Nursing Division, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
*Corresponding Author’s Email: sweegeok_lim@imu.edu.my
Keywords: Knowledge; Tuberculosis; Causes; Mode of Transmission; Symptoms; Risk Factors; Prevention
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis which is spread via droplets. However, despite Tuberculosis being a curable and preventable disease, TB is a major cause of morbidity and mortality in Malaysia. Recently there had been a rise in the number of suspected TB cases in health clinics in Kg Pandan, Kuala Lumpur (Lisut, Razali & Arshad, 2017).According to the Director General of Health Malaysia (2019), 25,837 TB cases were reported in 2019. TB death rate in 2018 was 6.6 per 100,000 populations and an increase of 6.5 per 100,000 populations in 2017 (WHO, 2020). In many developing countries such as Malaysia, TB is a public health issue that need to be concerns. The worldwide healthcare system is in trouble with an increasing number of Tuberculosis (TB) cases and leading mortality cases across the worlds. Globally, TB is one of the top ten cause of death and the leading cause from a single infectious agent other than Acquired Immunodeficiency Syndrome (AIDS). Millions of people continue to fall sick with TB every year. According to World Health Organization (2017), there is an estimate of 10.0 million people infected by TB disease globally in 2017. Out of it, 6.4 million cases were newly diagnosed, officially notified to national authorities and reported to the World Health Organisation, (2018). Nowadays the extrapulmonary cases involve other systems of the body, such as the lymphatic system, circulatory system, central nervous system. TB can spread from one system to another if not treated immediately.
Therefore, there is a need to know the resident’s level of knowledge on Tuberculosis as this disease is a communicable disease.
Sample size is calculated by using Raosoft calculator based on 5% margin error, 95% confidence level and 50% distribution rate. The estimated sample size required is 352 after taking into consideration 10% attrition rate.
The inclusion criteria for this study are the residents of this apartment who are 18 years old and above. Participants who were excluded from this study were non-residents of this apartment, less than 18 years old, mentally not fit, ill person and resident who are not keen to participate.
Measurement and Instrument: A set of self-administered questionnaires using a yes or no scale is used in this study. The questionnaire was adapted from Salleh et al., (2018). Permission was obtained from the author.
The questionnaire consists of two parts. Part I: Demographic data consisting of 6 items, Part II: Knowledge on TB which comprises of 6 sections. Section A: consist of 4 items that will focus on knowledge on causes of TB, Section B: consist of 11 items that will focus on knowledge on mode of transmission of TB, Section C: consist of 10 items that will focus on knowledge on symptoms of TB, Section D: consist of 8 items that will focus on knowledge on risk factors of TB infection, Section E: consist of 6 items that will focus on knowledge of TB investigation, and Section F: consist of 2 items that will focus on knowledge on TB prevention.
Each correct answer was given 1 point and the total score range is 0 to 41 points. The higher the total score, the higher the knowledge of tuberculosis among the residents.
Table 1: Demographic Data (n = 352)
Variables | Frequency n | Percentage (%) | M±SD | |
Gender | Male | 173 | 49.1 | NA |
Female | 179 | 50.9 | ||
Age (Years) | 18-29 | 60 | 17.0 | 48.08 ± 16.84 |
30-39 | 66 | 18.8 | ||
40-49 | 53 | 15.1 | ||
50-59 | 70 | 19.9 | ||
60 above | 103 | 29.3 | ||
Ethnic | Malay | 176 | 50.0 | NA |
Chinese | 114 | 32.4 | ||
India | 58 | 16.5 | ||
Other | 3 | 9.0 | ||
Highest Education Level | No formal education | 7 | 2.0 | NA |
Primary school | 51 | 14.5 | ||
Secondary School | 74 | 21.0 | ||
Undergraduate | 114 | 32.4 | ||
Postgraduate | 106 | 30.1 | ||
Occupation | Health related | 47 | 13.4 | NA |
Non-Health - related | 305 | 86.6 |
Table 2: Knowledge on Causes of Tuberculosis (n = 352)
Item | Answered correctly n (%) | M±SD | |
A1 | Bacteria | 342 (97.2) | |
A4 | Contaminated drink | 140 (39.8) | |
A3 | Contaminated food | 132 (37.5) | |
A2 | Genetic inheritance | 52 (14.8) | |
Total score of 4 items | 3.04 ± 1.19 |
Table 3: Knowledge on Mode of Transmission of Tuberculosis (n = 352)
Item | Answered correctly n (%) | M±SD | |
B1 | Cough | 346 (98.3) | |
B6 | Genetic | 328 (93.2) | |
B2 | Sneezing | 322 (91.5) | |
B7 | Sexual intercourse | 316 (89.8) | |
B9 | Using the same toilet | 299 (84.9) | |
B3 | Spitting | 262 (74.4) | |
B11 | Shaking hand | 260 (73.9) | |
B8 | Sharing clothes, bed or towels | 244 (69.3) | |
B4 | Talking | 198 (56.3) | |
B10 | Using the same toothbrush | 157 (44.6) | |
B5 | Laughing | 112 (31.8) | |
Total score of 11 items | 8.09 ± 2.07 |
that those with Tuberculosis will have chest pain, loss of weight (67.6%) and night sweat (49.7%) (Refer Table 4)
Table 4: Knowledge on Symptoms of Tuberculosis (n = 352)
Item | Answered correctly n (%) | M±SD | |
C3 | Urination at night | 337 (95.7) | |
C1 | Persistent cough | 317 (90.1) | |
C10 | Tiredness | 289 (82.1) | |
C9 | Loss of appetite | 286 (81.3) | |
C6 | Fever | 276 (78.4) | |
C2 | Haemoptysis (Coughing out blood) | 268 (76.1) | |
C5 | Shortness of breath | 253 (71.9) | |
C4 | Chest pain | 242 (68.8) | |
C7 | Weight loss | 238 (67.6) | |
C8 | Drenching night sweat | 175 (49.7) | |
Total score of 10 items | 7.58 ± 1.81 |
Table 5: Knowledge on Risk Factors of Tuberculosis Infection (n = 352)
Item | Answered correctly n (%) | M±SD | |
D1 | Human immunodeficiency virus | 274 (77.8) | |
D8 | Compromised immune systems | 270 (76.7) | |
D7 | Tobacco smoking | 203 (57.7) | |
D6 | Cancers | 184 (52.3) | |
D5 | Extreme aged | 153 (43.5) | |
D2 | Diabetic mellitus | 124 (35.2) | |
D3 | Alcohol consumption | 69 (19.6) | |
D4 | Chronic Kidney disease | 66 (18.8) | |
Total score of 8 items | 3.93 ± 1.52 |
Table 6: Knowledge of Tuberculosis Investigation (n = 352)
Item | Answered correctly n (%) | M±SD | |
E3 | Chest x-ray | 298 (84.7) | |
E4 | Urine analysis | 276 (78.4) | |
E5 | Stool examination | 264 (75) | |
E2 | Blood investigation | 257 (73) | |
E1 | Sputum test | 248 (70.5) | |
E6 | Skin test | 102 (29) | |
Total score of 6 items | 4.07 ± 0.97 |
Table 7: Knowledge on Tuberculosis Prevention (n = 352)
Item | Answered correctly n (%) | M±SD | |
F2 | By taking Panadol (Paracetamol) | 346 (98.3) | |
F1 | Through BCG vaccination. | 312 (88.6) | |
Total score of 2 items | 1.87 ± 0.39 |
Table 8: Level of Knowledge on Tuberculosis (TB) (n = 352)
Subdomains of knowledge of TB | Score range | M±SD | % answered all correctly |
Knowledge on TB prevention | 0-2 | 1.87 ± 0.39 | 88.4 |
Knowledge on causes of TB | 0-4 | 3.04 ± 1.19 | 56.0 |
Knowledge on mode of transmission of TB | 0-11 | 8.09 ± 2.07 | 13.9 |
Knowledge on symptoms of TB | 0-10 | 7.58 ± 1.81 | 10.8 |
Knowledge on TB investigation | 0-6 | 4.07 ± 0.97 | 5.1 |
Knowledge on risk factors on TB infection | 0-8 | 3.93 ± 1.52 | 1.4 |
Overall score of 41 items | 0-41 | 28.45 ± 5.18 |
Table 9: Differences between Demographic Variables and the Level of Knowledge on TB (n = 352)
Characteristic | Variable | n | M±SD | t | P |
Gender | Male | 173(49.10) | 28.35±5.38 | 0.32 | 0.75 |
Female | 179(50.90) | 28.54±5.00 | |||
Ethnic | Malay | 170(48.30) | 28.27±5.02 | -0.62 | 0.54 |
Non- Malay | 182(51.70) | 28.61±5.33 | |||
Age groups (years) | <49 | 179(50.90) | 28.81±5.65 | 1.34 | 0.18 |
>50 | 173(49.10) | 28.07±4.64 | |||
Highest Level of Education | Non-Degree | 141(40.10) | 29.96±4.69 | 4.63 | 0.00* |
Degree | 211(59.90) | 27.47±5.25 |
Sociodemographic: A total of 352 participants were recruited in this study with the majority (50.9%) being females as compared to males (49.1%). Similarly, in a study done by Sallehet al., (2018) who conducted a study on knowledge, attitude and practice (KAP) on TB among community of Kulim, Kedah. The respondents were mainly 67.6% females while 32.4% were males. The mean age of the participants in this study were 48.08 ±16.84 years old. In contrast, in the same study of Salleh et al., (2018) showed that the mean age of the participants was 38.91 ± 13.24 years old. This implied that the participants of this study are mainly from the middle-aged group.
Knowledge on Causes of Tuberculosis: Findings showed that 97.2% of the participants knew that bacteria were the cause of TB. This finding was supported by a study by Salleh et al.,(2018) on KAP towards TB in Kulim, Kedah. It was reported that 88.2% of the participants knew that bacteria were the cause of TB. This implied that majority of the participant knew that TB is caused by a bacterium. While in contrast, in a study on 403 residents of an outpatient department at Mecha district reported that nearly half of participant knew that TB caused by bacteria (Kasa, Minibel & Bantie, 2019). In a study done in Tamil Nadu, only 10.6% of subjects were aware that TB is caused by microorganisms (Easwaran et al., 2015). In another study by Kasa, Minibel & Bantie (2019), more than half (56%) of the study participants stated that bacteria are the responsible agent in causing TB. whereas 2% replied that heredity as the mode of transmission of the disease.
Knowledge on Mode of Transmission of Tuberculosis: A total of 98.3% of the participants knew that cough was the mode of transmission of TB. Similarly, as reported in a study done by Lin et al., (2017) on TB knowledge among members of a rural community in Myanmar, 95.50% knew that TB can be transmitted through coughing while 91.2 % of the respondent in a study done by Salleh et al., (2018) on KAP towards TB among Community of Kulim Municipal Council, Kedah also perceived that coughing can transmit TB. This finding implies that majority of the participant knew that coughing can transmit TB by releasing microscopic droplet that contains TB bacteria into the air. Kasa, Minibel & Bantie (2019), reported that from 403 study participants in Ethiopia who had information about TB, 74% mentioned that droplet inhalation as the main mode of transmission of the disease. A study by Easwaran et al., (2015) on 2030 participants in Tamil Nadu found that only 26.1% of them knew that TB is transmitted by cough. Another study done in Klang District, reported that only 20% of residents answered correctly said that inhaling Mycobacterium tuberculosis can cause tuberculosis (Kumar & Jagatheeswary, 2018). This study also revealed that approximately 71.1% of respondent were aware of typical factors on how the TB can be transmitted from person to person.
Knowledge on Symptoms of Tuberculosis: A good number of participants of 90.1% identify that persistent cough is one of the symptoms of Tuberculosis. This was supported by a study by Gelaw (2016) in Ethiopia on association of socioeconomic factors on knowledge of TB, where 71.4% knew that persistent cough is a symptom of Tuberculosis. In contrast, a study by Luba et al., (2019) in Lesotho on attitude, associated factors and TB knowledge, found that 55.5% of the respondents knew that persistent cough is one of the symptoms of TB while in Tamil Nadu, only 34.4% of the participants knew at least one of the symptoms of TB (Easwaran et al., 2015). Regarding sign and symptoms of TB, Kasa, Minibel & Bantie (2019), found that 39.4% mentioned that cough for greater than or equal 2 weeks is the clinical manifestation of a client with TB. Another study by Sanusi, Talip & Mohamed (2017) found that more than half (78.1%) of the respondents were aware of haemoptysis as a clinical symptom of TB, followed by chest pain (78.1%), coughing for over 2 weeks (77.8%), difficult breathing (67.4%), weight loss (55.6%) and loss of appetite (41.5%).
Knowledge on Risk Factors of Tuberculosis Infection: Findings of the study showed that 77.8% of the participants knew that compromised immune systems is one of the risk factors of TB infection. Similar findings were reported by a study done by Salleh et al., (2018) on KAP towards TB in Kulim, Kedah where 70.6% of the respondents knew that compromised immune systems is one of the risk factors of TB infection. On the other hand, a study by Sanusi, Talip & Mohamed (2017) found that HIV/AIDS (71.1%) was recognised by majority
of the respondents as one of the risk factors of TB, but diabetes mellitus which is second to HIV/AIDS as the risk factor of TB was known by less than half of the respondents (37.8%) as the risk factors of TB.
Knowledge of Tuberculosis Investigation: A total of 84.7% of the participants knew that chest x-ray is an investigation for Tuberculosis. It was supported by a research done by Salleh et al., (2018) on KAP towards TB in Kulim, Kedah stated that 75.5% also knew that chest x- ray was used in the investigation of Tuberculosis.
Knowledge on Tuberculosis Prevention: A total of 88.6% of the participants knew that BCG vaccination can prevent Tuberculosis infection. This was supported by a study by Salleh et al., (2018) on KAP towards TB that 75.5% of the respondents also knew that BCG vaccination can be used in the prevention of TB. According to Kasa, Minibel & Bantie (2019), forty-nine (12.2%) study participants in their study in Ethiopia thought that TB is not a preventable disease.
Overall Level of Knowledge on Tuberculosis: The mean overall score of the participants is 28.45±5.18 which implied that the participants had only fair knowledge on TB. A study conducted on 300 participants from Klang district revealed that knowledge towards tuberculosis within the population is average (Kumar & Jagatheeswary, 2018). Similarly, another study involving 102 respondents from Kulim Municipal Council, Kedah also found that the respondents had moderate knowledge on TB (Salleh et al., 2018).
Differences between Demographic Variables and Level of Knowledge on TB: The results from the analysis showed no significant differences between level of knowledge on TB according to gender and ethnic. Studies by Ghosh (2019) and Salleh et al., (2018) showed that there are no significant differences between level of knowledge on TB and demographic variable including gender, ethnic and age. In contrast, the results from the analysis showed significant difference between level of knowledge on TB and level of education. Those with degree qualification seem to have lower scores as compared to those with degree qualification. Therefore, the null hypothesis is accepted as there is no significant differences between demographic variables and level of knowledge regarding Tuberculosis among residents of an apartment in Kg. Pandan, Kuala Lumpur. groups. However, Hassan et al., (2017) reported that respondents with tertiary education had the highest proportion (81%) of TB knowledge. This implied that young persons between the ages of 16 to 29 years had access to information on TB compared with the older categories. In addition, more persons in this age group mostly belong to the tertiary education category where high TB knowledge was observed (𝑝𝑝 < 0.001).
Based on the finding of this study, there seems to be a lack of knowledge on TB among the residents of the apartment. Areas that need prioritised interventions to improve communication and information dissemination on Tuberculosis include causes, symptoms, diagnostic investigations, mode of transmission and risk factors contributing to TB.
In summary, the level of knowledge on Tuberculosis among the residents is fair with a total score of 28.45 ± 5.18. Majority of them did not know about causes, symptoms, diagnostic investigations, mode of transmission and risk factors contributing to TB. Therefore, there is an urgent need to create more awareness on Tuberculosis among the community in this area. It is suggested that more effort through collaboration between healthcare providers and housing management committee be carried out to communicate and improve the resident’s knowledge on TB through more health teaching activities to create awareness and improve their knowledge on TB.
The limitation of this study is that only one apartment in Kg Pandan, Kuala Lumpur, were involved in this study. Thus, the finding of this study cannot be generalised.
The authors declare that they have no conflict of interest.
The authors would like to thank the residents who participated in the study, as well as appreciate the cooperation and support given by the respective management of the apartment in Kg Pandan, Kuala Lumpur. This study was supported by the International Medical University research grant, BN I/2019 (PR-52).
Easwaran, M., Ramanchandran, D., Ramasamy, R., George, N., Mathew, M., Bazroy. J. & Singh, Z. (2015). Knowledge, attitude, and practice regarding tuberculosis among rural population in Tamil Nadu. International Journal of Medical Science and Public Health, 4(12), pp 1681-1684.
Gelaw, S. M. (2016). Socioeconomic Factors Associated with Knowledge on Tuberculosis among Adults in Ethiopia. Tuberculosis Research and Treatment. Retrieved from: https://www.hindawi.com/journals/trt/2016/6207457/
Ghosh, D. (2019). A descriptive study to assess the knowledge regarding tuberculosis among males aged between 20-50 years in selected rural areas of Moradabad, Uttar Pradesh: An original study. International Journal of Nursing Education, 11(4), pp 46-49.
Hassan, A. O., Richard, O., Ogbuji, Q. C., Afolabi, S., Okwuonye, L. S., Kusimo, O. C., Osho, J. A., Osinowo, K. A. & Ladipo O. A. (2017). Knowledge about Tuberculosis: A Precursor to Effective TB Control - Findings from a Follow-Up National KAP Study on Tuberculosis among Nigerians. Tuberculosis Research and Treatment. Retrieved from: https://doi.org/10.1155/2017/6309092
Kasa, A. S., Minibel, A. & Bantie, G. M. (2019). Knowledge, attitude and preventive practice towards tuberculosis among clients visiting public health facilities. BMC Research Notes, 12(276).
Kumar, S. & Jagatheeswary S. (2018). Assessment of knowledge towards tuberculosis among general population in Klang District, Malaysia. International Journal of Medical Toxicology & Legal Medicine, 21(3&4), pp 283-287.
Lin, K. S., Kyaw, C. S., Sone, Y. P. & Win, S. Y. (2017). Knowledge on tuberculosis among the members of a rural community in Myanmar. The International Journal of Mycobacteriology, 6(3), pp 274-280.
Lisut, O., Razali, S. A. & Arshad, N. A. (2017). Kampung Pandan is a place for immigrants. Retrieved from:
https://translate.google.com/translate?hl=en&sl=ms&u=https://www.bharian.com.my/berita/n asional/2017/12/362153/kampung-pandan-lubuk-pendatang&prev=searchl
Luba, T. R., Tang, S., Liu, Q., Gebremedhin, S. A., Kisasi, M. D. & Feng, Z. (2019). Knowledge, attitude and associated factors towards tuberculosis in Lesotho: A population- based study. BMC Infectious Diseases, 19(1), pp 96.
Polit, D. F. & Beck, C. T. (2014). Essentials of Nursing Research: Appraising Evidence for Nursing Practice, 8th ed. Wolters Kluwer Health /Lippincott Williams & Wilkins: Philadelphia.
Salleh, M., Farhanah, S., Rahman, A., Azlina, N. & Haque, M. (2018). Knowledge, attitude and practice towards tuberculosis among community of Kulim municipal council, Kedah, Malaysia. International Medical Journal, 25(5), pp 299-303.
Sanusi, S. B., Talip, B. A. & Mohamed, M. (2017). The Descriptive Study of Knowledge and Awareness of Tuberculosis Among Students in Universiti Tun Hussein Onn Malaysia, Journal of Science and Technology, 9(1), pp 15-19.
World Health Organization. (2017). Tuberculosis in Malaysia. Retrieved from: https://www.worldlifeexpectancy.com/malaysia-tuberculosis.
World Health Organization. (2018). Global Tuberculosis Report 2018. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf
World Health Organization. (2020). Tuberculosis. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis