 60%
Gene responsible for resistance 36%
Tests to detect drug resistance 30%

Knowledge about Antitubercular drugs and their Resistance

Table 3
Question Percentage of correct answers
DOTS 80%
DOTS facilities 87%
Definition of new case 26%
Definition of smear positive TB 30%
Category of TB 30%
Treatment for different categories of TB 35%
RNTCP guidelines 35%

Knowledge about DOTS and RNTCP

Discussion & conclusion

TB is an ancient infectious disease with new threat of MDR, XDR and TDR TB.

It is very important to have thorough knowledge of the disease to treat patients adequately. This study shows that the knowledge of medical students about the disease, its transmission, diagnosis is adequate about 80%, which is comparable with other studies.3,4,5 In contrast, a similar study conducted on interns in Delhi, by Sanjay Rajpal et al showed lesser knowledge about modes of transmission and diagnosis of TB.6 In a study done by Kutare et al only 38% correctly answered the method of diagnosis.7

In our study 70% know the definition of MDR TB, but knowledge about side effects of drugs, drug resistance, drugs used during pregnancy, TB- HIV co infection, DOTS regimen and RNTCP guidelines were very poor, similar finding was also reported by Revathi R et al, Giri PA et al, Busari O et al, Singla N et al.8,9,10

Conclusion

Regular training sessions, CMES, Conferences on tuberculosis is to be conducted for medical students in order to strengthen their knowledge about drug resistance, DOTS regimen and RNTCP guidelines. TB control is more likely to be achieved if the level of knowledge among medical students is increased, as they play a vital role in diagnosis and management of TB patients.

Source of Funding

None.

Conflict of Interest

None.

References

1 

TB India 2018, Revised National TB control Programme, Annual Status report. 2018http://www.tbcindia.org. Annual Status report

2 

2.Ministry of Health and Family Welfare GoI. Report of the first national anti-tuberculosis drug resistance survey India2014–16, 2018. Ministry of Health and Family Welfare GoI

3 

R A Patle G M Khakse Knowledge about tuberculosis and multidrug resistant tuberculosis among internsNational J Community Med2014515153

4 

P K Chennaveerappa H K Rajashekar N Jayashree B R Halesha K U Raghavendra Prasad M V Vinaykumar A study on awareness of tuberculosis and RNTCP among undergraduate medical students and internsJ Evolution Med Dent Sci201432981158121

5 

R Revathi R Dharanisri Knowledge about tuberculosis among undergraduate medical students in a private college in ChennaiInt J Community Med Public Health201852644646

6 

A Mittal V K Dhingra R Malhotra R Gupta C Malhotra S Rajpal Attitude and Practices regarding Tuberculosis and DOTS among interns in DelhiInd J Coll Physicians Surg Pak200717457461

7 

A Kutare M Rosario N Goudb A Study on Knowledge of Tuberculosis, DOTS And MDR-TB among Interns of Medical Colleges in BangaloreInt J Health Sci Res2012233238

8 

P A Giri D B Phalke Impact of sensitization workshop on knowledge regarding tuberculosis among final year medical studentsInt J Med Public Health201323100103

9 

O Busari A Adeyemi B Olusogo Knowledge of tuberculosis and its management Practices among medical interns in a resource-poor setting: implications for disease control In sub Saharan AfricaInternet J Infect Dis20136215

10 

Survey of knowledge, attitudes and practices for tuberculosis among general practitioners in Delhi, IndiaInt J Tuberc Lung Dis199825384389



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