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Myths about Tuberculosis and How to Burst them

Updated: Mar 17

IN 2016, TUBERCULOSIS WAS THE UNDERLYING CAUSE OF 1.3 MILLION DEATHS AMONG HUMAN IMMUNODEFECIENCY VIRUS (HIV)-NEGATIVE PEOPLE IN 2016. [1] KNOWLEDGE, BELIEFS, AND PERCEPTIONS OF TUBERCULOSIS AMONG PEOPLE IS NOT VERY MUCH WELL-UNDERSTOOD AND CLEAR. A BROADER THEORECTICAL UNDERSTANDING OF PEOPLE'S HEALTH BELIEFS AND CONCERNS ABOUT TB CAN INFORM AND CLARIFY EXISTING PERCEPTIONS AND MISCONCEPTIONS AND ENHANCE A BETTER UNDERSTANDING OF GRAVITY OF TB DISEASE. [2,3]





TUBERCULOSIS (TB) IS AN INFECTION CAUSED BY A BACTERIUM, MYOBACTERIUM TUBERCULOSIS. WHILE IT CAN AFFECT ANY PART OF THE BODY, ONLY PULMONARY TB IS INFECTIOUS. [4] TUBERCULOSIS (TB) IS AN IMPORTANT CAUSE OF MORTALITY AND MORBIDITY ALL OVER THE WORLD WITH MORE THAN EIGHT MILLION NEW CASES OF TUBERCULOSIS AND 1.3 MILLION DEATHS EVERY YEAR AND IS PARTICULARY RELEVANT IN DEVELOPING COUNTRIES LIKE INDIA WHERE THE DISEASE IS ENDEMIC. [5,6] MYTHS AND MISCONCEPTIONS ABOUT TB CAN SERVE AS A BARRIER TO EFFORTS AT REDUCING STIGMATISATION OF PEOPLE INFECTED AND AFFECTED BY THE DISEASE. UNDERSTANDING SUCH DRIVERS OF MYTHS AND MISCONCEPTIONS IS IMPORTANT FOR IMPROVING INFORMATION, EDUCATION AND COMMUNICATION (IEC) EFFORTS OF NATIONAL CONTROL AND PREVENTIVE INTERVENTIONS. [7] THERE IS A STIGMA ASSOCIATED WITH HAVING TUBERCULOSIS BECAUSE THE DISEASE IS COMMONLY VIEWED AS A ‘DIRTY DISEASE’ WHICH CAN HAVE A NEGATIVE IMPACT ON AN INDIVIDUAL AND MAY DELAY THE PERSON SEEKING TREATMENT. [8] THERE IS A MISCONCEPTION AMONG THE NORMAL POPULATION THAT TUBERCULOSIS IS A HEREDIATARY, WHEN A GENETIC DISORDER IS DIAGNOSED IN A FAMILY, FAMILY MEMBERS OFTEN WANT TO KNOW THE LIKELIHOOD, OF THE DISEASE DEVELOPING AMONG THEM, WHICH MAY LEAD TO TREPIDATION AMONG INDIVIDUALS, SINCE TB IS NOT A HEREDIATARY DISORDER THE BELIEFS SHOULD BE ELIMINATED. HOWEVER TUBERCULOSIS IS CONSIDERED TO HAVE A GENETIC COMPONENT. A GROUP OR RARE DISORDERS CALLED ‘MENDELIAN SUSCEPTIBILITY TO MYCOBACTERIAL DISEASE (MSMD)’ WHICH IS A GENETIC DEFECT THAT RESULTS IN INCREASED SUSCEPTIBILITY TO MYCOBACTERIAL INFECTION.


A BELIEF THAT FOLLOWS TUBERCULOSIS IS THAT EVERY INDIVIDUAL WITH TUBERCULOSIS IS INFECTIOUS, THIS IS A COMPLETE MYTH; IF THE BACTERIA IS PRESENT IN OTHER PARTS OF BODY SUCH AS KIDNEY OR SPINE , A PERSON IS UNLIKELY TO BE INFECTIOUS. ONLY PATIENTS SUFFERING FROM PULMONARY TB ARE INFECTIVE, ALTHOUGH WITH COMPLETE AND EFFECTIVE TREATMENT THE RISK OF TUBERCULOSIS INFECTION SPREADING AROUND PEOPLE CAN BE REDUCED. GENERALLY TUBERCULOSIS PATIENT STOP BEING INFECTIOUS AROUND 2-3 WEEKS AFTER STARTING TREATMENT.


A HEALTH SURVEY WAS PERFOMED IN 2013-2016 AT MALAWI TO DETERMINE TB KNOWLEDGE AND MYTHS AND MISCONCEPTIONS AMONG THE POPULATION WHICH SHOWED THAT OUT OF 97% INDIVIDUALS 82.6% KNEW THAT TB CAN BE CURED, HOWEVER SIGNIFICANTLY HIGHER PROPORTIONS OF MEN AND WOMEN WHO WERE HIV POSITIVE KNEW THAT IT IS TRANSMITTED THROUGH AIR WHILE COUGHING, SNEEZING AND ALSO THAT IT CAN BE CURED. HOWEVER ON COUNTERPART A VERY HIGH PROPORTION OF MEN AND WOMEN HAD THE MISCONCEPTION THAT TB IS SPREAD THROUGH SHARING UTENSILS OR WOULD OVERALL SAY THEY DID NOT KNOW HOW IT IS SPREAD.[9]


AS TUBERCULOSIS IN CHILDREN IS RARELY SPUTUM SMEAR POSITIVE IT HAS LED MANY TO BELIEVE THAT CHILDREN ARE NOT IMPORTANT IN TUBERCULOSIS CONTROL, THIS IS A MISCONCEPTION. THE ULTIMATE GOAL OF TUBERCULOSIS SERVICES SHOULD BE ERADICATION OF MYCOBACTERIUM TUBERCULOSIS, BUT UNTIL NOW ONLY THOSE DISEASE WHOSE VACCINES ARE AVAILABLE HAVE BEEN ERADICATED. PRESENTLY THERE IS NO VACCINE AVAILABLE AGAINST TUBERCULOSIS TO PREVENT ITS INFECTION AND THEREFORE PROTECTION AGAINST THE INFECTION MUST BE ACHIEVED IN OTHER WAYS, WHICH MAY INCLUDE EARLY INDENTIFICATION OF THE DISEASE AND SUCESSFUL TREATMENT OF THE MOST INFECTIOUS CASES OF TUBERCULOSIS HAS BECOME THE FOCUS OF ATTEMPTS AND IS PRESENTLY THE MOST EFFECTIVE MEANS TO PROTECT CHILDREN FROM INFECTION WITH M.TUBERCULOSIS. [10]


AS EARLIER MENTIONED THE COMMUNITY REFERS TO TUBERCULOSIS AS A ‘DIRTY DISEASE’ OR LIKE TO CALL IT THE DISEASE OF LOWER SOCIO-ECONOMIC CLASS PEOPLE, HOWEVER SINCE TUBERCULOSIS IS AN INFECTIOUS DISEASE ANY INDIVIUDAL IRRESPECTIVE OF ONES SOCIAL STATUS, FINANCIAL BACKGROUND, LIVING CONDITION CAN BE AFFECTED.


MYHTS, OR MISCONCEPTIONS, OF DISEASE AND THERAPY ARE NOT CONFINED TO PATIENTS; THEY ALSO AFFECT THOSE WHO PRACTICE MEDICINE. IF ELIMINATION OF TUBERCULOSIS IS TO BE ACHIEVED, WE MUST FIRST ELIMINATE THE MYTHS, WHICH CAN BE DONE BY A COMBINATION OF MASSMEDIA AND INTERPERSONAL COMMUNICATION, FACE-TO-FACE COMMUNICATION WITH COMMUNITY MEMBERS, PATIENT PROVIDER DISCUSSIONS, AND INFORMATION THROUGH TELEVISION IS A VERY EFFECTIVE TECHNIQUE TOO.[11, 12]


CONCLUSION

TUBERCULOSIS IS AN INFECTIOUS DISEASE WHICH CAN AFFECT ANY INDIVIDUAL IRRESPECTIVE OF AGE, CASTE, GENDER ETC. HOWEVER HIV POSITIVE INDIVIDUALS ARE MORE SUSCEPTIBLE TO THE DISEASE; VAST MAJORITY OF INDIVDUALS IN DEVELOPING COUNTRIES OR EVEN IN DEVELOPED COUNTRIES STILL DON’T HAVE THE PROPER INFORMATION OR BASIC KNOWLEDGE REQUIRED FOR UNDERSTANDING TUBERCULOSIS, THIS LEADS TO MISCONCEPTIONS, FALSE BELIEFS, DISCRIMINATION AMONG INDIVIDUALS. THEREFORE WITH THE HELP OF GOVERNMENT AS WELL AS MEDICAL PRACTIONERS ON SOME LEVEL ELEMINATION OF SUCH MYTHS CAN BE ACHIVED AS WELL AS WITH PROPER KNOWLEDGE BETTER MANAGEMENT OF INDIVIDUALS WITH TUBERCULOSIS CAN BE DONE.

REFERENCES:-

1] Glaziou P, Floyd K, Raviglione MC. Global Epidemiology of Tuberculosis. Semin Respir Crit Care Med. 2018 Jun;39(3):271-285. doi: 10.1055/s-0038-1651492. Epub 2018 Aug

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6] Ghosh K, Ghosh K, Chowdhury JR. Tuberculosis and female reproductive health. J Postgrad Med. 2011 Oct-Dec;57(4):307-13. doi: 10.4103/0022-3859.90082. PMID: 22120860.

7] Amo-Adjei J, Kumi-Kyereme A. Myths and misconceptions about tuberculosis transmission in Ghana. BMC Int Health Hum Rights. 2013 Sep 12;13:38. doi: 10.1186/1472-698X-13-38. PMID: 24028419; PMCID: PMC3847526.

8] Juniarti N, Evans D. A qualitative review: the stigma of tuberculosis. J Clin Nurs. 2011 Jul;20(13-14):1961-70. doi: 10.1111/j.1365-2702.2010.03516.x. Epub 2010 Oct 29. PMID: 21040040.

9] Musuka G, Teveredzi V, Mutenherwa F, Chingombe I, Mapingure M. Tuberculosis knowledge, misconceptions/myths in adults: findings from Lesotho, Malawi, Namibia and Zambia Demographic Health Surveys (2013-2016). BMC Res Notes. 2018 Oct 31;11(1):778. doi: 10.1186/s13104-018-3884-6. PMID: 30382927; PMCID: PMC6208015.

10] Enarson DA. Children and the global tuberculosis situation. Paediatr Respir Rev. 2004;5 Suppl A:S143-5. doi: 10.1016/s1526-0542(04)90027-9. PMID: 14980260.

11] Lanphear BP, Snider DE Jr. Myths of tuberculosis. J Occup Med. 1991 Apr;33(4):501- 4. PMID: 1645402.

12] Arulchelvan S, Elangovan R. Effective communication approaches in tuberculosis control: Health workers' perceptions and experiences. Indian J Tuberc. 2017 Oct;64(4):318-322. doi: 10.1016/j.ijtb.2016.11.017. Epub 2016 Dec 16. PMID: 28941856


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