Healthcare workers’ knowledge, attitudes, and practices towards multi-drug resistant tuberculosis, Arua District, Uganda

Abstract

Background: Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. The incidence of MDR TB in Uganda is 3.2 cases per 100,000 population. Cumulatively the MDR TB unit in the Arua region has enrolled 360 DR-TB patients since 2006, 52 (14%) patients have died on treatment. The occurrence of MDR TB could probably be due patient related factors or the knowledge attitudes and practices (KAP) of healthcare workers (HCWs). Studies conducted in other African countries have found that HCWs do not always have sufficient knowledge or the correct positive attitude and do not exhibit acceptable practices regarding prevention and treatment of MDR- TB. Methods: The study was a quantitative cross-sectional study to determine the KAP of HCWs towards MDR TB at ARRH and River Oli HC IV. Quantitative methods of data collection i.e., a questionnaire was used to assess the KAP of HCWs towards MDR TB. Results: A total of 138 HCWs participated in the study, the response rate was 100 %. The median age of the HCWs was 30yrs, half (n=77; 55.8%) were male, half were married (n=70; 50.7%) and majority were catholic (n=56; 40.6%). The majority of the respondents were from ARRH (n=111; 80.4%), over half (n=84; 60.9%) worked at the outpatient department, a bulk (n=58; 42.0%) were nurses and midwives and slightly over one tenth (n=23; 16.7%) were pharmacy and lab staff. Over half (n=82; 59.4%) of the HCWs had worked for 1-5 years and the majority (n=108; 78.3%) had never had a training in MDR TB management. Overall, (n=8; 5.8 %) of the HCWs were judged to have good knowledge of MDR TB, (n=71; 51.5%) had moderate knowledge and (n=59; 42.8 %) had poor knowledge. Majority of the HCWs, (n=113; 81.9 %) were judged to have a good attitude towards MDR TB and (n=25; 18.1 %) had poor attitude. Over a half, (n=93; 67.39%) of the HCWs were judged to have poor practices towards MDR TB while (n=45; 32.61%) had good practice towards MDR TB. At multivariate analysis, the odds of good MDR TB knowledge were lower in nurses and midwives (AOR: 0.68, 95%CI: 0.49-0.94) and higher among HCWs who had worked 6-10 years (AOR: 1.60, 95%CI: 1.22- 2.11). The odds of good MDR TB practice were lower in nurses and midwives (AOR: 0.39, 95%CI: 0.23- 0.67), pharmacy and lab staff (AOR: 0.23, 95%CI: 0.08 – 0.68) and HCWs who were not trained in MDR TB (AOR: 0.48, 95%CI: 0.31 – 0.73). Conclusion: Overall, the scores for MDR TB knowledge and practice were not desirable. Poor MDR TB knowledge was associated with being a nurse or a midwife, poor self-reported practice of MDR TB this was associated with being a nurse or midwife, a pharmacy or a laboratory staff and not being trained in MDR TB management.