Background: Correct knowledge about transmission of tuberculosis (TB) can influence better health-seeking behaviors, and in turn, it can aid TB prevention in society. Therefore, this study aimed to examine the prevalence and predictors of self-reported correct knowledge about TB transmission among adults in Malawi. Methods: We conducted a secondary analysis of the data obtained from the Malawi Demographic and Health Survey, 2015/16 (MDHS 2015/16). Questions regarding self-reported TB transmission were computed to evaluate the correct knowledge about TB transmission. The factors associated with the correct knowledge about Tb were assessed using univariate and multivariable logistic regression. Results: Overall, the prevalence of correct knowledge about TB transmission in the general population of Malawian adults was 61.5%. Specifically, the prevalence of correct knowledge about TB transmission was 63.6 and 60.8% in men and women, respectively. Those aged 35–44 years, having secondary or high education, belonging to the richest household, being exposed to mass media, being in professional/technical/managerial, having knowledge that "TB can be cured", and those living in urban areas were significantly associated with correct knowledge about TB transmission. Conclusions: The findings of this study show that if appropriate strategies for TB communication and education to address the rural masses, young individuals, poor individuals, and individuals in the agriculture sector are put it place, can enhance TB prevention in Malawi.
Keywords: Tuberculosis transmission; TB knowledge; Determinants; Malawi
Peter A. M. Ntenda, Christopher C. Stanley, Susan Banda and Owen Nkoka contributed equally to this work.
Tuberculosis (TB), an infectious disease which is caused by a bacteria called Mycobacterium tuberculosis (MTB), continues to be a major public health issue [[
It is known that having the correct knowledge about the symptoms and transmission mode of a disease is essential for disease prevention, screening, early detection, and early treatment-seeking behaviors – thereby improving overall management of health conditions [[
The World Health Organization (WHO) declared TB as a global emergency in 1993 and later launched the Directly Observed Therapy short course (DOTs) strategy [[
[[
Therefore, using the population-based data, this study aimed to examine the prevalence and predictors of self-reported correct knowledge about Tb transmission among adults in Malawi.
The current study used data taken from the 2015–16 Malawi Demographic and Health Survey (MDHS). The 2015–16 MDHS sample was selected using a two-stage cluster sampling design and produced a nationally representative sample. The census sampling frame is considered as a complete list of all the census standard enumeration areas (SEAs). Thus, in the first stage, 850 SEAs (i.e., 173 SEAs in urban areas and 677 SEAs in rural areas) were selected with probability proportional to the SEA size. During the second stage, a fixed number of 30 and 33 households per urban rural cluster/SEA, respectively, were selected with an equal probability systematic selection criterion. All women and men of reproductive age 15–49 years and 15–54 years respectively, who were either permanent residence of the selected households or visitors who stayed in the household the night prior to the data collection were eligible for the interviews. The MDHS selected a total of 27,516 households, of which 24,562 women and 7478 men were successfully interviewed for the response rate of 97.7 and 94.6% respectively. Using women's and men's questionnaires, data were collected on socio-demographic characteristics and major health indicators, including knowledge, attitudes, and behaviors related to other health issues such as injections, smoking, fistula, tuberculosis HIV/ acquired immune deficiency syndrome (AIDS), and non-communicable diseases (NCDs). One of the key aims of The DHS Program is to collect data that are comparable across countries. Thus, to achieve this, standard model questionnaires have been developed and these model questionnaires—which have been reviewed and modified in each of the eight phases of The DHS program—form the basis for the questionnaires that are implemented in each country. The datasets for women and men were explored and after excluding respondents with missing data, a total of 28,862 respondents (6937 men and 21,925 women) were included in our analysis.
The dependent variable considered in this study was correct and adequate knowledge regarding the mode of TB transmission. This variable was created from the following 6 questions to evaluate the correct knowledge regarding mode of TB transmission among adult male and female.
- TB is spread from person to person through the air when coughing or sneezing?
- TB can be transmitted by sharing utensils?
- TB can be transmitted through food?
- TB can be transmitted by touching a person with TB?
- TB can be transmitted through sexual contact?
- TB can be transmitted through mosquito bites?
For the purposes of this study, the response to Q1 "Through air when coughing or sneezing" was used to measure the knowledge about the mode of TB transmission. The responses from 'Q2' to 'Q6' were regarded as misconceptions. However, individuals who responded 'yes' to the Q1 and responded 'no' to the other questions were recorded to have correct knowledge.
The present study considered the following covariates as independent variables; sex of the respondents, age of the respondents, educational level, wealth index, religion, occupation, marital status, amount of media exposure, perception about TB cure, perception about keeping secret when family member gets TB, place of residence, geographical religion, and ethnicity. These variables were selected after a thoroughly review of literature [[
We conducted our analyses while taking into account the complex design of the survey (i.e. weighting, clustering, and stratification). First, the baseline statistics were presented as frequency and weighted percentage. Second, the bivariate analyses using Chi-Square test were performed to explore the distribution of the selected characteristics according to the correct knowledge about the mode of TB transmission among adult women and men. Third, using the generalized estimating equation (GEE) logistic regression, the multivariable analyses were performed to investigate the strength of associations between the selected factors and correct knowledge about TB transmission. GEE models were used to account for the correlated responses within the hierarchical data such DHS data [[
The 2015–2016 MDHS was implemented by the National Statistical Office (NSO) and the Community Health Sciences Unit (CHSU). The protocols and procedures that were developed for data collection were reviewed and approved by the ICF Macro Institutional Review Board (ICF Macro IRB) and the Malawi National Health Science Research Committee. The MDHS 2015–2016 complied with all requirements of the US Department of Health and Human Services' the 45 Code of Federal Regulations 46 (45 CFR 46), Protection of Human Subjects [[
A total of 28,862 adults (6937 males and 21,925 females) were sampled and analyzed in this study. Table 1 presents the baseline characteristics of the study participants stratified by sex. The overall prevalence of correct about TB knowledge in the general population of Malawi was adequate (61.5%). Most of the respondents (40.6%) were distributed in the age group 15 to 24 years and near two-thirds (59.2%) of the respondents had primary school education. Nearly 30.0% of respondents were residing in the richest households while about two-thirds (64.3%) currently in union. Approximately 40% of the participants did not have any form of mass media and a similar proportion (38.6%) of respondents were employed in agriculture sectors. Furthermore, over three-fourth (77.4%) of participants were rural dwellers and 44.98% were southern region dwellers.
Table 1 Descriptive statistics of Individual and community characteristics by sex, Malawi Demographic Health Survey, 2015–16
Variable Male 6937 (24.04) Female 21,925 (75.96) Overall 28,862 (100.00) Individual-level factors Age (years) <.0001 < 25 2838 (40.91) 8891 (40.55) 11,729 (40.64) 25–34 1896 (27.33) 7012 (31.98) 8908 (30.86) 35–44 1441 (20.77) 4626 (21.10) 6067 (21.02) ≥ 45 762 (10.98) 1396 (6.37) 2158 (7.48) Educational level <.0001 No education 366 (5.28) 2285 (10.42) 2651 (9.19) Primary 3834 (55.27) 13,260 (60.48) 17,094 (59.23) Secondary or high 2737 (39.46) 6380 (29.10) 9117 (31.59) Wealth index† <.0001 Poorest 939 (13.54) 3631 (16.56) 4570 (15.83) Poorer 1204 (17.36) 3824 (17.44) 5028 (17.42) Middle 1328 (19.14) 3982 (18.16) 5310 (18.40) Richer 1467 (21.15) 4440 (20.25) 5907 (20.47) Richest 1999 (28.82) 6048 (27.58) 8047 (27.88) Religion <.0001 Roman catholic 1299 (18.73) 3916 (17.86) 5215 (18.07) CCAP 1180 (17.01) 3590 (16.37) 4770 (16.53) Anglican 361 (5.20) 1133 (5.17) 1494 (5.18) Seventh Day Adventist/Baptist 491 (7.08) 1679 (7.66) 2170 (7.52) Other Christian 2776 (40.02) 9215 (42.03) 11,991 (41.55) Muslim 655 (9.44) 2273 (10.37) 2928 (10.14) No religion/other 175 (2.52) 119 (0.54) 294 (1.02) Marital status <.0001 Never in union 2575 (37.12) 4526 (20.64) 7101 (24.60) Currently in union 4108 (59.22) 14,443 (65.87) 14,443 (64.27) Formerly in union 254 (3.66) 2956 (13.48) 2956 (11.12) Amount of media exposure‡ <.0001 0 1076 (15.51) 9046 (41.26) 10,122 (35.07) 1 2101 (30.29) 6684 (30.49) 8785 (30.44) 2 2157 (31.09) 3988 (18.19) 6145 (21.29) 3 1603 (23.11) 2207 (10.07) 3810 (13.20) Occupation <.0001 Not working 960 (13.84) 7148 (32.60) 8108 (28.09) Professional/technical/managerial 490 (7.06) 1280 (5.84) 1770 (6.11) Clerical/sales/services 478 (6.89) 1537 (7.01) 2015 (6.98) Agricultural employee 2701 (38.94) 8448 (38.53) 11,149 (38.63) Skilled manual 800 (11.53) 335 (1.53) 1135 (3.93) Unskilled manual 1508 (21.74) 3177 (14.49) 4685 (16.23) Tb can be cured <.0001 No 1010 (14.56) 4375 (19.95) 5385 (18.66) Yes 5927 (85.44) 17,550 (80.05) 23,477 (81.34) Community-level factors Place of residence 0.3626 Urban 1594 (22.98) 4923 (22.45) 6517 (22.58) Rural 5343 (77.02) 17,002 (77.55) 22,345 (77.42) Geographical region 0.0025 Northern 1447 (20.86) 4286 (19.55) 5733 (19.86) Central 2489 (35.88) 7657 (34.92) 10,146 (35.15) Southern 3001 (43.26) 9982 (45.53) 12,983 (44.98) Ethnicity <.0001 Chewa 2167 (31.24) 6556 (29.90) 8723 (30.22) Tumbuka 747 (10.77) 2326 (10.61) 3073 (10.65) Lomwe 1251 (18.03) 4128 (18.83) 5379 (18.64) Tonga 253 (3.65) 871 (3.97) 1124 (3.89) Yao 704 (10.15) 2337 (10.66) 3041 (10.54) Sena 299 (4.31) 949 (4.33) 1248 (4.32) Nkhonde 121 (1.74) 290 (1.32) 411 (1.42) Ngoni 878 (12.66) 2829 (12.90) 3707 (12.84) Mang'anja 178 (2.57) 499 (2.28) 677 (2.35) Nyanja 115 (1.66) 491 (2.24) 606 (2.10) Other 224 (3.23) 649 (2.96) 873 (3.02) Correct knowledge of TB transmission <.0001 No 2522 (36.36) 8602 (39.23) 11,124 (38.54) Yes 4415 (63.64) 13,323 (60.77) 17,738 (61.46)
TB tuberculosis, OR Odds Ratio, AOR adjusted Odds Ratio, CI Confidence Interval
Table 2 presents the domains that were used to measure correct knowledge about the mode of TB transmission among women and men of reproductive age. Ninety-seven percent of men and 94% of women had heard of TB. Overall, 8908 (71.83%) of the participants responded correctly that TB is spread from one person to another through air by coughing or sneezing. Furthermore, 81.34% of respondents believed that TB can be cured and 31.89% of participants would want a family member's TB status kept secret. There were significant differences between men and women who reported having heard of TB, such that 69.64% of women and 78.77% of men reported that TB is spread through the air by coughing or sneezing (P <.0001). Additionally, 85.44% of women and 80.05% of men believe that TB can be cured (P <.0001) while 25.39% of men and 33.94% of women would want a family member's TB status kept secret (P <.0001). Figure 1 shows the distribution of the domain that were used to construct knowledge related to TB transmission.
Table 2 Proportion of respondents with correct knowledge about tuberculosis transmission in Malawi, MDHS 2015–16
Variable Male n (%) 6937 (24.04) Female n (%) 21,925 (75.96) Overall n (%) 28,862 (100.00) TB spread by air when coughing or sneezing (Yes) 5464 (78.77) 15,268 (69.64) 8908 (71.83) <.0001 TB spread by sharing utensils (No) 6365 (91.75) 20,664 (94.25) 27,029 (93.65) <.0001 TB spread by touching a person with TB (No) 6556 (94.51) 21,314 (97.21) 27,870 (96.56) <.0001 TB spread by food (No) 6609 (95.27) 21,485 (97.99) 28,094 (97.34) <.0001 TB spread by sexual contact (No) 6670 (96.15) 20,458 (93.31) 27,128 (93.99) <.0001 TB spread by mosquito bites (No) 6917 (99.71) 21,842 (99.62) 28,759 (99.64) 0.2719 TB can be cured (Yes) 5927 (85.44) 17,550 (80.05) 23,477 (81.34) <.0001
TB Tuberculosis
Graph: Fig. 1 Domains used to measure correct knowledge about tuberculosis transmission in Malawi
Table 3 shows the prevalence of correct knowledge about TB transmission among men and women of reproductive age by sociodemographic characteristics. The prevalence of correct knowledge about TB transmission was significant different from those who had incorrect knowledge by sex of the respondents (P <.0001), age of the respondents (P <.0001), educational level (P <.0001), household wealth (P <.0001), religion (P <.0001), amount of media exposure (P <.0001), respondent's occupation (P <.0001), respondents with a belief that TB can be cured (P <.0001), respondents would want a family member's TB status kept secret (P <.0001), place of residence (P <.0001), geographical region (P <.0001), and ethnicity (P <.0001).
Table 3 Prevalence of correct knowledge of TB transmission by individual and community characteristics MDHS 2015–16
Variable Over all n (%) 28,862 (100.00) No n (%) 11,124 (38.54) Yes n (%) 17,738 (61.46) Individual-level factors Sex <.0001 Male 6937 (24.46) 2522 (22.67) 4415 (24.89) Female 21,925 (75.96) 8602 (77.33) 13,323 (75.11) Age (years) <.0001 < 25 11,729 (40.64) 4869 (43.77) 6860 (38.67) 25–34 8908 (30.86) 3202 (28.78) 5706 (32.17) 35–44 6067 (21.02) 2220 (19.96) 3847 (21.69) ≥ 45 2158 (7.48) 833 (7.49) 1325 (7.47) Educational level <.0001 No education 2651 (9.19) 1238 (11.13) 1413 (7.97) Primary 17,094 (59.23) 7348 (66.06) 9746 (54.94) Secondary or high 9117 (31.59) 2538 (22.82) 6579 (37.09) Wealth index† <.0001 Poorest 4570 (15.83) 2076 (18.66) 2494 (14.06) Poorer 5028 (17.42) 2140 (19.24) 2888 (16.28) Middle 5310 (18.40) 2154 (19.36) 3156 (17.79) Richer 5907 (20.47) 2308 (20.75) 3599 (20.29) Richest 8047 (27.88) 2446 (21.99) 5601 (31.58) Religion <.0001 Roman catholic 5215 (18.07) 2020 (18.16) 3195 (18.01) CCAP 4770 (16.53) 1680 (15.10) 3090 (17.42) Anglican 1494 (5.18) 564 (5.07) 930 (5.24) Seventh Day Adventist/Baptist 2170 (7.52) 716 (6.44) 1454 (8.20) Other Christian 11,991 (41.55) 4946 (44.44) 7048 (39.73) Muslim 2928 (10.14) 1081 (9.72) 1874 (10.41) No religion/other 294 (1.02) 120 (1.08) 174 (0.98) Marital status 0.5732 Never in union 7101 (24.60) 2755 (24.77) 4346 (24.50) Currently in union 14,443 (64.27) 7158 (64.35) 11,393 (64.23) Formerly in union 2956 (11.12) 1211 (10.89) 1999 (11.27) Amount of media exposure‡ <.0001 0 10,122 (35.07) 4291 (38.57) 5831 (32.87) 1 8785 (30.44) 3563 (32.03) 5222 (29.44) 2 6145 (21.29) 2215 (19.91) 3930 (22.16) 3 3810 (13.20) 1055 (9.48) 2755 (15.53) Occupation <.0001 Not working 8108 (28.09) 3094 (27.81) 5014 (28.27) Professional/technical/managerial 1770 (6.11) 401 (3.60) 1369 (7.72) Clerical/sales/services 2015 (6.98) 720 (6.47) 1295 (7.30) Agricultural employee 11,149 (38.63) 4799 (43.14) 6350 (35.80) Skilled manual 1135 (3.93) 384 (3.45) 751 (4.23) Unskilled manual 4685 (16.23) 1726 (15.52) 2959 (16.68) Tuberculosis can be cured <.0001 No 5385 (18.66) 2927 (26.31) 2458 (13.86) Yes 23,477 (81.34) 8197 (73.69) 15,280 (86.14) Community-level factors Place of residence <.0001 Urban 6517 (22.58) 1925 (17.30) 4592 (25.89) Rural 22,345 (77.42) 9199 (82.70) 13,146 (74.11) Geographical region <.0001 Northern 5733 (19.86) 2671 (24.01) 3062 (17.26) Central 10,146 (35.15) 4031 (36.24) 6115 (34.47) Southern 12,983 (44.98) 4422 (39.74) 8561 (48.26) Ethnicity <.0001 Chewa 8723 (30.22) 3558 (31.98) 5165 (29.12) Tumbuka 3073 (10.65) 1361 (12.23) 1712 (9.65) Lomwe 5379 (18.64) 1704 (15.32) 3675 (20.72) Tonga 1124 (3.89) 554 (4.98) 570 (3.21) Yao 3041 (10.54) 1080 (9.71) 1961 (11.06) Sena 1248 (4.32) 461 (9.71) 787 (4.44) Nkhonde 411 (1.42) 170 (1.53) 241 (1.36) Ngoni 3707 (12.84) 1353 (12.16) 2354 (13.27) Mang'anja 677 (2.35) 240 (2.16) 437 (2.46) Nyanja 606 (2.10) 243 (2.18) 363 (2.05) Other 873 (3.02) 400 (3.60) 473 (2.67)
TB tuberculosis, OR Odds Ratio, AOR adjusted Odds Ratio, CI Confidence Interval
Table 4 shows results of univariate and multivariate logistics regression that were used to test independent predictors of the given variables and assess their strength of associations between those predictors with correct knowledge about TB transmission. In univariate analysis characteristics that were significantly associated with correct knowledge about TB transmission included sex of the respondents, age of the respondents, educational level, household wealth, religion, amount of media exposure, occupation, tuberculosis can be cured, TB status kept secret, place of residence, geographical region, and ethnicity (all P-values less than 0.05). The results of multivariate logistics regression showed that respondents of age groups 25–34 years odds (adjusted odds ratio [aOR]: 1.219; 95% confidence interval [CI]: 1.145–1.297; P <.0001), 35–44 years (aOR: 1.275; 95% CI: 1.187–1.371; P <.0001), and 45+ years (aOR: 1.239; 95% CI: 1.116–1.375; P <.0001) had increased compared to those respondents of age group 15 to 24 years. The odds of having correct knowledge about TB transmission was also high in respondents with primary education (aOR: 1.253; 95% CI: 1.144–1.371; P <.0001) and secondary and high education (aOR: 2.000; 95% CI: 1.793–2.232; P <.0001) compared to those with no formal education. Furthermore, respondents from middle household wealth (aOR: 1.106; 95% CI: 1.016–1.205; P- = 0.0205), richer households (aOR: 1.096; 95% CI: 1.005–1.196; P = 0.0387), and richest households (aOR: 1.166; 95% CI: 1.053–1.292; P = 0.032) had increased odds of having correct knowledge about TB transmission compared to respondents from poorest households. Additionally, respondents who had exposure to 3 forms of mass media (aOR: 1.190; 95% CI: 1.076–1.315; P = 0.0007), respondents who believed that TB can be cured (aOR: 1.708; 95% CI: 1.600–1.823; P <.0001), respondents from urban (aOR: 1.165; 95% CI: 1.063–1.277; P = 0.0011), and respondents from Lomwe tribe (aOR: 1.286; 95% CI: 1.066–1.551; P = 0.0086) had also increased odds of having correct knowledge about TB transmission. Conversely, agricultural employee (aOR: 0.909; 95% CI: 0.843–0.981; P = 0.0143), respondents who would want a family member's TB status to be kept secret (aOR: 0.886; 95% CI: 0839–0.935; P <.0001) had reduced odds of having correct knowledge about TB transmission. Furthermore, respondents from central region (aOR: 0.896; 95% CI: 0.819–0.980; P = 0.0161) and northern region (aOR: 0.581; 95% CI: 0.512–0.659; P <.0001), had also reduced odds of having correct knowledge about TB transmission compared to those from the southern region.
Table 4 Determinants of correct and adequate knowledge about tuberculosis transmission among adult men and women
Variable Univariate Multivariable CrOR 95% (CI) P-value AOR 95% (CI) Individual-level factors Sex Male 1.150 (1.085–1.218) <.0001 1.012 (0.949–1.079) 0.7118 Female 1.000 1.000 Age (years) < 25 1.000 1.000 25–34 1.279 (1.206–1.357) <.0001 1.219 (1.145–1.297) <.0001 35–44 1.256 (1.175–1.342) <.0001 1.275 (1.187–1.371) <.0001 ≥ 45 1.173 (1.064–1.293) 0.0014 1.239 (1.116–1.375) <.0001 Educational level No education 1.000 1.000 Primary 1.181 (1.083–1.286) 0.0002 1.253 (1.144–1.371) <.0001 Secondary or high 2.225 (2.022–2.447) <.0001 2.000 (1.793–2.232) <.0001 Wealth index† Poorest 1.000 1.000 Poorer 1.140 (1.048–1.240) 0.0022 1.081 (0.993–1.176) 0.0734 Middle 1.238 (1.139–1.346) <.0001 1.106 (1.016–1.205) 0.0205 Richer 1.324 (1.218–1.439) <.0001 1.096 (1.005–1.196) 0.0387 Richest 1.822 (1.670–1.987) <.0001 1.166 (1.053–1.292) 0.0032 Religion Roman catholic 1.063 (0.828–1.364) 0.6319 0.957 (0.743–1.232) 0.7339 CCAP 1.212 (0.944–1.557) 0.1322 1.037 (0.804–1.338) 0.7768 Anglican 1.110 (0.845–1.459) 0.4523 1.145 (0.868–1.510) 0.3365 Seventh Day Adventist/Baptist 1.305 (1.006–1.693) 0.0452 1.073 (0.824–1.398) 0.6004 Other Christian 0.964 (0.754–1.231) 0.7675 0.951 (0.742–1.219) 0.6936 Muslim 1.042 (0.804–1.352) 0.7541 1.020 (0.777–1.339) 0.8855 No religion/other 1.000 1.000 Amount of media exposure‡ 0 1.000 1.000 1 1.103 (1.038–1.172) 0.0015 1.010 (0.948–1.076) 0.7571 2 1.306 (1.218–1.399) <.0001 1.056 (0.978–1.140) 0.1621 3 1.787 (1.636–1.959) <.0001 1.190 (1.076–1.315) 0.0007 Occupation Not working 0.934 (0.864–1.010) 0.0885 1.011 (0.931–1.097) 0.7992 Professional/technical/managerial 1.911 (1.676–2.180) <.0001 1.336 (1.166–1.531) <.0001 Clerical/sales/services 1.028 (0.917–1.153) 0.6346 0.893 (0.795–1.004) 0.0588 Agricultural employee 0.841 (0.780–0.907) <.0001 0.909 (0.843–0.981) 0.0143 Skilled manual 1.125 (0.976–1.296) 0.1032 0.983 (0.850–1.137) 0.8176 Unskilled manual 1.000 1.000 Tuberculosis can be cured No 1.000 1.000 Yes 2.088 (1.960–2.223) <.0001 1.708 (1.600–1.823) <.0001 Community-level factors Place of residence Urban 1.674 (1.528–1.835) <.0001 1.165 (1.063–1.277) 0.0011 Rural 1.000 1.000 Geographical region Northern 0.588 (0.533–0.650) <.0001 0.581 (0.512–0.659) <.0001 Central 0.777 (0.715–0.845) <.0001 0.896 (0.819–0.980) 0.0161 Southern 1.000 1.000 Ethnicity Chewa 1.214 (1.025–1.439) 0.0249 1.052 (0.878–1.259) 0.5836 Tumbuka 1.125 (0.941–1.345) 0.1956 1.054 (0.886–1.253) 0.5553 Lomwe 1.709 (1.434–2.036) <.0001 1.286 (1.066–1.551) 0.0086 Tonga 0.919 (0.738–1.145) 0.4520 0.898 (0.727–1.108) 0.3158 Yao 1.423 (1.184–1.710) 0.0002 1.122 (0.911–1.382) 0.2769 Sena 1.387 (1.120–1.719) 0.0028 1.100 (0.881–1.373) 0.4018 Nkhonde 1.199 (0.914–1.572) 0.1900 1.146 (0.878–1.497) 0.3156 Ngoni 1.398 (1.168–1.673) 0.0003 1.063 (0.882–1.281) 0.5220 Mang'anja 1.484 (1.173–1.877) 0.0010 1.086 (0.850–1.386) 0.5110 Nyanja 1.251 (0.979–1.599) 0.0735 0.997 (0.780–1.274) 0.9807 Other 1.000 1.000
TB tuberculosis, CrOR Crude Odds Ratio, AOR adjusted Odds Ratio, CI Confidence Interval
The purpose of the current study was to examine the prevalence and factors associated with the correct knowledge concerning TB transmission among adults in Malawi. An understanding of such knowledge and its predictors is of great essence as it may help TB control programme managers and policymakers to develop effective community based health promotion programs [[
As with previous research [[
We found also that respondents who had secondary or high education had higher likelihood of having correct knowledge about TB transmission. Our results are consistent with prior literature [[
In agreement with previous studies [[
This study cannot determine the causation between the exposure variables and the outcome variable due to the cross-sectional nature of the study design. Considering that the sample size of females was 3 times that of male participants, and that a large percentage of the participants were under the age of 25, the external validity of the results to the entire Malawian population maybe compromised (i.e., the results may not be generalizable to the Malawian population). Nevertheless, the factors observed in this study may help inform TB control programs aimed at improving overall TB knowledge in Malawi. However, despite these limitations, the findings presented in this study would contribute to our understanding of the determinants of TB transmission which may improve the quality of TB management in Malawi. These results can be generalized only in a certain specific population such as women and those age less than 25 years.
The findings of this study revealed that if appropriate strategies for TB communication and education to address the rural masses, young individuals, poor individuals, and individuals in the agriculture sector are put it place, can enhance TB prevention in Malawi.
The authors want to sincerely thank the National Statistical Office (NSO) and the Community Health Sciences Unit (CHSU) of Malawi for data collection. The authors would like also give thanks to The DHS Program for providing him with the population-based dataset through their archives.
All authors conceived and led the study. PAMN extracted the dataset, CCS, SG, and ON prepared the analysis plan, PAMN, AB, AM, and performed the data analysis. PAMN, RM, SB and GB wrote the manuscript. AS1, AS2, EM, CCS, and ON reviewed the manuscript critically. All authors approved the final manuscript.
This research received no specific grant from any funding agency in public, commercial or not-for-profit sectors.
The datasets generated and/or analyzed during the present study are available in The DHS Program repository.
https://dhsprogram.com/data/dataset/Malawi_Standard-DHS_2015.cfm?flag=1
The 2015/16 MDHS was implemented by the NSO and the Community Health Sciences Unit (CHSU). The protocols and procedures that were developed for data collection were reviewed and approved by the ICF Macro Institutional Review Board (ICF Macro IRB) and the Malawi National Health Science Research Committee. The MDHS 2015–2016 complied with all requirements of the US Department of Health and Human Services' the 45 Code of Federal Regulations 46 (45 CFR 46), Protection of Human Subjects [[
Not applicable.
The author declares that he has no competing interests.
• AIDS
- Acquired immune deficiency syndrome
• aORs
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• CFR
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By Peter A. M. Ntenda; Razak Mussa; Steve Gowelo; Alick Sixpence; Andy Bauleni; Atusayi Simbeye; Alfred Matengeni; Ernest Matola; Godfrey Banda; Christopher C. Stanley; Susan Banda and Owen Nkoka
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