FINAL RESEARCH

J.PERANANTHAM
COHORT -03
LC 0007000077
BSc Nursing
Lincoln University College

FACULTY OF NURSING
BSC (HONS) IN NURSING
(POST REGISTRATION)
 TITLE OF THE RESERCH

KNOWLEDGE AND AWARENESS ON FACTORS

INFLUENCING PULMONARY TUBERCULOSIS
INFECTION AMONG PATIENTS AT CHEST CLINICS IN
EASTERN PROVINCE OF SRILANKA
Keywords: factor influencing tuberculosis patient
clinics
 INTRODUCTION
O Tuberculosis (TB) is a specific infectious disease caused by
Mycobacterium Tuberculosis (M.tuberculosis) (Park, 2009). It
is a historical disease; Evidence of its presence can be found
in the preserved spines of Egyptian mummies (Zink, 2007).TB
one of the communicable disease (WHO, 2000).

O These communicable diseases of mankind continue to remain

a formidable challenge till this day, all over the world
(Dhaar&Robbani, 2006).

O TB remains an important cause of death from an infectious

agent, second only to the human immunodeficiency virus, or
HIV (WHO, 2004). In 2012, 8.6 million people fell ill with TB
and 1.3 million died from TB (WHO, 2012).
INTRODUCTION Cont
O People infected with TB bacteria have a lifetime risk of
falling ill with TB of 10 % (WHO, 2012).

O There are several factors, that are influencing

spreading of tuberculosis among world population, but
these factors are not equal for every region, it will differs
place to place.

O Researches in Eastern Province regarding influencing

factors of tuberculosis, through this research, it was
identified that some factors such as poverty, knowledge
deficit, crowded area, mal nutrition and war
environment are the influencing factors of the
tuberculosis in this province.
 Background
O TB occurs in every part of the world; in 2012, the
largest number of new TB cases occurred in Asia,
accounting for 60% of new cases globally (WHO,
2012).

O More than 2,000 million people, one out of three

persons in the world, are infected with M.
tuberculosis (WHO, 2012).
 Background Cont.

O In developing countries , increased

population, lack of access to health
care, poverty, civil unrest, ineffective
TB control programmes, and drug
resistance are the factors influencing
to TB (Haslett e, 2002).
 PROBLEM STATEMENT

O Importance of identifying factors of

tuberculosis, leads to proper treatment and
prevention of tuberculosis in eastern
province.

O Although number of affected patients is day

by day increasing, there is no proper
research finding so far.
 Problum statement Cont

O In 2016, 13 patients died due to TB in Batticaloa district

alone and the number of death increased to 23, in 2016.

O In Trincomalee there are 144 new cases identified last year

(District chest clinic register 2016).

O This year 84 new cases identified (quarter annual report of

chest clinic Trincomalee,

O To control and prevent TB in this region, it is necessary to

identify the factors that influence to TB.

O This actual health problem needs a study to finds the

factors that influence to TB. The study finding provided
guidelines to stop TB in this region
 RESEARCH OBJECTIVES OF THE
STUDY
O Research OBJECTIVES
To determine the level of knowledge and awareness on
factors influencing pulmonary tuberculosis infection among
patients at chest clinics in eastern province

SPECIFIC OBJECTIVES OF THE STUDY

1. Identify the level knowledge on factors influencing
pulmonary tuberculosis infection among patients at chest
clinics in eastern province

2. to determine the nutritional factor.

O The World Health Organization (2012) estimates around
11,000 incident tuberculosis cases yearly; the number
of patients that are put on treatment in Sri Lanka is
around 9,000.

O Identification of Rest of the victims is very important.

Through this study it can be found out the reason why
others did not access the treatment? .
OBJECTIVES OF THE STUDY

O Identify the knowledge and attitude related to

tuberculosis among at TB clinics in Eastern
Province.
O Identify the socio economic factors related to
tuberculosis among at TB clinics in Eastern
Province.
O Identify the nutritional factors related to
tuberculosis patients at TB clinics in Eastern
Province.
O Identify the existing medical conditions related
to tuberculosis patients at TB clinics in Eastern
Province
 Research Questions
O 1. What are the level knowledge on factors
influencing pulmonary tuberculosis
infection among patients at chest clinics in
eastern province

O 2.what are the level of awareness on factors

influencing pulmonary tuberculosis
infection among patients at chest clinics in
eastern province.
 Hypothesis

O There is a Significant relationship between

Knowledge and awareness with Disease of
Tuberculosis
Dependent and Independent Variables

Independent Variables
O Knowledge
O Nutritional factors
O Demographic data(Socio economical)

Dependent Variables
O Pulmonary TB
 SIGNIFICANCE OF THE STUDY

O The level of knowledge from patients on factors identified

by this study can be given more priority in planning TB
control program. The study finding will guide the National
TB Control programme,

O The identified data was included in teaching content while

planning the health teaching session to the people in the
region. The TB screening program can give more priority to
the area where the identified factors are prevalence
 Definition of the Term
O Knowledge : Details knowledge of the
Tuberculosis
O Factors : Causative Factors of the
Tuberculosis which is inhibiting democratic
factors
O Tuberculosis: Tuberculosis (TB) is a specific
infectious disease caused by Mycobacterium
Tuberculosis
 Chapter 2

O Literature Review
Author Name Literature
Issues Review Year

Hill researcher came under conclusion 2006

that house hold crowding past house
hold exposure to a known TB cases
are the main risk factors of TB. In
different places, different factors
were associated for TB.
(WHO) Some countries show TB was 2008
associated with male sex, HIV
diya87
infection, smoking (with a dose-effect 18
relationship), and history of asthma,
family history of TB, marital status,
Author Name
Literature
Issues
Review Year

Siddique,M.S, According to the finding of this study, 2011

Moizefakin,H.A et al 54persentage for male sex,25 percentage for
diabetes, 10 percentage for smoking(20
cigarettes per day), 69.6 percentage for live
in over crowd.

Maria Teresa Findings from the global context indicate that 2014
Montagna et al a populations knowledge of TB is crucial to
facilitate the seeking of early medical care
and avoidance of further M.
diya87 tuberculosis transmission. Deficient 19

knowledge often results in delays in TB

diagnosis and treatment, increasing the risk
Author Name
Literature
Issues
Review Year

Siddique,M.S, According to the finding of this study, 2011

Moizefakin,H.A et al 54persentage for male sex,25 percentage for
diabetes, 10 percentage for smoking(20
cigarettes per day), 69.6 percentage for live
in over crowd.

Maria Teresa Findings from the global context indicate that 2014
Montagna et al a populations knowledge of TB is crucial to
facilitate the seeking of early medical care
and avoidance of further M.
diya87 tuberculosis transmission. Deficient 20

knowledge often results in delays in TB

diagnosis and treatment, increasing the risk
Author Name
Literature
Issues
Review Year

Siddique,M.S, According to the finding of this study, 2011

Moizefakin,H.A et al 54persentage for male sex,25 percentage for
diabetes, 10 percentage for smoking(20
cigarettes per day), 69.6 percentage for live
in over crowd.

Maria Teresa Findings from the global context indicate that 2014
Montagna et al a populations knowledge of TB is crucial to
facilitate the seeking of early medical care
and avoidance of further M.
diya87 tuberculosis transmission. Deficient 21

knowledge often results in delays in TB

diagnosis and treatment, increasing the risk
Author Name
Literature
Issues
Review Year

Singla N et all. If responding correctly to 75% of the 2012

questions asked is taken as the criterion for
satisfactory awareness, only 40.2% of
tuberculosis nurses and 10.7% of general
hospital nurses had a satisfactory level of
awareness. There was no effect of increasing
age or years of experience on the level of
awareness.
There is a general lack of knowledge
regarding various aspects of tuberculosis
diya87
among nurses. Active interventions are 22
required to improve awareness for a better
implementation of the revised national
tuberculosis control programme in India.
Conceptual Frame work

Knowledge
Factors
influencing
pulmonary
tuberculosis
Awareness
Demographic
data
Age
Gender
Weight
Civil status
Rationale of Using Framework
O To Provide a Strong guidance in the data and
Facts

O To provide the framework for research and

to help the researcher in compilling the
research hypotheses
 Chapter 3

Methodolody
 RESEARCH METHODOLOGY

STUDY DESIGN
O The researcher select a quantitative
approach and descriptive design to describe
the influencing factors of Tuberclosis in
Eastern Province.
TypeofStudy : Quantitative type study

Study design : quantitative approach and

descriptive design to describe the influencing
factors of Tuberclosis

Setting: Chest Clinics, Teaching Hospital

,Batticaloa, General Hospital Trincomalae
 PERIOD OF STUDY

O This study will be carried out over a six (06)

month period

O The study population of this study is the all

diagnosed TB patients who live in Eastern
Province of Sri Lanka.
 TypeofStudy : Quantitative type study

O Study design : quantitative approach and descriptive

design to describe the influencing factors of Tuberclosis

O Setting: Chest Clinics, Teaching Hospital ,Batticaloa, General

Hospital Trincomalae
 Population &Sampling Technique

O Study Populatioan : Patients who are follow

clinic in TB Clinic in Teaching Hospital
Batticaloa, General Hospital ,Trincomalae
O The researcher will use convenience
sampling method for this study.

O total number of sample size is : 155 Patiets

INCLUSION AND EXCLUSION
INCLUSION
The patients who give informed
consent to participate in the
study
EXCLUSION
The patients who refuse to
give informed consent, and
mentally ill patients

The patients who have diagnostic The patients who are in

document or records that severe chest conditions, such
confirm TB as frequent cough and
difficulty in breathing.

The patients who live and stay in

eastern province continuously
PILOT STUDY
Pilot study will be done among 10 TB patients. The results will
be analyzed and alteration will be made on the questionnaire
if necessary.

DATA COLLECTION INSTRUMENT

The questionnaire prepared in English. It will be translated into
Tamil and singhale
Data collection Process
Permission Letter will be obtained from Head of the
Institution Eastern Province

Nursing Head will be Approached to take permission

fo the distribution of questionnaire

A self Administrated survey questionnaire will be

distributed by hand in Tb Clinics

Participants will be given 15- 20 minutes to

complete the survey form
 ETHICAL CONSIDERATION

Permission carry out the reasearch taken from

O Lincoln University College
O The permission were obtained from the Hospital
Directors of who are working at TeachinHospital
Batticaloa,
O The Participant were informed his/her right to
refuse and withdraw anytime during the study
 Data analysis
O The questionnaire were prepared with the help of the
supervisor. The patients were explained thoroughly
about the study and consent was obtained before the
data collection.

O Patients who refuse to participate in the study were

excluded.
O Used spss22 version and word Excel ,
 Chapter 4

O Data Analysis
 Research Limitation
The limitation of the time affected throughout this study.
Researcher used purposive sampling method, and self-
administrated questionnaire which take more time to
collect data.

Not only the data tool but also patients literacy level, clinic
environment, patients hurry up to return back to home
were also make impact this study and juice the researcher
time allocation.

The major disadvantage of the close ended questionnaire

lies in the possibility of researcher neglecting and over
working some potentially important response and there are
no changes to respondents to express their views.
 Limitation
O Researcher covered a wide area for this
study and collect data from two main chest
clinics and thirteen sub clinics. few clinic
days some patients not came when
researcher available for data collection on
there. It was disappoint to this study.
Demographic factors Frequency Percentag
e%
Age
Less than 20 02 1.2
21-35 21 13.5
35-50 86
51-65 43 55.4
More than 65 03 27.7
1.9
Sex
Male 106
68.3
female 49
31.6
Weight
Less than 20 0 0
21-40 33 21.2
41-60 104 67
61-80 18 11.6
More than 60 0 0
Civil status
Married 90
Unmarried 39 58
Widow 10 25.1
Separated 12 6.4
Others 04 7.7

2.5
Ethnicity
Tamil 64 41.2
Sinhala 19
Muslim 72
12.2
46.4

Religion
Hindu 57 36.7
Buddhist 18 11.6
Muslim 74
Christian 06
47.7
3.8

Educational level
Below grade 3 62
Up to grade 8 56 40
Up to O/L 22 36.1
Up to A/L 13 14.1
Degree or above 02 8.3

1.2
Employment status
Unemployment 52 33.5
Government sector 14 9
Private sector 04 2.5
Self employment 85 54.8
Others 0 0
Living with
Alone 03 1.9
Wife 86 55.4
Husband 43 27.7
Mother 30 19.3
Father 22 14.1
Children 61 39.3
Relatives 27 17.4
BCG and scar
BCG vaccination
YES 115 74.1
NO 40 25.8
scar formation
YES 101 65.1
NO 54 34.8

Income(LKR per month)

< 10000 60 38.7
10000- 20000 79 50.9
21000- 30000 14 9
> 30000 02 1.2
 Knowledge and Attitude Data
160
140
120
Number of patients

100
80
60
40
20
0
YES NO YES NO YES NO YES NO YES NO YES NO
Before disease After disease Before disease After disease Before disease After disease
Infectious disease Caused by bacteria Mainly afected Lungs

Figure 1 distribution of knowledge about Tuberculosis

Below figure 1 and 2 interpret the knowledge about the disease; researchers gave six answers to choose patients for express their knowledge before
and after the disease with yes or no type.
Figure 1 show after the disease patients known this is an infectious disease but they do not understand the causative agent and response not enough
with weather lungs will affected or not
 160

140

120

100

80
Number of patients

60

40

20

0
YES NO YES NO YES NO YES NO YES NO YES NO
Before disease After disease Before disease After disease Before disease After disease
Other Body systems affected Complications will occur Trasmited person to person

Figure 2 distribution of knowledge about Tuberculosis

Same as earlier, graph two interpret the poor knowledge about the TB
infection after the disease also.
 160
140
120
Number of 100
Patients 80
60
40
20
0
YES NO YES NO YES NO YES NO YES NO
Coughing Night sweats Loss of weight Chest pain Fever
symptoms of TB as you know

Figure 3. Distribution of Knowledge about Symptoms of Tuberculosis

Patients well known about cough and fever related to tuberculosis but they do not have sufficient
knowledge about other symptoms.
 Number of Patients

0
20
40
60
80
100
Totally agree

Agree

patially agrre

disagree

Avoiding infected person

totally disagree

Totally agree

Agree

patially agrre

Chewing beetle disagree

totally disagree

Totally agree

Agree

patially agrre
items

disagree
Figure 4 Distribution of Knowledge about prevention
Using common house hold

totally disagree

Totally agree

Agree

patially agrre

disagree
Need barrier for droplet

totally disagree
 Number of Patients

0
20
40
60
100

80
Totally agree

Agree

patially agrre

disagree

Spitting public places

totally disagree

Totally agree

Agree

patially agrre

preparation
disagree
Good hygienic food
totally disagree

Totally agree

Agree

patially agrre

disagree
Isolation of the patient

totally disagree
Figure 5 Distribution of Knowledge about prevention

Totally agree

Agree

patially agrre
Vaccination

disagree

totally disagree
 Number of Patients

0
10
20
30
40
50
60
80
90

70

Totally agree
Agree
patially agrre
disagree

Vaccination
totally disagree
Totally agree
Agree
patially agrre
disagree

Using barier
mechanisms
totally disagree
Totally agree
Agree
patially agrre
disagree
public toilets
Using uncleaned

totally disagree
Totally agree
Agree
patially agrre
disagree
excreations
Avoid Open air

totally disagree
Totally agree
Agree
patially agrre
disagree
in public places
Tobaco smoking

totally disagree
Figure 6 Distribution of Knowledge about prevention

Totally agree
Agree
patially agrre
Alchohol

disagree
consumption

totally disagree
 150
Number of Patients

Nutritional Factors
100

50

0
Starchy Vegetables Fish, Egg, meat Full of Fruits Dairy Others
food cereals products
Type of main food

Figure 7 Distribution of main food

Patients take starch food highly 78.84% as usual Sri Lankans but participants fish, egg, meat intake was very low, and it may be
their poor socio economic condition
Weight
 Smoking habits high (52.56%) among patients
Socio Economic Factors especially among males
Smoking habits

Alcohol

82
80 100
80
78
60
76 Series1
40
74
20
72
0
70 Yes No
Yes No
Alchohol
smoking

Figure 9 Distribution of alcohol consumption

Figure 8 Distribution of smoking habit

 Alcohol usage also very high among patients (53.84%)
TB awareness programme

TB awareness
progrmmes Yes
TB awareness
progrmmes No
TB awareness
progrmmes No idea

Figure 10 Distribution of availability of awareness programme

There the availability of TB awareness programmes (17%) is not enough in this province
 0
5
10
15
20
25
30
35
40
1 month

2 months

3 months

Hepatic diseases
4 months

More than 4months

1 month

2 months

3 months

For any surgery 4 months

More than 4months

1 month
Existing medical condition

2 months

3 months
Renal diseases

4 months

More than 4months

60

50

40

30 Series1
Series2
20
Series3

10

0
Diabetic Mellaitus Wheezing/ Asthma Sexual Transmitted HIV infections
diseases
Do you have One or more of following Conditions ?

Figure 12 Distribution of existing medical condition of patients

33.97 % patients have diabetes mellitus and 25% have asthmatic or wheezing condition with TB
 Findings
O Gender - 68.3% Male
- 31.6% Female
Age - 55.4% - 35-50 Years
27.7% - 51-65 Years
13.5% - 21-35 Years
1.2 - 20> Years

Weight 41-60 Kg - 67%

 Finding Cont
O Educational Level - Below Grade 3 - 40%

Civil Status - 58% Married

36% Widowed
6% Unmarried
 Findinng Continue
Clinic staffs very busy their routine schedules.
Increasing activities of knowledge and attitude
changes will reduce the tuberculosis in this region,

because prevention is better than cure. The National

Programme for Tuberculosis Control and Chest
Diseases (NPTCCD) is the only hope for the public and
is responsible for the tuberculosis control activities of
the entire country.

Through this programme TB awareness programme

and health education are the most valuable activities
to control TB in eastern province. Patients and public
need knowledge and that will be provided by nurses.
 Discussions
O Significant number of participants in this study already have affected by some kind
of diseases such as hepatic diseases, diabetics and renal diseases.

O A systematic review comparing 13 studies examining the association between

diabetes and TB found that diabetic patients had about a threefold increased risk
of developing TB when compared to those without diabetes (Jeon, 2008).

O Renal diseases also cause immunosuppressive condition. Immune suppressive

conditions make the way too easy for Tuberculosis infection.

O Similar study in India shows, that the incidence of tuberculosis is high in chronic
kidney disease (CKD) which needs a high index of suspicion, early diagnosis and
management for gratifying outcome.

O In majority male (69.4%), tuberculosis was observed , Venkata et al (2007)

O In this study shown effected male 68.3% and female 31.6% , if compare Venkatas
study there is similar percentage.
 Implication&Recomondation
O Ensure early case detection. Facilitate and engage in partnerships with community
and community health workers for TB action. Tuberculosis control policies should
in the future incorporate tobacco control as a preventive intervention.

O Direct Observation Treatment (DOT) should be expanded among patients with the
help of the community health worker who are responsible for TB control.

O Increase nurses in main chest clinics. Established health education for TB patients
in every hospital and combine it with health education unit of every hospital.
Established health awareness programmes for tuberculosis and appoint a nursing
officer for that.

O Publish health advice regularly in newspapers.

O Broadcast and transmit health awareness programmes in radio and television.

O Placed large size posters or cut out busy places such as market, bus stand, beach,
in near of schools and worship places. Develop strategies to stop water pollution
by hard metals and fertilizers to avoid renal diseases. To make awareness quotes
about TB in public transports vehicles.
 Limitations

The limitation of the time affected throughout this study.

Researchers used purposive sampling method, and self-administrated
questionnaire which take more time to collect data.

Not only the data tool but also patients literacy level, clinic environment,
patients hurry up to return back to home were also make impact this study and
juice the researchers time allocation.

The major disadvantage of the close ended questionnaire lies in the possibility
of researcher neglecting and over working some potentially important response
and there are no changes to respondents to express their views.
 CONCLUSION
Based on the research results all of the special
objectives were identified.
Throughout the patients answers demographic
datas interpret the results as similar as
international results,

such similarities are range of age, and sex; poor

income and low education level were taken major
influence in tuberculosis infection in eastern
province.

At the same time high crowded and concentration

of public one of the factor. This factor influenced
among Muslims community for increasing
tuberculosis in eastern province.
CONCLUSION Cont..
Smoking and alcohol usage were very high among
these participants. It should be reduced through TB
awareness programmes, unfortunately these
programmes still not available in this region.

Existing medical conditions such as renal diseases,

diabetic mellitus, chronic wheezing were much
influence TB

Healthy water resources, balanced food and clean

environment will make free these conditions among
general public and it helped reduce the number of TB
patients in Eastern Province.
 Grant Chart
11 TIME

TIME April MAY JUNE JULY AUG SEP

FRAME 2017 2017 2017 2017 2017 2017

01 Heading
selection,
preparing
proposal and
questionnaire
02 Approval

03 Collection of
data
04 Data
processing
and analysis
05 Writing
report

06 Typing and
Binding
07 Submission
of report
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