Browsing by Author "Islam, Shayla"

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Assessing the knowledge, attitude and practice of anti-microbial resistance (AMR) among the adult drug sensitive tuberculosis patients in BRAC DOTS center in Dhaka city
(BRAC University, 2025) Salman, Abdullah; Rahman, Ataur; Islam, Shayla
Introduction: Tuberculosis (TB) remains a significant public health challenge globally. Moreover it is burdened by the growing threat of antimicrobial resistance (AMR). In Bangladesh, Anti microbial Resistance contributes to treatment failures, particularly among drug-sensitive TB (DS-TB) patients. Additionally, lack of knowledge regarding AMR among the adult TB patients often result in treatment non-adherence. This non- adherence often creates implementation challenges in the Directly observed treatment shortcourse (DOTS) program. To mitigate the implementation challenges, targeted educational interventions are needed that can be integrated into the DOTS program. Understanding the knowledge, attitude, and practice (KAP) levels regarding AMR among the adult Drug Sensitive-TB patients is crucial for designing targeted interventions to mitigate resistance. Objective: This study aimed to assess the knowledge, attitude and practice (KAP) of AMR among adult DS-TB patients in BRAC DOTS center in Dhaka city. Also it tried to see the socio-demographic factors influencing this KAP level. Methods: A quantitative cross-sectional study was conducted among 128 adult DS-TB patients from Dhaka city enrolled in the BRAC DOTS program. It was done using a structured KAP questionnaire validated by Institute of Health Economics, Dhaka University . Participants were selected through simple random sampling based on their registration number. Data were analyzed using descriptive statistics and ordered logistic regression to determine associations between KAP levels and socio-demographic factors. Results: The majority of participants demonstrated moderate knowledge (46.9%) and attitudes (44.5%) toward AMR, while 58.6% reported good practices. Higher education, internet access, and urban residency were significantly associated with better KAP levels. Ordered logistic regression analysis showed that reading AMR-related articles in the Newspaper or in the internet significantly improved knowledge , attitudes and practice of AMR. Moreover individuals having higher education were more likely to have positive attitude towards AMR. Respondents living in the urban area were more likely to have better practices towards AMR than the respondents from peri-urban area . Despite this, critical gaps were identified, such as unawareness about Antibiotics treating bacterial infection infections and the importance of completing antibiotic course. Conclusion: The study highlights the need for targeted educational interventions to address misconceptions and improve AMR-related KAP among DS-TB patients. Integrating AMR education into DOTS programs, focusing on peri-urban areas, and leveraging digital platforms can enhance patient behavior and support Bangladesh's efforts to achieve the End TB Strategy goals.
Assessment of self-management behavior and psychological adjustment practices among drug-sensitive tuberculosis patients at BRAC DOTS TB Center in Dhaka city: a cross-sectional study
(BRAC University, 1/5/2025) Musavi, Zainab; Rahman, Ataur; Islam, Shayla
Introduction: the study used a cross-sectional study design to assess the self-management behaviors and self-efficacy practices of drug-sensitive TB (DS-TB) patients at the BRAC TB DOTS center Kamrangirchar located in Dhaka South City Corporation (DSCC). The primary goal of this study was to assess and evaluate DS-TB patient's self-management behaviors and psychological adjustment practices with a focus on socio-demographic factors. Method: The study was conducted among the 121 DS-TB patients with validated tools self-management scale for tuberculosis patients (SMSTP) & tuberculosis self-efficacy scale (TBSES). The study tool consisted of 24 questions within 4 domains including adherence to treatment, support behavior, disease transmission prevention behavior, and psychological adjustment. Data analysis was conducted using descriptive and inferential statistics including chi-square and t-tests to examine the associations between self-management behaviors, self-efficacy, and socio-demographic characteristics. Findings: The study found variability across each domain of self-management behaviors and self-efficacy practices. The findings indicate the majority of the participants (51.1%) have moderate self-management behaviors followed by 25.7% with low self-management behaviors and 23.1% with high self-management behaviors. Gender-based findings were particularly significant, with females exhibiting moderate and higher self-management 80.6% compared to male patients 66.7%. In addition, education level and occupation of the patients have also been found to be influencing factors, 83.54% of patients with secondary or higher education have moderate and high self-management compared to 57.14% uneducated or primary education completed. Students 94.12% and homemakers 82.05%, have higher self-management behaviors. Additionally, larger household sizes impact the psychological adjustment negatively as 76.92% of patients with 7 or more family members have lower psychological adjustment score. Conclusion: The study found gender as one influencing factor that is important to be considered for gender-specific interventions addressing health education, mental health support, and community-based awareness to improve the effectiveness of the DOTS intervention through self-management behaviors and self-efficacy practices in urban Bangladesh. The findings emphasize the need for community-based interventions and policy development to address the gap in self-management and psychological adjustment to achieve the targeted goal of the End TB strategy and National Tuberculosis Program (NTP).
Double trouble: prevalence and factors associated with tuberculosis and diabetes comorbidity in Bangladesh
(BRAC Univeristy, 10/31/2016) Sarker, Malabika; Barua, Mrittika; Guerra, Fiona; Saha, Avijit; Aftab, Afzal; Latif, A. H. M. Mahbub; Islam, Shayla; Islam, Akramul
Background Diabetes among tuberculosis patients increases the risk of tuberculosis treatment failure, death, and development of multidrug-resistant tuberculosis. Yet, there is no data is available in Bangladesh on the prevalence of diabetes among tuberculosis patients. The objective of the current study was to estimate prevalence and identify factors associated with tuberculosis-diabetes co-morbidity among TB patients enrolled in the Directly Observed Treatment, Short course program. Methods A community based cross-sectional quantitative study was conducted among 1910 tuberculosis patients living in six urban and eleven rural areas among whom Oral Glucose Tolerance Test (those who fasted) and Random Blood Sugar test (those who did not fast) were performed. Besides glucose levels, data on socio-demographic information, family history of diabetes and anthropometric measurements (height and weight) were also collected. Result Among the 1910 TB patients who participated in screening for diabetes, 245 (12.8%) were found to have diabetes and 296 (15.5%) to have pre-diabetes. Out of those who had diabetes, 34.7% were newly diagnosed through the current study and 65.3% already knew their status. Among those who were found to have prediabetes, 27 (9.1%) had impaired Fasting Blood Glucose (FBG), 230 (77.7%) had Impaired Glucose Tolerance (IGT), and 39 (13.2%) had both Impaired FBG and IGT. Older age, higher BMI, higher education (secondary level and above), being married, participation in less active work, and family history of diabetes are associated with higher prevalence of diabetes. Conclusion We observed a higher prevalence of diabetes and pre-diabetes in TB patients than reported previously in Bangladesh among the general population which may challenge TB and diabetes control in Bangladesh. Diabetes diagnosis, treatment and care should be integrated in the National TB Program.
Estimating catastrophic costs due to Pulmonary Tuberculosis in Bangladesh
(Atlantis Press, 2020-06-07) Chowdhury, Anita Sharif; Ahmed, Md Shakil; Ahmed, Sayem; Khanam, Fouzia; Farjana, Fariha; Reza, Saifur; Islam, Shayla; Islam, Akramul; Khan, Jahangir A.M.; Rahman, Mahfuzar
To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15–55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15–55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the total consumption and 3.1% of non-food expenditure among the surveyed households. The poorest quintile of the households experienced higher CHE than their richest counterpart, 5% vs. 1%. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes.
Healthcare worker perceived barriers and facilitators to implementing a tuberculosis preventive treatment (TPT) program in Dhaka BRAC TB centers
(BRAC University, 2025) Niki, Atqiya Faizah; Rahman, Ataur; Rahman, Atiya; Ireen, Santhia; Islam, Shayla
Introduction: Tuberculosis preventive Treatment (TPT) is a crucial step that will prevent the further development of latent tuberculosis infection (LTBI) into active tuberculosis. Yet, it faces numerous constraints when implemented in resource-limited urban environments, e.g., Dhaka, Bangladesh. This research analyzes the barriers and facilitators of TPT uptake at BRAC urban TB centers and provides direction for enhancing program delivery. Methods: Using an explanatory sequential mixed-methods design, qualitative and quantitative data were collected. In the above procedures, interviews with 17 healthcare providers were also conducted, and 41 Field Organizers (FOs) were polled through a survey. The qualitative data were coded thematically, and quantitative data were summarized using descriptive statistics. The Consolidated Framework for Implementation Research (CFIR) was applied to describe the study's outcome. Results: Barriers included resource constraints, such as drug shortages, funding gaps, and insufficient human resources. Logistical difficulties, stigmatization, lack of patient information, and inefficiencies in data capture also hampered the provision of TPT. Patient adherence was influenced by beliefs, pill size, side effects, and competing demands, including daily earnings. Factors included a willingness to use BRAC health care providers, adaptable TPT guidelines (e.g., 3HP regimen), suitable staffing, and working in partnership with the National Tuberculosis Program (NTP). Community support and engagement also emerged as critical enablers. Conclusion: Results underscore the need to take action on funding, staffing, and supply chains to enhance TPT delivery. Improvements to community education, private-sector collaboration, and streamlined documentation and monitoring practices can improve adherence and coverage. These recommendations offer a pathway to enhance TPT programs in settings with limited resources and help set targets to achieve the ambitious goal of TB elimination globally.
Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh
(© 2015 BioMed Central Ltd., 2015) Paul, Sukanta; Akter, Rahima; Aftab, Afzal; M Khan, Antora; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika
Background: Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. Methods: This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Results: Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. Conclusions: This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh
(© 2015 BioMed Central Ltd., 2015) Paul, Sukanta; Akter, Rahima; Aftab, Afzal; M Khan, Antora; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika
Background: Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. Methods: This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Results: Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. Conclusions: This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh
(© 2015 BioMed Central Ltd., 2015) Paul, Sukanta; Akter, Rahima; Aftab, Afzal; M Khan, Antora; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika
Background: Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. Methods: This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Results: Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. Conclusions: This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh
(© 2015 BioMed Central Ltd., 2015) Paul, Sukanta; Akter, Rahima; Aftab, Afzal; M Khan, Antora; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika
Background: Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. Methods: This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Results: Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. Conclusions: This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh
(© 2015 BioMed Central Ltd., 2015) Paul, Sukanta; Akter, Rahima; Aftab, Afzal; M Khan, Antora; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika
Background: Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. Methods: This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Results: Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. Conclusions: This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh
(© 2015 BioMed Central Ltd., 2015) Paul, Sukanta; Akter, Rahima; Aftab, Afzal; M Khan, Antora; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika
Background: Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. Methods: This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Results: Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. Conclusions: This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh
(© 2015 BioMed Central Ltd., 2015) Paul, Sukanta; Akter, Rahima; Aftab, Afzal; M Khan, Antora; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika
Background: Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. Methods: This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Results: Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. Conclusions: This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
Knowledge and practice of formal physicians regarding control and prevention of TB in light of national guidelines
(BRAC Research and Evaluation Division (RED), 2013) Islam, Qazi Shafayetul; Ahmed, Syed Masud; Islam, Md. Akramul; Islam, Shayla
The study explored the current knowledge and practice of interns and general physicians regarding control and prevention of tuberculosis in light of national guidelines. The study was conducted on 13 public and seven private medical college hospitals to collect information from intern physicians, and the general physicians who were practicing in a half kilometer radius of each medical college. A total of 1474 intern physicians and 539 general physicians participated in the study. It was a self-administered survey. About three-fourth of physicians (75%) had knowledge about community based TB control programme. However, Only 36% reported that they knew details about the programme. Despite majority (90-96%) had comprehensive knowledge on TB as a major public health problem in Bangladesh but, many of them (70%) did not express their intention to become involved in TB control. Because 92% did not know that the main vision of TB control programme (TB would no more as a public health problems). The knowledge score was constructed on 17 knowledge variables regarding basic and clinical aspects of TB. 61% of intern physicians had adequate knowledge (mean scores~ 1 0.82) unlike among general physicians where as it was 44%, (p<0.0001). The logistic regression depicts that physicians were more likely to be knowledgeable when they were aware of national guidelines for TB control (AOR 2.16, 95% Cl: 1.36, 3.44), when physician had access to more sources of TB information (AOR 1.43, 95%CI: 1.1 0, 2.36), more duration of TB information sharing (>6 hours) (AOR 3.10, 95% Cl: 2.37,.07). We also found, male physicians were less knowledgeable than that of female physician (AOR 0.77, 95% Cl: 0.63, 0.95). The majority of physicians treated TB suspects with antibiotics (40-6%), and only advised for further tests (39-44%). Majority of interns and general physicians did not follow the NTP guideline of three mandatory visits of patients to health facilities for follow up during treatment period. Still significant proportion of physicians (37 -50%) did not refer TB patients and suspects for further investigations and services to the nearest DOTS corner. Majority would not ask for X-ray for further investigation when they got two negative results out of three sputum examinations. Onethird of physicians (39%) perceived that medical curriculum was not sufficient for practicing TB (39%). A great majority of physicians (75%) confessed that they sought TB information beyond classroom. In conclusion, they seriously lacked knowledge regarding its clinical aspect of TB management in light of national guidelines. Most of them did not know the details activities of TB control programmes, and did not follow the national guidelines in managing TB patients. Activities of National TB progamme should be visible more. Guidelines should be incorporated in the final year medical curriculum. Appropriate tools, protocols and customized training packages need to be developed for intern and general physicians.
Lost in care pathway: a qualitative investigation on the health system delay of extra pulmonary tuberculosis patients in Bangladesh
(BRAC Univeristy, 3/28/2017) Sarker, Malabika; Mohammad, Din; Paul, Sukanta; Akter, Rahima; Islam, Shayla; Biswas, Goutam; Hossain, Asheque; Islam, Akramul
Background: Although extra pulmonary tuberculosis (EPTB) has long been known as a major public health concern globally, the complex healthcare-seeking pathways of EPTB patients are not widely studied. This study aims to explore the pattern of healthcare-seeking pathways of rural and urban EPTB patients registered with the BRAC TB control programme. BRAC is a Bangladesh-based non-governmental organization dedicated to alleviating poverty through empowering the poor. Method: Data were collected through 60 in-depth interviews with rural and urban EPTB patients in Bangladesh. Results: The findings reveal that the rural EPTB patients encountered a substantial diagnostic delay as compared to the urban patients. However, the difference between the average number of healthcare providers consulted by the rural verses the urban EPTB patients was not significant. This study also shows that the healthcare-seeking journey of rural and urban EPTB patients usually starts either at pharmacies or private facilities. Through exploring the detailed nature of the pathway, this study reveals the ways in which non-medical informants, mainly relatives and friends, can benefit patients. Conclusions: The private and informal healthcare providers should receive appropriate training on the diagnosis of EPTB. Such training could effectively shorten the long and complex healthcare-seeking pathways of EPTB patients.
Lost in care pathway: a qualitative investigation on the health system delay of extra pulmonary tuberculosis patients in Bangladesh
(BRAC Univeristy, 3/28/2017) Sarker, Malabika; Mohammad, Din; Paul, Sukanta; Akter, Rahima; Islam, Shayla; Biswas, Goutam; Hossain, Asheque; Islam, Akramul
Background: Although extra pulmonary tuberculosis (EPTB) has long been known as a major public health concern globally, the complex healthcare-seeking pathways of EPTB patients are not widely studied. This study aims to explore the pattern of healthcare-seeking pathways of rural and urban EPTB patients registered with the BRAC TB control programme. BRAC is a Bangladesh-based non-governmental organization dedicated to alleviating poverty through empowering the poor. Method: Data were collected through 60 in-depth interviews with rural and urban EPTB patients in Bangladesh. Results: The findings reveal that the rural EPTB patients encountered a substantial diagnostic delay as compared to the urban patients. However, the difference between the average number of healthcare providers consulted by the rural verses the urban EPTB patients was not significant. This study also shows that the healthcare-seeking journey of rural and urban EPTB patients usually starts either at pharmacies or private facilities. Through exploring the detailed nature of the pathway, this study reveals the ways in which non-medical informants, mainly relatives and friends, can benefit patients. Conclusions: The private and informal healthcare providers should receive appropriate training on the diagnosis of EPTB. Such training could effectively shorten the long and complex healthcare-seeking pathways of EPTB patients.
Prevalence and associated factors of depression & anxiety among drug-sensitive TB patients at urban BRAC DOTS TB program in Dhaka city with a focus on facilitators and barriers of integrating mental health services – a mixed-methods convergent study
(BRAC University, 1/5/2025) Zaw, Aung Khine; Rahman, Ataur; Islam, Shayla
Introduction: Tuberculosis (TB) remains a major public health concern in Bangladesh, with significant challenges in addressing the psychological well-being of patients. Depression among TB patients is often underdiagnosed and untreated, despite its impact on treatment adherence and outcomes. This study aimed to assess the prevalence and associated factors of depression among drug-sensitive TB patients and explore their experiences with mental health challenges, as well as the facilitators and barriers to integrating mental health services into TB programs at BRAC DOTS centers in Dhaka, Bangladesh. Method: This mixed-methods convergent study utilized quantitative and qualitative approaches to investigate mental health challenges among drug-sensitive TB patients and identify facilitators and barriers to integrating mental health services. Quantitative data were collected through structured surveys at the Kamrangirchar BRAC DOTS-TB center, analyzed using descriptive statistics and multivariable logistic regression. Qualitative data were gathered via in-depth and key informant interviews with patients and healthcare providers and analyzed using thematic inductive analysis. Findings: The study found that 50.4% of drug-sensitive TB patients experienced mild to severe depression, and a similar proportion had mild to severe anxiety. Depression was significantly associated with female gender (OR = 3.1, p = 0.023), short sleep duration (OR = 4.2, p = 0.003), and anxiety (OR = 8.39, p < 0.001). Anxiety was linked to financial deficits (OR = 4.63, p = 0.001), comorbidities (OR = 2.81, p = 0.037), and dissatisfaction with sleep (OR = 3.25, p = 0.011). Patients reported stigma, lack of social support, and a need for urgent psychosocial interventions. Both patients and providers emphasized that integrating mental health services into TB care could improve treatment adherence, reduce relapses, and enhance outcomes, though challenges such as stigma, resource constraints, and systemic barriers were noted. Conclusion: This study emphasizes the high level of depression and anxiety among DSTB patients and stresses the need for improving mental health services for DSTB patients addressing the barriers and leveraging the factors could improve patient outcomes and augment TB management in Bangladesh.
Prevention and control of tuberculosis in workplaces: how knowledgeable are the workers in Bangladesh?
(BMC Public Health, 2015-06) Islam, Qazi Shafayetul; Islam, Md Akramul; Islam, Shayla; Ahmed, Syed Masud
Background: The National Tuberculosis (TB) Control Programme (NTP) of Bangladesh succeeded in achieving the dual targets of 70 % case detection and 85 % treatment completion as set by the World Health Organization. However, TB prevention and control in work places remained largely an uncharted area for NTP. There is dearth of information regarding manufacturing workers’ current knowledge, attitudes and practices (KAP) on pulmonary TB which is essential for designing a TB prevention and control programme in the workplaces. This study aimed to fill-in this knowledge gap. Methods: This cross-sectional survey was done in multiple workplaces like garment factories, jute mills, bidi/tobacco factories, flour mills, and steel mills using a multi-stage sampling procedure. Data on workers’ KAP related to pulmonary TB were collected from 4800 workers in face-to-face interview. Results: The workers were quite knowledgeable about symptoms of pulmonary TB (72 %) and free- of-cost sputum test (86 %) and drug treatment (88 %), but possessed superficial knowledge regarding causation (4 %) and mode of transmission (48 %). Only 11 % knew about preventive measures e.g., taking BCG vaccine and/or refraining from spitting here and there. Knowledge about treatment duration (43 %) and consequences of incomplete treatment (11 %) was poor. Thirty-one percent were afraid of the disease, 21 % would feel embarrassed (and less dignified) if they would have TB, and 50 % were afraid of isolation if neighbours would come to know about it. Workers with formal education (AOR 1.92; 95 % CI 1.61, 2.29) and exposure to community health workers (CHW) (AOR 31.60; 95 % CI 18.75, 53.35) were more likely to have TB knowledge score ≥ mean. Workers with knowledge score ≥ mean (AOR = 1.91; 95 % CI:1.44, 2.53) and exposure to CHWs either alone (AOR = 42.4; 95 % CI: 9.94, 180.5) or in combination with print media (AOR = 37.35; 95 % CI: 9.1, 180.5) were more likely to go to DOTS centre for treatment . Only around 43 % had sputum examination despite having chronic cough of ≥ 3 weeks duration. Conclusion: The workers had inadequate knowledge regarding its causation, transmission and prevention which may interfere with appropriate treatment-seeking for chronic cough including sputum test. NTP needs to be cognizant of these factors while designing a workplace TB prevention and control programme for Bangladesh.
Prevention and control of tuberculosis in workplaces: how knowledgeable are the workers in Bangladesh?
(© 2015 BioMed Central Ltd., 2015) Shafayetul Islam, Qazi; Akramul Islam, Md; Islam, Shayla; Masud Ahmed, Syed
Background: The National Tuberculosis (TB) Control Programme (NTP) of Bangladesh succeeded in achieving the dual targets of 70 % case detection and 85 % treatment completion as set by the World Health Organization. However, TB prevention and control in work places remained largely an uncharted area for NTP. There is dearth of information regarding manufacturing workers' current knowledge, attitudes and practices (KAP) on pulmonary TB which is essential for designing a TB prevention and control programme in the workplaces. This study aimed to fill-in this knowledge gap. Methods: This cross-sectional survey was done in multiple workplaces like garment factories, jute mills, bidi/tobacco factories, flour mills, and steel mills using a multi-stage sampling procedure. Data on workers' KAP related to pulmonary TB were collected from 4800 workers in face-to-face interview. Results: The workers were quite knowledgeable about symptoms of pulmonary TB (72 %) and free- of-cost sputum test (86 %) and drug treatment (88 %), but possessed superficial knowledge regarding causation (4 %) and mode of transmission (48 %). Only 11 % knew about preventive measures e.g., taking BCG vaccine and/or refraining from spitting here and there. Knowledge about treatment duration (43 %) and consequences of incomplete treatment (11 %) was poor. Thirty-one percent were afraid of the disease, 21 % would feel embarrassed (and less dignified) if they would have TB, and 50 % were afraid of isolation if neighbours would come to know about it. Workers with formal education (AOR 1.92; 95 % CI 1.61, 2.29) and exposure to community health workers (CHW) (AOR 31.60; 95 % CI 18.75, 53.35) were more likely to have TB knowledge score ≥ mean. Workers with knowledge score ≥ mean (AOR = 1.91; 95 % CI:1.44, 2.53) and exposure to CHWs either alone (AOR = 42.4; 95 % CI: 9.94, 180.5) or in combination with print media (AOR = 37.35; 95 % CI: 9.1, 180.5) were more likely to go to DOTS centre for treatment. Only around 43 % had sputum examination despite having chronic cough of ≥ 3 weeks duration. Conclusion: The workers had inadequate knowledge regarding its causation, transmission and prevention which may interfere with appropriate treatment-seeking for chronic cough including sputum test. NTP needs to be cognizant of these factors while designing a workplace TB prevention and control programme for Bangladesh
Prevention and control of tuberculosis in workplaces: how knowledgeable are the workers in Bangladesh?
(© 2015 BioMed Central Ltd., 2015) Shafayetul Islam, Qazi; Akramul Islam, Md; Islam, Shayla; Masud Ahmed, Syed
Background: The National Tuberculosis (TB) Control Programme (NTP) of Bangladesh succeeded in achieving the dual targets of 70 % case detection and 85 % treatment completion as set by the World Health Organization. However, TB prevention and control in work places remained largely an uncharted area for NTP. There is dearth of information regarding manufacturing workers' current knowledge, attitudes and practices (KAP) on pulmonary TB which is essential for designing a TB prevention and control programme in the workplaces. This study aimed to fill-in this knowledge gap. Methods: This cross-sectional survey was done in multiple workplaces like garment factories, jute mills, bidi/tobacco factories, flour mills, and steel mills using a multi-stage sampling procedure. Data on workers' KAP related to pulmonary TB were collected from 4800 workers in face-to-face interview. Results: The workers were quite knowledgeable about symptoms of pulmonary TB (72 %) and free- of-cost sputum test (86 %) and drug treatment (88 %), but possessed superficial knowledge regarding causation (4 %) and mode of transmission (48 %). Only 11 % knew about preventive measures e.g., taking BCG vaccine and/or refraining from spitting here and there. Knowledge about treatment duration (43 %) and consequences of incomplete treatment (11 %) was poor. Thirty-one percent were afraid of the disease, 21 % would feel embarrassed (and less dignified) if they would have TB, and 50 % were afraid of isolation if neighbours would come to know about it. Workers with formal education (AOR 1.92; 95 % CI 1.61, 2.29) and exposure to community health workers (CHW) (AOR 31.60; 95 % CI 18.75, 53.35) were more likely to have TB knowledge score ≥ mean. Workers with knowledge score ≥ mean (AOR = 1.91; 95 % CI:1.44, 2.53) and exposure to CHWs either alone (AOR = 42.4; 95 % CI: 9.94, 180.5) or in combination with print media (AOR = 37.35; 95 % CI: 9.1, 180.5) were more likely to go to DOTS centre for treatment. Only around 43 % had sputum examination despite having chronic cough of ≥ 3 weeks duration. Conclusion: The workers had inadequate knowledge regarding its causation, transmission and prevention which may interfere with appropriate treatment-seeking for chronic cough including sputum test. NTP needs to be cognizant of these factors while designing a workplace TB prevention and control programme for Bangladesh
Urban-rural and sex differentials in tuberculosis mortality in Bangladesh: Results from a population-based survey
(Wiley Online Library, 10/22/2022) Sarker, Malabika; Homayra, Fahmida; Rawal, Lal B.; Kabir, Razin; Aftab, Afzal; Bari, Rahmatul; Dzokoto, Agnes; Shargie, Estifanos Biru; Islam, Shayla; Islam, Akramul; Latif, A. H. M. Mahbub
Objective To assess tuberculosis mortality in Bangladesh through a population-based survey using a Verbal Autopsy tool. Methods Nationwide mortality survey employing the WHO-recommended Verbal Autopsy (VA) tool, and using InsilicoVA, a data-driven method, to assign the cause of death. Using a three-stage cluster sampling method, 3997 VA interviews were conducted in both urban and rural areas of Bangladesh. Cause-specific mortality fractions (CSMF) were estimated using Bayesian probabilistic models. Results 6.8% of total deaths in the population were due to TB [95% CI: (5.1, 8.9)], comprising 12.0% [95% CI: (11.1, 12.8)] and 6.42% [95% CI: (5.4, 7.3)] of total male and female deaths, respectively. This proportion was highest among adults age 15–49 years [12.2%, 95% CI: (9.4, 14.6)]. The urban population is more likely to die from TB, and urban males have highest CSMF [13.6%, 95% CI: (9.1, 16.9)]. Conclusion Our survey results show that TB is the fifth major cause of death in the general population and that sex and place of residence (urban/rural) have a significant effect on TB mortality in Bangladesh. The underlying causes of higher rates of TB-related deaths in urban areas and particularly among urban males, who have better knowledge and higher enrollment in the DOTS Program, need to be explored.