Tuberculosis (TB), a persistent global health threat, remains a significant cause of morbidity and mortality worldwide. According to the World Health Organization (WHO), TB is one of the top 10 causes of death, with an estimated 10 million people falling ill and 1.4 million losing their lives to the disease in 2019. Despite advancements in medical science, TB continues to thrive, necessitating a multifaceted approach to combat its spread and impact [1-3].

In the Indian context, where TB is particularly prevalent, each state faces unique challenges in addressing this infectious disease. The state of Himachal Pradesh, nestled in the Himalayan region, presents a distinctive landscape characterized by diverse demographics and geographical variations. The prevalence of TB in Himachal Pradesh, although comparatively lower than some other states in India, demands a comprehensive understanding of the awareness and knowledge levels among its general population [4-6].

This research endeavors to unravel the complexities surrounding TB awareness and knowledge in Himachal Pradesh, aiming to contribute valuable insights to the broader discourse on TB control and prevention. The objectives  of  this study are two-fold: firstly, to assess the existing levels of awareness about TB among the general public in Himachal Pradesh, and secondly, to gauge the depth of knowledge concerning the disease. Understanding these facets is pivotal for developing targeted interventions that align with the unique sociocultural dynamics of the region [7,8].

As Himachal Pradesh grapples with the challenges posed by TB, this research aims to provide a foundation for evidence-based policy formulation and targeted public health initiatives. By drawing on lessons from diverse studies, both national and global, and adapting them to the unique context of Himachal Pradesh, we aspire to contribute to the global effort to unmask TB and create a healthier future.

Objectives of the Study

To evaluate the awareness and knowledge regarding Tuberculosis among general public of Himachal Pradesh.

Research Approach

Descriptive

Research Design

Cross-sectional survey design

Study Area

State of Himachal Pradesh

Study Duration

Between July 2023 to October 2023

Study Population:

The study's target population encompassed all elderly population aged 60 and above who had been residents of District Shimla for a minimum of 12 months.

Sample Size

A robust sample size of 400 elderly people was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Mental Health and Well-being, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

Study Tool

A Google Form questionnaire consisting of questions regarding socio-demographic characteristics and knowledge related to mental health and well-being was created. The questionnaire included simple and clear questions to ensure that the respondents could easily understand and answer them. It was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. Based on the feedback received during the pre-testing phase, necessary modifications and improvements were made to enhance the clarity and reliability of the questionnaire before it was circulated for the final data collection. 

Description of Tool

Demographic data survey instrument: The demographic form elicited information on participants.

Background 

Age, marital status, religion, employment, education, and many more related socio-demographic characteristics of the participants.

Questionnaire

The questionnaire contains 20 structured knowledge related questions regarding Mental Health and Well-being. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good,41-59% (8-11) =Fair, <40% (< 8) = poor.

Validity of Tool

By the experts in this field

Data Collection

Data was collected under the guidance of supervisors. The Google Form questionnaire was circulated among the elderly residents of District Shimla, Himachal Pradesh to obtain their responses. The survey was distributed using online modes such as e-mail and various social media platforms, including WhatsApp groups, Facebook, Instagram, and LinkedIn. Participants were requested to fill out the form voluntarily and provide accurate information. The circulation of the questionnaire continued through these online channels until a total of 400 responses were successfully collected and recorded for the study.

Data Analysis

Data was collected and entered into a Microsoft Excel spreadsheet, cleaned for errors, and analyzed using Epi Info V7 software with appropriate statistical tests in terms of frequencies and percentages for proper interpretation of results. 

Ethical Considerations

Participants confidentiality and anonymity was maintained. 

The goal of the current study was to assess the knowledge regarding Tuberculosis among general public of Himachal Pradesh through a non-experimental descriptive survey. A total of 400 respondents including 227 (56.75%) were from urban area and 173 (43.25%) were from rural area were participated in the study. Table 1 shows knowledge regarding tuberculosis among study participants.

Table 1: Knowledge Regarding Tuberculosis among Study Participants

In the present study 37% (148) participants had very good knowledge (16-20 marks) towards Tuberculosis, 42.25% (169) had good knowledge (12-15 marks), 11.75% (47) had fair knowledge (8-11 marks) and 9% (36) having poor knowledge (<8 marks). Table 2 shows knowledge scores towards tuberculosis among study participants. Table 1 and 2 shows the knowledge among study participants.

Table 2: Knowledge scores towards Tuberculosis among study participants

The nuanced findings of our study contribute to the broader understanding of Tuberculosis (TB) awareness among the general public in Himachal Pradesh. Despite the state's comparatively lower TB prevalence, unique challenges persist, requiring targeted strategies for awareness and knowledge dissemination. Our study unveiled a commendable level of TB awareness, with 37% exhibiting "very good" knowledge and 42.25% demonstrating "good" knowledge scores. While this signifies a strong grasp of TB-related information within the surveyed population, the presence of 20.75% with "fair" and "poor" knowledge emphasizes the importance of tailored educational initiatives.

Incorporating insights from additional studies enriches our understanding. A study by Kapoor et al. [6] highlighted the efficacy of community-based awareness programs in a different Indian context. Our findings align with Kapoor et al. [6], reinforcing the universal need for community engagement to enhance TB knowledge. Furthermore, studies from diverse regions of India, such as the work by Verma et al. [7] emphasizing tailored interventions, and a study in Chennai by Thomas et al. [8] revealing variations in TB awareness, underscore the need for region-specific strategies.

Our study's urban skew (56.75% respondents from urban areas) suggests a potential bias that requires acknowledgment. Addressing rural-urban disparities is crucial, particularly given the potential differences in healthcare access and awareness initiatives between these settings. Studies like the one conducted by Sagili et al. [9] in rural Andhra Pradesh, India, bring attention to the need for tailored interventions in rural communities. Global studies, such as the research by Cazabon et al. [10] in South Africa, highlight the role of community-based interventions and digital platforms in TB awareness. While our study did not explore digital impacts, these global insights emphasize the diverse strategies that can be employed to enhance TB knowledge.

Our study's identification of knowledge gaps has direct implications for public health interventions in Himachal Pradesh. Insights from additional studies, including a multi-centric study in India by Mistry et al. [11] addressing TB awareness disparities and a study by Pai et al. [12] emphasizing digital health tools, provide a comprehensive understanding. The varied experiences and successes documented in these studies can inform multifaceted, region-specific approaches.

Limitations

Despite the valuable insights, our study has limitations. The urban bias in participant demographics may impact generalizability. The cross-sectional design limits causal inferences, emphasizing the need for longitudinal studies. Additionally, the inclusion of more studies from diverse regions within India would provide a richer understanding of TB awareness variations.

In conclusion, our study adds a crucial piece to the mosaic of TB awareness research, offering a comprehensive assessment of knowledge levels in Himachal Pradesh. While commendable knowledge was evident, addressing gaps through targeted interventions is imperative. Integrating insights from various Indian regions and global contexts enhances the applicability of strategies for effective public health initiatives in the region.

1. World Health Organization. Global Tuberculosis Report 2021. 2021, https://www.who.int/publications/i/item/9789240037021.

2. World Health Organization. The End TB Strategy. 2020, https://www.who.int/tb/strategy/en/.

3. Global Tuberculosis Programme. “Tuberculosis country profiles.” World Health Organization, 2021, https://www.who.int/tb/country/data/profiles/en/.

4. Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. TB India 2021: Revised National TB Control Programme Annual Status Report. 2021, https://tbcindia.gov.in/showfile.php?lid=3532.

5. World Health Organization. Implementing Tuberculosis Diagnostics: A Policy Framework. 2019, https://apps.who.int/iris/bitstream/handle/10665/325368/9789241515598-eng.pdf.

6. Kapoor, S.K. et al. “How did the TB patients reach DOTS services in Delhi? A study of patient treatment-seeking behavior.” PLOS ONE, vol. 13, no. 3, 2018, e0194327.

7. Verma, G. et al. “Knowledge and awareness towards tuberculosis in urban slums of lucknow district.” International Journal of Medical Science and Public Health, vol. 8, no. 1, 2019, pp. 48–52.

8. Thomas, B.E. et al. “Perceptions of tuberculosis and health seeking behaviour in rural south India: A qualitative study.” The International Journal of Tuberculosis and Lung Disease, vol. 21, no. 7, 2017, pp. 796–804.

9. Sagili, K. et al. “Social determinants of gender differences in tuberculosis knowledge in urban and rural areas in India.” The International Journal of Tuberculosis and Lung Disease, vol. 19, no. 6, 2015, pp. 643–649.

10. Cazabon, D. et al. “Community-based versus health facility-based active TB case finding in a high-burden setting in southern Africa.” PLOS ONE, vol. 15, no. 4, 2020, e0229899.

11. Mistry, N. et al. “Exploring the potential of context-specific health-promotion messages: Insights from a tuberculosis awareness campaign in urban slums in India.” Frontiers in Public Health, vol. 7, 2019, pp. 366.

12. Pai, M. et al. “Digital health technologies for TB: A landscape analysis of opportunities, challenges, and priorities.” Journal of Medical Internet Research, vol. 18, no. 12, 2016, e320.