Introduction

Tuberculosis
Tuberculosis is an infectious, airborne disease usually caused by the bacterium
Mycobacterium tuberculosis (MTB). Tuberculosis may infect any part of the
body, but most commonly occurs in the lungs (known as pulmonary
tuberculosis). Extrapulmonary TB occurs when tuberculosis develops outside of
the lungs, although extrapulmonary TB may coexist with pulmonary TB. When
people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel
infectious aerosol droplets 0.5 to 5.0 µm in diameter. A single sneeze can
release up to 40,000 droplets. People with prolonged, frequent, or close
contact with people with TB are at particularly high risk of becoming infected,
with an estimated 22% infection rate.
Multi Drug Resistant TB is often abbreviated to MDR-TB and it is a particular
type of drug resistant TB. It means that the TB bacteria that a person is infected
with are resistant to two of the most important TB drugs, isoniazid (INH) and
rifampicin (RMP). If bacteria are resistant to certain TB drugs this means that
the drugs don’t work. Other drugs then need to be taken by the person if they
are to be cured of TB. People with RR-TB are resistant to rifampicin. They may
or may not have resistance to other drugs. MDR/RR-TB means patients with
MDR-TB as well as patients with TB resistant to rifampicin.
Stigma of tuberculosis
Due to the lack of understanding about the disease, it is often met with high
levels of stigma and discrimination. People who become ill with tuberculosis
are often cast out from their community and even from their families.
In some cultures, TB is associated with witchcraft. TB can be considered a
‘curse’ on a family, as the illness often affects multiple generations – we know
that this is simply because TB is an airborne illness, which is more likely to be
spread among people living in close proximity.
TB is often associated with factors that can themselves create stigma: HIV,
poverty, drug and alcohol misuse, homelessness, a history of prison and
refugee status.

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Aim and objective
 The aim of the study was to determine the level of awareness among the
people of the community.
 The general objective was to understand the epidemiology of TB in the
community.
 Stigma and discrimination in the community and families.

Materials and Methods

Study Design
This was carried out using the cross-sectional study design to obtain the
difference among the people affected with TB and the people not affected with
TB.
Selection of community
Salia Sahi in Bhubaneswar is the largest slum of Odisha, India, spanning over
256 acres and containing a population of over 100,000.( 2016, Thakur)

 Most of the families residing there are not exactly poor rather we can say
them low-income people with an avg. income ranging from 12k to 15k
per month. (2016,Thakur )
 Mostly they were having nuclear family with 4 to 5 members in every
family
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  Majority of the respondent said that they have no problem related to
health issues.
 Most of the people are migrated from different district of Odisha like
Mayubhanj, Phulbani, Kandhamal, Ganjam, Puri etc.

Sample size determination

From the 1 lakh population of Salia Sahi, a number of 200 samples were taken
as consideration. Most of the people did not respond us showing different
causes. Among them only 60 responds us from which 2 were TB patients and
remaining were not affected with TB. Details of 2 TB patients were collected
from the nearby dispensery(PHC,Salia Sahi). The patients have already
completed their DOTS. Both of them were taking medicine in the surveillance
of health workers and AASHA.
Questionnaire
The survey was cross-sectional in design. Following participant enrolment in
the study, data were collected by self-administered questionnaire that assessed
participants’ knowledge about TB signs/symptoms, transmission, management
and control. Data were elicited on the following variables: sociodemographic
profile (age and sex), degree major (clinical and non-clinical), year in the
medical programme, TB knowledge (symptoms, mode of transmission,
treatment, knowledge of TB control facilities in the study setting, local TB
control policies and programme) and core knowledge of TB, namely, five core
TB knowledge areas which include the following: (1) classic TB symptoms of
cough/blood-tinged sputum, (2) TB modes of transmission, (3) curability of TB,
(5) location and services provided by TB local dispensaries and (5) the national-
free TB treatment policy.

Field Activities

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I went to Salia sahi Despensery to collect the data from the medical staffs(ANM
and Pharmacist). 2 TB patients were reported ( 1 of Pulmonary and another is
extrapulmonary). I went to their home and studies were done. Besides the TB
patients 198 other people were studied.
Case Studies
Case Study-1
Bishnuprasad Sahoo, a TB patient of Salia sahi lives with his father and
mother(A family of three member). He had already completed his DOTS in
05/05/2018. He was tested again for the confirmation of recovery from TB and
the result of the test(CBNAAT) was awaited.
Patient Name Bishnuprasad Sahoo
Father name Rabi Sahoo
Mother name Sabita Sahoo
Age 15
Sex Male
Qualification Matriculation
Occupation Student
Date of Detection 02/12/2017
Date of treatment initiation 05/12/2017
End of TB Treatment 05/05/2018
Sputum Result 1+(Pulmonary TB)
Knowledge regarding TB When he was asked how TB is transmitted he
replied that sharing of clothes and daily used
substances can cause TB. He also said that by
cough and sneezing it also be transmitted.
Patient perception He said that he was well treated by his family
members and mixed freely with them. As he was
a student and staying at boarding house, he was
taken out from the hostel and treated at home till
the completion of DOTS.
Community attitude Community is fully aware about TB and it behaves
him as a normal patient. Community people don’t
believe in any supernatuaral power like ancient
curses and witchcraft. Thay avoid the patient due
to the fear of transmission.

Case study -2
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Dhrubacharan Sahoo, a TB patient of lives with his wife, son and daughter in
law. He was affected by gland TB( an extrapulmonary TB at neck adenitis). He
has also completed his DOTS on 14/05/2018. Once he had discontinued his
DOTS after 2 month of 1st treatment and again took medicine.
Patient Name Dhrubacharan Sahoo
Age 52
Sex Male
Qualification 7th
Occupation Labourer
Date of Detection 11/10/2017
Date of treatment initiation 15/10/2017
End of TB treatment 14/05/2018(MDR)
Sputum result No Cough (Extra pulmonary TB)
Knowledge about TB When he was asked how TB is
transmitted he replied close contact
with a patient causes transmission of
TB.
Patient perception He said that his family members
treated him separately and forbid to
share his daily use commodities. He
stayed in a separate room after
detection of TB.
Community attitude Community knows that TB is a
communicable disease and it can be
cured by using drugs. People of the
community don’t believe in any
supernatural power for the reason of
TB.

Results and discussion

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Results
Demographic characteristics of participants
The people affected with TB and The people not affected with TB were studied.
Most of the people did not respond due to improper time, Bad heath condition
Absence of their Head of household and lack of knowledge about TB. 60
families respond me to answer the questionnare. Among them 2 were TB
patients and rest were not affected with TB.30% people responded to answer
the questionnaire, From the remaining 70 % people denied to respond due to
lack of time and some didn’t show interest for this study.
Knowledge of TB symptoms
The family members of 2 patients have the good knowledge of TB symptoms
and they know very well that continuous cough, fever, weight loss and night
sweating are the common symptoms of TB. But they have no knowledge about
the asymptomatic TB. 90% of the total respondants know about the symptoms
of TB. 10% of the respondants don’t know about the symptoms of TB
Knowledge about TB transmission
When the people were asked how the TB is transmitted. 80% people said that
using of patient’s materials are the main cause of TB transmission. They didn’t
know that TB is a airborne desease and can be transmitted by the air.
Knowledge about TB treatment and policies
Very few i.e. only 30% people know about the treatment of TB. 2 TB patients
and their family members and some educated people know about the DOTS
method.
Stigma of community and family
The people don’t have any superstitious belief and they properly care the
patients. They know that it is caused by bacterial infection and can be cured by
the chemotherapeutics treatment. All respondants told that TB patients are not
curse it is caused caused by the infection of bacteria. In rural areas we show
that the patients are criticised and cast out from the family and community, but
here in urban slums it was seen that the family mambers know how to treat a
patient.

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As TB is mostly occurred in poor,dirty and over crowded areas, it is important
to aware the people of urban slums. The people of these areas have the
probability to affected by TB.
Salia Sahi is a slum which is full of tribals and poor people and it is also a
crowded.So it is required to aware the people regarding TB. But fortunately, I
got only 2 TB patients as they are aware about the disease.The people of the
slum have also no such superstitious belief to cast out the patient from the
community or family.
Now a days people of this community don’t believe in any supernatural power
responsible for TB transmission, even in any curse of family member or
witchcraft. This transformation in the community was evolved due to the
exposure to city centre, Media & thus expantion of knowledge regarding TB.
However they had such believe before migrating to the city centre.

Conclusion
In countries with high TB burden, it is important to use all the opportunities to
raise population awareness about the disease TB are used to the optimum.
India is the highest TB burden country; with population density of 2.79 million,
So it is necessary to create awareness among people.
Fear of discrimination can mean people with TB symptoms delay seeking help,
making it much more likely that they will become seriously ill and infect others.
This then perpetuates the myth that it is the TB treatment itself that causes
deaths, as treatment is much less effective if left until the illness is in its
advanced stages.
Stigma around TB can also make people reluctant to stick with their course of
treatment – over the many months this takes – for fear of being ‘found out’. By
taking treatment irregularly, people risk developing drug resistance.
The slum people are benefited by migrating to city centre as they got instant
information and more knowledges regarding disease.

References

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 1. David Schlossberg, Tuberculosis and nontuberculous mycobacterial
infections, 6th edition.
2. K Park, Park’s Textbook of Preventive and social medicine, 24th edition.
3. https://www.scribd.com/document/296803280/Salia-Sahi-Report
4. Dodd,P “Global burden of drug-resistant tuberculosis in children: a
mathematical modelling study”, the Lancet, 2016,
www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30132-
3/abstract
5. O. Kusimo ,R. Olukolade, A. Hassan, L. Okwuonye, K. Osinowo, Q. Ogbuji,
A. Osho,O.A. Ladipo, International Journal of Mycobacteriology, Volume
4, Supplement 1, March 2015, Page 61
6. https://www.tbalert.org/about-tb/global-tb-challenges/stigma-myths/

Annexures

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Annexure- 1( TB card of Bishnuprasad Sahoo)

Annexure- 2( TB card of Dhrubacharan Sahoo)

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