Tuberculosis (TB) remains a formidable global public health challenge, exerting a substantial burden on both individuals and societies worldwide. It is a contagious bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs but with the potential to impact other organs as well. Despite considerable progress in TB control efforts, the disease continues to prevail as one of the leading causes of morbidity and mortality, particularly in low- and middle-income countries. It is essential to assess the level of awareness and knowledge about TB among the general population to develop effective strategies for its prevention and control [1-4].

India, as a high TB-burden country, grapples with the significant health, social and economic implications of TB. It is estimated that India accounts for approximately 26% of the global TB burden. Although substantial efforts have been made to combat TB through government-sponsored programs and international initiatives, gaps in TB awareness and knowledge among the general public remain a considerable challenge [5-8].

Himachal Pradesh, a picturesque state nestled in the northern part of India, while known for its breathtaking landscapes and vibrant culture, is not immune to the TB epidemic. Within this region, a diverse populace faces the potential threat of TB transmission and infection. To design targeted interventions and education campaigns that can effectively mitigate the spread of TB, it is imperative to assess the levels of awareness and knowledge regarding TB among the state's general population.        

Understanding the awareness and knowledge of TB is of paramount importance for several reasons. First, it enables individuals to recognize the signs and symptoms of TB, facilitating early diagnosis and treatment initiation. Second, it reduces the stigma surrounding TB, which often leads to delayed healthcare-seeking behavior and hinders effective TB control efforts. Lastly, it assists public health authorities and policymakers in tailoring awareness campaigns and educational programs to address specific knowledge gaps within the population [9-12].

While several studies have explored TB awareness and knowledge in various parts of India, the unique cultural and geographical characteristics of Himachal Pradesh necessitate a dedicated investigation. This study seeks to bridge the existing knowledge gap and provide insights into the state of TB awareness and knowledge in Himachal Pradesh, ultimately contributing to more effective public health strategies to combat TB.

Objectives of the Study

The objective of this study is to evaluate the awareness and knowledge regarding Tuberculosis among the general public of Himachal Pradesh.

Research Approach

This study employs a descriptive research approach to assess the level of knowledge regarding Tuberculosis among the general public of Himachal Pradesh. A descriptive approach is chosen as it allows for the systematic collection and analysis of data to describe and understand the current awareness and knowledge of the study participants on the specific topic of interest.

Research Design

A cross-sectional survey design is utilized for this study, enabling data collection at a single point in time from a diverse sample of individuals. This design ensures that information about the awareness of Tuberculosis can be obtained from a representative sample of the target population, thereby providing a snapshot of the prevailing knowledge at the time of the study.

Study Area and Duration

The research is conducted in Himachal Pradesh. The study duration spans from May 2023 to July 2023, during which data collection and analysis are performed.

Study Population and Sample Size

The study's target population comprises all adults above 18 years of age who have resided in Himachal Pradesh for a minimum of 12 months. A sample size of 400 adults is determined, considering a 50% estimated knowledge level about Tuberculosis, a 5% absolute error, a 95% confidence level and a 5% non-response rate. This sample size ensures adequate representation and generalizability of findings to the larger population.

Data Collection Tool

To gather information on Tuberculosis awareness, a well-structured and validated Google Form questionnaire is developed. The questionnaire consists of two sections: the first section captures socio-demographic data, including age, gender, marital status, religion, employment and education, while the second section comprises 20 carefully crafted questions related to knowledge about Tuberculosis.

Description of the Questionnaire

The questionnaire is designed to evaluate participants' knowledge on Tuberculosis, with each correct response receiving one mark and incorrect answers receiving zero marks. Based on their scores, participants' knowledge levels are categorized into four groups: very good >80%, good 60-79%, fair 41-59% and poor <40%. This scoring system allows for a clear understanding of the overall awareness levels among respondents.

Data Collection and Analysis

Data collection is conducted under the supervision of experienced supervisors and the Google Form questionnaire is disseminated through various online platforms, such as email, WhatsApp groups, Facebook, Instagram and LinkedIn, to reach both rural and urban areas of Himachal Pradesh. Collected data is then meticulously entered into a Microsoft Excel spreadsheet and thoroughly checked for accuracy and completeness. Epi Info V7 software is employed for data analysis and appropriate statistical tests, such as frequencies and percentages, are used to present the findings in a clear and concise manner.

Ethical Considerations

Throughout the study, utmost care is taken to adhere to ethical guidelines to ensure the privacy and confidentiality of participants. Informed consent is obtained from all respondents before their inclusion in the study and their personal information is kept confidential. The research team ensures that all data is anonymized, safeguarding the participants' identities at all times.

The goal of the current study was to assess the knowledge regarding Tuberculosis among general public of Himachal Pradesh. A total of 400 respondents including 247 (61.75%) were from urban area and 153(38.25%) were from rural area were participated in the study (Table 1).

Table 1: Knowledge Regarding Tuberculosis Among Study Participants

Table 2: Knowledge Scores Towards Tuberculosis Among Study Participants

In the present study 38.25% (153) participants had very good knowledge (16-20 marks) towards Tuberculosis, 34.25% (137) had good knowledge (12-15 marks), 16% (64) had fair knowledge (8-11 marks) and 11.5% (46) having poor knowledge (<8 marks) (Table 2).

The present study aimed to evaluate the awareness and knowledge levels regarding Tuberculosis (TB) among the general public of Himachal Pradesh, India. TB remains a critical public health issue both globally and in India and understanding the extent of awareness and knowledge within specific populations is crucial for developing effective prevention and control strategies [13-15].

The findings of this study reveal a mix of encouraging awareness and knowledge along with areas that require further attention. A substantial proportion of respondents 93.75% demonstrated a strong understanding of what TB is and what causes it. This foundational knowledge is crucial for recognizing the disease and its risk factors. A moderate number of participants 54.25% were able to name the two main types of TB and explain the difference between them. This knowledge is valuable for distinguishing between latent TB infection and active TB disease. Approximately 58.25% of respondents correctly understood how TB is transmitted from person to person. Recognizing the modes of transmission helps individuals take preventive measures. While 49% identified common risk factors for contracting TB, this awareness could be improved to encourage risk assessment and mitigation strategies among the population.

An encouraging 58% knew that TB is not spread through casual contact like shaking hands. This understanding is crucial for reducing stigma and misconceptions surrounding the disease. A significant majority 77% recognized the typical clinical features or symptoms of TB. This awareness can contribute to early diagnosis and timely treatment, reducing the spread of the disease and its complications. An impressive 81% were aware of how healthcare professionals typically diagnose TB. Understanding the diagnostic process is essential for individuals to seek medical care when needed. Nearly 78.5% recognized the importance of early diagnosis and treatment for TB. This awareness underscores the significance of prompt healthcare-seeking behavior. While 57.5% identified potential complications resulting from untreated TB, this knowledge could be further disseminated to emphasize the importance of treatment initiation. A smaller proportion 21.75% could explain the importance of the BCG vaccine in TB prevention. This indicates a potential gap in knowledge regarding vaccination programs. Knowledge about latent TB infection was relatively low, with only 23% correctly explaining its difference from active TB disease. This area may benefit from additional education.

Knowledge regarding preventive measures for individuals with latent TB infection was limited, with 21.5% providing correct responses. Expanding education in this regard could empower individuals to protect themselves and others. A substantial number 63.75% could name government-sponsored TB control programs or schemes. This awareness indicates some success in promoting government initiatives. Approximately 56.5% were aware of public health campaigns or initiatives related to TB awareness and prevention. This suggests that awareness efforts have reached a significant portion of the population. An encouraging 77.25% recognized the role of individuals and communities in raising awareness about TB and reducing its stigma. This awareness is vital for promoting open discussions and dispelling myths associated with TB [16,17].

Comparing these findings with similar studies conducted in other regions of India, it is evident that the awareness and knowledge levels regarding TB among the general public vary.11-16 While this study indicates relatively good levels of awareness, there are specific areas, such as knowledge about latent TB infection, preventive measures and the importance of the BCG vaccine, where additional education and awareness campaigns could yield significant benefits.

In conclusion, this study provides valuable insights into the levels of awareness and knowledge regarding Tuberculosis among the general public of Himachal Pradesh. While there are several areas of strength, such as understanding the disease's definition, symptoms and the importance of early diagnosis, there are also clear opportunities for improvement. These include enhancing knowledge about latent TB infection, preventive measures and the significance of vaccination.

The implications of this study are multifaceted. Public health authorities and policymakers can use these findings to tailor targeted awareness campaigns, educational programs and interventions to address specific knowledge gaps effectively. Expanding education on latent TB infection, vaccination and preventive measures can contribute to more informed decision-making among individuals, ultimately leading to a healthier population and a stronger TB control program.

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