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

Abstract

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.