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      Knowledge, Attitudes, and Perceptions of Tuberculosis in Indonesia: A Multi-Center Cross-Sectional Study

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          Abstract

          Introduction

          Tuberculosis (TB) is still a persistent health challenge in Indonesia and ranks high on the list of factors causing morbidity and mortality. Improving knowledge, attitudes, and perceptions (KAP) of the general community about TB can help to control the disease.

          Purpose

          This study aimed to examine the KAP about TB in Indonesian society and investigate their sociodemographic determinants.

          Participants and Methods

          An online cross-sectional survey in 34 provinces in Indonesia was carried out in June 2022. The scores of KAP were classified as low, moderate, and high. Bivariate and multivariate ordinal logistic regression were applied to identify the potential sociodemographic determinants of KAP. Adjusted odds ratio and 95% confidence interval (CI) for each determinant were provided.

          Results

          Among the 3205 participants, 56.4%, 91%, and 38% had high scores on knowledge, attitude, and perception, respectively. Independent determinants of high knowledge were age (26–35 years; adjusted odds ratio: 1.53 [95% CI: 1.19–1.97]), marital status (married; adjusted odds ratio: 1.18 [95% CI: 1.00–1.39]), and salary (middle income; adjusted odds ratio: 0.76 [95% CI: 0.63–0.93]). Independent factors associated with high scores in attitude and perception were the residence location (village; adjusted odds ratio: 0.76 [95% CI: 0.59–0.98]) and the occupation type (civil servant; adjusted odds ratio: 1.53 [95% CI: 1.09–2.13]), respectively.

          Conclusion

          Most Indonesians have a high knowledge and good attitude, although they have a moderate perception toward TB. Improving public awareness and health education with the right strategies is critical to reducing the country’s TB burden.

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          Most cited references39

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          Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study

          Summary Background COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. Methods Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. Findings In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. Interpretation Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic. Funding Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.
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            Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts

            The October 2020 Global TB report reviews TB control strategies and United Nations (UN) targets set in the political declaration at the September 2018 UN General Assembly high-level meeting on TB held in New York. Progress in TB care and prevention has been very slow. In 2019, TB remained the most common cause of death from a single infectious pathogen. Globally, an estimated 10.0 million people developed TB disease in 2019, and there were an estimated 1.2 million TB deaths among HIV-negative people and an additional 208, 000 deaths among people living with HIV. Adults accounted for 88% and children for 12% of people with TB. The WHO regions of South-East Asia (44%), Africa (25%), and the Western Pacific (18%) had the most people with TB. Eight countries accounted for two thirds of the global total: India (26%), Indonesia (8.5%), China (8.4%), the Philippines (6.0%), Pakistan (5.7%), Nigeria (4.4%), Bangladesh (3.6%) and South Africa (3.6%). Only 30% of the 3.5 million five-year target for children treated for TB was met. Major advances have been development of new all oral regimens for MDRTB and new regimens for preventive therapy. In 2020, the COVID-19 pandemic dislodged TB from the top infectious disease cause of mortality globally. Notably, global TB control efforts were not on track even before the advent of the COVID-19 pandemic. Many challenges remain to improve sub-optimal TB treatment and prevention services. Tuberculosis screening and diagnostic test services need to be ramped up. The major drivers of TB remain undernutrition, poverty, diabetes, tobacco smoking, and household air pollution and these need be addressed to achieve the WHO 2035 TB care and prevention targets. National programs need to include interventions for post-tuberculosis holistic wellbeing. From first detection of COVID-19 global coordination and political will with huge financial investments have led to the development of effective vaccines against SARS-CoV2 infection. The world now needs to similarly focus on development of new vaccines for TB utilizing new technological methods.
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              Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study

              Background Tuberculosis (TB) is a major cause of death. The condition is highly stigmatised, with considerable discrimination towards sufferers. Although there have been several studies assessing the extent of such discrimination, there is little published research explicitly investigating the causes of the stigma and discrimination associated with TB. The objectives of our research were therefore to take the first steps towards determining the causes of discrimination associated with TB. Methods Data collection was performed in Kathmandu, Nepal. Thirty four in-depth interviews were performed with TB patients, family members of patients, and members of the community. Results Causes of self-discrimination identified included fear of transmitting TB, and avoiding gossip and potential discrimination. Causes of discrimination by members of the general public included: fear of a perceived risk of infection; perceived links between TB and other causes of discrimination, particularly poverty and low caste; perceived links between TB and disreputable behaviour; and perceptions that TB was a divine punishment. Furthermore, some patients felt they were discriminated against by health workers Conclusion A comprehensive package of interventions, tailored to the local context, will be needed to address the multiple causes of discrimination identified: basic population-wide health education is unlikely to be effective.
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                Author and article information

                Journal
                Infect Drug Resist
                Infect Drug Resist
                idr
                Infection and Drug Resistance
                Dove
                1178-6973
                28 March 2023
                2023
                : 16
                : 1787-1800
                Affiliations
                [1 ]Department of Pharmacy, Faculty of Health, Universitas Harapan Bangsa , Purwokerto, Indonesia
                [2 ]Departement of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged , Szeged, Hungary
                [3 ]Department of Pharmacy, Siloam Hospital’s Mampang , Jakarta, Indonesia
                [4 ]Department of Pharmacy, Faculty of Health Science, Universitas Malahayati , Lampung, Indonesia
                [5 ]Faculty of Pharmacy, STIFAR Yayasan Pharmacy Semarang , Semarang, Indonesia
                [6 ]Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin , Makassar, Indonesia
                Author notes
                Correspondence: Muh Akbar Bahar, Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin , Makassar, 90245, Indonesia, Tel +62 819-4422-8642, Fax +62 411 590663, Email akbarbahar@unhas.ac.id
                Author information
                http://orcid.org/0000-0003-4402-8710
                http://orcid.org/0000-0003-1248-042X
                http://orcid.org/0000-0003-0053-526X
                http://orcid.org/0000-0002-1160-4040
                http://orcid.org/0000-0002-8881-7941
                http://orcid.org/0000-0002-6582-5615
                Article
                404171
                10.2147/IDR.S404171
                10066633
                37013169
                eea34648-5b80-46af-9320-7e6b1b4e6eca
                © 2023 Kaaffah et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 16 January 2023
                : 23 March 2023
                Page count
                Figures: 4, Tables: 5, References: 43, Pages: 14
                Categories
                Original Research

                Infectious disease & Microbiology
                tuberculosis,knowledge,attitude,perception,indonesia
                Infectious disease & Microbiology
                tuberculosis, knowledge, attitude, perception, indonesia

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