Baseline KAP Study Under RNTCP Project

BASELINE KAP STUDY UNDER RNTCP PROJECT
Submitted to
CENTRAL TB DIVISION, MINISTRY OF HEALTH & FAMILY WELFARE

GOVERNMENT OF INDIA
Submitted By
R K SWAMY BBDO Advertising Pvt. Ltd.

In Association With
Centre for Media Studies
March 4, 2003
CONTENTS Page No. Chapter. I: Introduction 1.0. Background 1.2. The Research Component 1.3. Baseline Report 1.4. Methodology 1.5. Choice of Indicators- Rationale 1.6. Tools for Study 1.7. Limitation Chapter. II: Respondent Profile 2.1. Socio Demo Graphic Profile of Respondent Chapter. III: Knowledge Attitude And Practice About TB and DOTS 3.1. TB is Common 3.2. Aware about the Symptoms 3.3. Myth about mode of spread still exist 3.4. Perception about who are prone to TB 3.5. TB is curable 3.6. Availability of TB related health facility in the vicinity 3.7. Preference for system of medicine 3.8. Diagnosis of TB suspect 3.9. Treatment of TB Patients 3.10. Precautions 3.11. Gender bias/Stigma & Discrimination 3.12. Knowledge about DOTS/Dot Centre 3.13. Facilities available at Dot Centre 3.14. Initiative taken by OL, NGO 16 18 21 22 23 24 25 27 30 33 35 38 38 42 1 3 4 5 7 10 10 11
Chapter. IV: Information Sources 4.1. Information Sources 4.2. Visit by a health personnel to make people aware of TB 4.3. Information Sought on 4.4. Information Source for HSPs Chapter. V: Media Habits 5.1. Ownership of asset 5.2. Preferred Time slot for Radio 5.3. Preferred Radio Station 5.4. Preferred Time slot for Television 5.5. Preferred Channel in Television 5.6. Preferred Programme in Television 5.7. Readership Pattern Annexure 1. Schedule for Public and Private Health Service Providers 2. Schedule for Opinion Leaders 3. Schedule for Households 48 48 49 49 50 51 52 44 45 46 47
LIST OF TABLES Page No. Table. 2.1: Sample covered Table. 2.2: Urban rural representation of Household Table. 2.3: HSP category Table. 2.4: Level of Education Household Table. 2.5: Level of Education Opinion Leaders Table. 2.6: Educational Qualifications of Health Service Providers Table. 2.7: Occupation Table. 2.8: Nature of Dispensing Table. 2.9: Household Income Table. 3.1: Heard of TB Table. 3:2: Getting TB Patients Table. 3.3: Prevalence of TB in the family or neighbourhood Table. 3.4: Sex wise distribution of patients Table. 3.5: Symptoms mentioned by HSPs Table 3.5a : Breakup of Private and Govt. doctors looking for coughing up blood Table. 3.6: HIV + People (PLWA) prone to TB Table. 3.7: TB curable in HIV + people Table. 3.8: TB Hospital in the Vicinity Table. 3.9: System of medicine preferred Table. 3.10: Preferred centre for treatment Table. 3.11: Reasons for not going to Govt. Hospital Table. 3.12: TB Suspect Table. 3.13: Investigation 11 11 12 13 13 13 14 14 15 16 17 17 17 20 20 23 24 24 25 25 26 27 29
Page No. Table 3.13a Breakup of Private and Public doctors advising only sputum test when given only one choice Table. 3.14: Why Table. 3.15: Frequency of Sputum test for TB suspect Table. 3.16: Where sent for Sputum Exam Table. 3.17: Problem for sputum Examination Table. 3.18: What are the problems Table. 3.19: Duration of Treatment Table. 3.20: Treat Pulmonary TB Table. 3.21: System of Medicine followed Table. 3.22: MDR-TB Table. 3.23: Symptoms of Cure Table. 3.24: How many completed treatment (in a year) Table. 3.25: Difficulties in treating Table. 3.26: Precautions Table. 3.27: TB constitutes any risk to health of other patients Table. 3.28: Precaution suggested to avoid spread of TB Table. 3.29: Allowed to attend Table. 3.30: Difference in Concern Noticed Table. 3.31: Who accompanies a TB Patient? Table. 3.32: Facilities provided dat DOT centre Table. 3.33: About DOTS Household Table. 3.34: About DOTS Opinion Leaders Table. 3.35: Would like to become a DOT Provider 29 29 29 29 30 30 31 32 32 32 32 33 33 33 34 35 36 37 37 39 39 39 40
Page No. Table. 3.36: If yes, Why? Table. 3.37: If No, Why? Table. 3.38: DOTS Regime Table. 3.39: About DOTs Table. 3.40: Involvement in DOTS Table. 3.41: Interested in DOTS Table. 3.42: If yes, Why? Table. 3.43: If no, Why? Table. 3.44: What do you advice Table. 3.45: Have you taken any initiative Table. 3.46: If yes, What? Table. 4.1: Update knowledge from Table. 4.2: Best medium to generate awareness among the community about TB Table. 5.1: Ownership of assets Table. 5.2: Top Two Preferred Slots for Listening Radio Table. 5.3: Top Two Preferred stations of Radio Table. 5.4: Top Two Preferred Radio Programme Table. 5.5: Top Two Preferred slot of watching Television Table. 5.6: Readership among male female household 40 40 40 40 41 41 42 42 43 43 43 47 47 48 48 49 49 49 52
LIST OF GRAPHS Page No. Graph. 2.1 Graph. 2.2 Graph. 2.3 Graph. 3.1 Graph. 3.2 Graph. 3.3 Graph. 3.4 Graph. 3.5 Graph. 3.6 Graph. 3.7 Graph. 3.8 Graph. 3.9 Graph. 3.10 Graph. 3.11 Graph. 3.12 Graph. 3.13 Graph. 3.14 Graph. 3.15 Graph. 3.16 Graph. 3.17 Graph. 3.18 Graph. 3.19 Graph. 20 11 12 12 16 17 18 18 19 19 19 19 19 19 20 20 21 21 21 21 22 22 22 23
LIST OF GRAPHS Page No. Graph. 3.21 Graph. 3.22 Graph. 3.23 Graph. 3.24 Graph. 3.25 Graph. 3.26 Graph. 3.27 Graph. 3.28 Graph. 3.29 Graph. 3.30 Graph. 3.31 Graph. 3.32 Graph. 3.33 Graph. 3.34 Graph. 3.35 Graph. 3.36 Graph. 3.37 Graph. 3.38 Graph. 3.39 Graph. 3.40 Graph. 3.41 Graph. 3.42 23 23 24 26 27 27 28 28 28 28 30 31 31 31 34 34 35 35 35 36 37 38
LIST OF GRAPHS Page No. Graph. 4.1 Graph. 4.2 Graph. 4.3 Graph. 4.4 Graph. 4.5 Graph. 4.6 Graph. 5.1 Graph. 5.2 Graph. 5.3 Graph. 5.4 Graph. 5.5 44 44 45 45 46 46 50 50 51 51 52
EXECUTIVE SUMMARY
Tuberculosis (TB) is the single largest infectious cause of death in the world, accounting for about 500,000 deaths per year in India alone. TB inflicts significant socio-economic costs. It affects persons during their most productive age. Studies suggest that on an average there is a loss in potential earnings of about 30% of annual household income. The AIDS epidemic is making the situation more threatening as 70% of HIV mortality is likely to be through TB. Indias National Tuberculosis Programme (NTP) was established in 1962 and after more than three decades of operation, the NTP can justly claim to have established an infrastructure and raised awareness of TB and TB treatment. However, with a treatment completion rate of only 30 percent, the programme did not make a significant dent in the problem. The Revised National Tuberculosis Control Programme (RNTCP) is designed to address the limitations of the earlier NTP i.e., lack of coverage coverage, shortages of essential drugs, poor cure and completion rates, poor quality of sputum microscopy, and a series of factors that have resulted in a non-friendly atmosphere for the patients. The goal of RNTCP is to achieve a curerate of at least 85% of new smear-positive cases of tuberculosis and a detection rate of at least 70% of such patients, after the desired cure rate has been achieved. RNTCP is essentially a patient focused programme and presently covers 600 million populations in the country. The programme lays equal emphasis on creating a system that reliably cures the patient and moves beyond simply detecting cases. The programme believes that cured patients act as one of the best motivators promoting case detection and patient adherence to treatment. In this backdrop the Central TB Division (DGHS), MoH&FW has contracted M/s RK SWAMY BBDO Advertising Pvt Ltd to develop and implement the IEC strategy for RNTCP. The IEC is aimed to promote better understanding of TB and its cure, improve the quality of TB patient care (patient-friendly) and help reduce stigma. RK SWAMY BBDO Advertising Pvt Ltd and Centre for Media Studies (CMS) have, in consultation with CTD and the international donor agencies, designed the research component to help shape, monitor, evaluate and measure the impact of communication.
A Baseline Report by CMS
The research has been conceptualized as a process keeping in mind the need for flexibility. The process has three components of Baseline; where a Communication Needs Assessment of the target audience including KAP related to TB their media habits and information sources used and preferred will be collected, Tracking ; where impact of IEC strategy will be tracked once every six months and the Endline; where IEC strategy will be evaluated and changes in KAP will be recorded. The present report of the Baseline Study aims to understand the KAP of beneficiaries, Opinion Leaders and health Service Providers related to TB; tries to assess the interest of the Opinion leaders and Health service providers in becoming a part of the RNTCP / DOTS programme; identifies the information needs and the preferred sources of the beneficiaries for receiving messages related to TB and to map Media habits/preferences of the Beneficiaries. For conducting the study a multi-stage random sampling procedure was used for selection of 9 states, 18 districts, urban rural locations and convenient sampling were done for each group in consultation with CTD, World Bank and WHO. Impact & process indicators were cautiously chosen to measure the level of knowledge, the attitude and practices of the three segments at the baseline, monitored at a regular interval and evaluated at the Endline study. The study covered 1444 beneficiaries, 180 opinion leaders and 211 health service providers. As per the methodology 50:50 ratio among male female beneficiaries and HSPs were attempted. About 23% of the beneficiaries across the states were illiterate but the opinion leaders were mostly literates and majority were graduates and above. More than half of the doctors contacted were MBBS qualified. The household income of 78% of the respondents across the states was less than Rs 4000/- per month (40.8% reported less than Rs 2000/- per month). Between 1-20% of the Householders / Beneficiaries spontaneously mentioned TB as a common infection and nearly all of them said that they have heard about TB when aided. Almost all doctors reported treating TB patients. Very low percentage of household and opinion leaders mentioned about someone in the family or neighbourhood whom they knew had TB. TB in female was comparatively less known by our respondents.
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Symptoms People were aware about the symptoms of TB but quite alarmingly a considerable percentage of the general population, opinion leaders and even doctors associate coughing up blood as a symptom of TB. HSPs in all the states mainly come across Pulmonary TB patients. However, a very small percentage of doctors mentioned having come across genetic TB. HIV-TB and MDR TB was also quite common among the doctors across the states. Doctors from all the states except Chattisgarh reported to have treated PLWH with TB. Myths about mode of Spread Myths about mode of spread still exist among the beneficiaries and opinion leaders. The study highlighted that about 15% of the community was totally unaware of the mode of spread of TB. A few associated spread with unsafe sex, defecation at open field, unhygienic living condition and even inheritance. Prone to TB Both the beneficiaries and opinion leaders had varied opinion about people who are prone to TB. Those living in congested locality and unhygienic conditions and persons having low immunity were identified by most of the respondents. More interestingly male respondents in some states mentioned people smoking tobacco to be prone to TB. A few respondents both among household and opinion leaders feel that TB is a poor mans disease and are not clear about women being more prone to TB or not. TB is curable Majority of the respondents in both the categories feel that TB is completely curable and agreed that only medicine can cure TB completely. Majority also felt that once cured a TB patient can lead a normal life. Majority of the doctors opined that TB in PLW HIV is curable. Availability of TB related health facility Public health services for treatment of TB was mentioned to be available in the vicinity but not that all the respondents knew about it.
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Preference for system and place of treatment Clear preference for Allopathic system of medicine and Government Hospitals and Private Practitioners for treatment emerged out of the study. Distance from residence, non-availability of medicine and unfriendly behaviour of staff were stated by the staff, who do not prefer Government hospitals. Diagnosis of TB suspect Govt. Hospital was preferred for diagnosis as well as treatment by household respondents and opinion leaders with minor variations across the states. DOT /TB center was mentioned by quite a few. Method of diagnosis and practice Respondents were quite familiar with Sputum examination but a significant percentage still recognizes X-ray as a reliable method for diagnosing TB. Doctors also confirmed that they advise sputum test and chest X-ray for diagnosing Pulmonary TB. On further probing about 22% of the HSP still chose X-ray. Treatment of TB Majority of the respondents preferred government hospital for seeking treatment for TB except for West Bengal where households mentioned DOTS center. Similar trend was noticed among the opinion leaders. They felt that completing full course of TB treatment is essential on failure of which the disease becomes untreatable. Cure In most of the states, doctors look for positive sputum turning negative to confirm whether the patient is cured or not. Most of the doctors stated that people hesitate to come for treatment and do not reveal previous history of TB in the family easily. The doctors also reported that more than two-third of the patients that went for treatment of TB completed the treatment. Precautions The respondents pointed out that covering face while coughing and using separate utensils was the major precautions that patients and their family took to control the spread the infection. They also opined that TB patient should be kept in isolation to prevent spread of infection. Although more than half of the doctors in all the states felt that TB do not pose any risk either to their own health or to other patients visiting them, they wear mask & gloves and maintain distance from the patients. A few doctors in some states mentioned that patients avoid visiting them because they treat TB patients. Precautions suggested by doctors to their patients varied from state to state. The three most commonly advised precautions include cover face while coughing, use separate utensils and not to spit anywhere.
iv
Gender bias/Stigma & Discrimination The responses of the beneficiaries reflecting gender bias and discrimination was quite contrary to our hypothesis that there still exists considerable gender bias in society, related to treatment of TB. However according to the opinion leaders and HSPs discrimination still exists in the society. Knowledge about DOTS /DOT CENTER Very few could spontaneously mention about DOTS as a center for treatment. On probing they could recall and remember the facilities specifically associated with DOT center. The study found a wide variation on the issue. All opinion leaders in West Bengal have mentioned DOT center. Except for AP, doctors have heard of DOTS and mostly among them informed that DOT service is available in their locality. Facilities available at DOT center Free diagnosis followed by free medicine was spontaneously indicated as special facilities or features available in DOTS center by the beneficiaries. Very few among the opinion leaders actually had the correct idea about free medicine and DOTS being surest way of cure for TB. Involvement with DOTS Majority of the opinion leaders showed their keenness to become a DOT Provider because they wanted to serve the community, and wanted to ensure free and good quality drugs for the patients. Private practitioners were interested in becoming a part of DOTS programme as they felt that DOTS is the surest way to complete cure. HSPs and DOTS DOTS regimen was widely known among the HSPs and most of them follows it for treating TB patients. They are also aware of the schemes to involve private practitioners in DOTS programme. Andhra Pradesh in all cases and Tamil Nadu in some are exceptions. Majority of government doctors in all the states, excluding AP are involved in DOTS scheme. Information Sources Hospital, television and in some cases friends were the main sources of information on TB. Newspaper was also mentioned by quite a few in some states. Journals is the most used source by the doctors for updating knowledge on TB
Apart from mass media sources in most of the states, village health worker followed by doctor was recalled as the Inter personal Communication Sources (IPC) who visited the respondents to make them aware on TB. Information sought on When the respondents were probed on the kind of information they would like to have on TB, majority asked for prevention, precaution and treatment. Preferred time, format, programme and channel in Electronic media Preferred time slot for listening radio in all the states was early morning (6-8 pm) while for watching television was late evening (7-9 pm) among majority of the respondents. Vividh Bharti for beneficiaries and regional station among opinion leaders came out as the most preferred station on radio. On the other hand, on television Doordarshans National Network was singled out as the most preferred channel in all the states. News in radio and television and serials in television emerged as the most preferred programme. Readership pattern Readership varied among states among the beneficiaries. However almost all the opinion leaders read newspaper.
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CHAPTER I INTRODUCTION
1.0 BACKGROUND
Tuberculosis (TB) is the single largest infectious cause of death in the world, accounting for about two to three million deaths per year. In India alone, 500,000 people die of TB every year one person dying every minute. The public perception is that TB is a poor mans disease; however a significant proportion of those infected are literate, educated and are economically better off. TB inflicts significant socio-economic costs. It affects persons during their most productive age. The largest indirect cost of TB for a patient is income lost by being too sick to work. Studies suggest that on an average, 3 to 4 months of work time are lost resulting in average loss in potential earnings of about 29% to 30% of annual household income. The AIDS epidemic is making the situation more threatening. Between 1993 and 1996, there was a 13% increase in estimated tuberculosis cases worldwide, one third of which can be attributed to HIV. 70% of HIV mortality is likely to be through TB. After independence in 1947, India began to shape its own health programmes, and two pioneering institutions the Tuberculosis Chemotherapy Centre in Chennai and the National Tuberculosis Institute in Bangalore were established under the sponsorship of the Indian Council of Medical Research (ICMR) and the Government of India, respectively. These two institutions have contributed world-class research that not only shaped Indias subsequent tuberculosis policies; they also contributed to tuberculosis control the world over. Indias National Tuberculosis Programme (NTP) was established in 1962 and provided a system for TB control throughout the country. After more than three decades of operation, the NTP can justly claim to have established an infrastructure for tuberculosis treatment in India. The NTP created an extensive infrastructure for tuberculosis control, with a network of 446 District TB Centres, 330 TB Clinics and more than 47,600 TB beds. The NTP also raised awareness of TB and TB treatment facilities, and has succeeded in placing more than 13 lakh patients on treatment on a yearly basis. However, with a treatment completion rate of only 30 percent, the programme did not make a significant dent in the problem. In 1992, a review of the National Tuberculosis Programme by national and international experts in coordination with the World Health Organization and the Swedish International Development Association determined that the programme had not had the desired impact on tuberculosis in India.
The review observed that less than 30% of the patients enrolled under the NTP completed their treatment and thus the pool of infection was not declining whereas the danger of drug resistance was developing. The review also noted the following issues: inadequate budgets, a lack of coverage in some parts of the country, shortages of essential drugs, poor administration, varying standards of care at the district centres, unmotivated and unevenly trained staff, lack of equipment, poor quality of sputum microscopy, and focus on case detection without an accompanying emphasis on treatment outcomes. The Revised National Tuberculosis Control Programme (RNTCP) was designed to address these and other issues. Patient-centred: RNTCP has been designed placing the patient as both the starting point and as focus of the programme. It recognizes the need to understand the patterns of diagnosis and treatment from the patients perspective. It also builds on the very substantial strengths and accomplishments of the National Tuberculosis Programme (NTP). The goal of RNTCP is to achieve a cure-rate of at least 85% of new smear-positive cases of tuberculosis and a detection rate of at least 70% of such patients, after the desired cure rate has been achieved. Estimates in India indicate that not more than 20 percent of patients who develop tuberculosis in India each year are cured. Many of the remaining patients remain chronically ill or die slowly from the disease, infecting others with strains of the disease, which may have developed drug resistance. Thus RNTCP lays equal emphasis on creating a system that reliably cures the patient and moves beyond simply detecting cases. This is based on experience that clearly shows that reliably curing patients results in a recruitment effect; ie, wherever effective services are offered, case detection rates steadily increase. Cured patients act as one of the best motivators promoting case detection and patient adherence to treatment. This Programme has been introduced in phases in the country. It presently covers over 450 million. It is hoped that entire country will be covered by 2005 under this programme. Experience of over a year now shows a detection rate of 127 per lakh and cure rates of 84% (in new cases), which is a remarkable achievement. Estimates suggest that the introduction of DOTS (Directly Observed Treatment, Short-course) could halve the current potential national economic loss from TB. Fear / Stigma: Studies reveal that most patients are reluctant to admit that they have TB because they fear stigma, and they prefer not to discuss the disease in the presence of family or neighbors. This has been recorded more so in urban than in rural areas. Family support for treatment was more frequent among cured patients than among those who had defaulted. 2 A Baseline Report by CMS
IEC: The Central T.B Division (DGHS), Ministry of Health and Family Welfare has contracted M/s R.K Swamy BBDO Pvt Ltd for developing and implementing IEC strategy for RNTCP. The IEC activities under RNTCP are fashioned as a response of the health system towards such behavior. They aim to promote better understanding of TB and its cure (KAP), improve the quality of TB patient care (patient-friendly), and to reduce stigma. It is understood that IEC activities at the national and state levels are complementary. While mass media activities are planned at the national level, state-level activities are more specific and need-based, with emphasis on sensitization of the health provider, production of state-specific IEC material, and dissemination of this material to local levels and optimum use of folk media at the district levels. Effective, regular and consistent IEC activities are expected to enhance the performance of the RNTCP. Research: Recognizing the need to map and track the Knowledge, Attitudes and Practices of the a)Beneficiaries b)Health Service Providers and c)Influencers as part of the overall IEC strategy, R.K Swamy BBDO and Centre for Media Studies (CMS) have, in consultation with CTD and the international donor agencies, designed the research component to help shape, monitor, evaluate and measure the impact of communication .
1.2
THE RESEARCH COMPONENT
The research component, which has been formulated to give direction to the mass media campaign IEC strategy, has been conceptualized as a process. The process keeping in mind the need for flexibility - has three components: Baseline, Tracking and Endline. Baseline The Baseline study undertakes Communication Needs Assessment based on the knowledge level, behavior patterns and habits of the target audience, i.e. Beneficiaries / Patients, Health service Providers and Influencers / Opinion leaders. It is comprised of a field survey on i) KAP based on the indicators developed (refer to page 9) ii) Media habits and iii) Information sources used by the audience.
Tracking Tracking the impact of the designed and implemented IEC strategy, (approximately once every six months), ensures effective monitoring and proper feedback for strategic flexibility. The IEC strategy would be tracked by monitoring the implementation, execution and delivery of the campaign. This would be done by interviewing State IEC officials. Impact on the audience and exposure to the campaign are additionally to be assessed by means of Rapid Assessment Survey (RAS). Endline The Endline study is intended to be an evaluation of the IEC strategy after rounds of Tracking. It would record the change in KAP of the target audience using the same indicators that were used for the Baseline. The present report is of the Baseline on KAP, Media Habits, Information sources and Communication Needs Assessment pertaining to TB across nine states in the country.
1.3
BASELINE REPORT
1.3.1 Statement of Aim

To understand the knowledge, attitude and practices (KAP) of Beneficiaries, opinion leaders and health service providers related to Tuberculosis towards guiding the mass media campaign strategy.
1.3.2 Specific Objective

1. 2. 3. 4. 5. 6. To assess the Awareness level of the Beneficiaries, Opinion leaders and Health Service Providers regarding Tuberculosis and DOTS To understand the Attitude of the three segments towards TB patient with particular reference to gender. To know the tuberculosis-related Practices prevailing in the three segments. To assess the interest of the Opinion leaders and Health service providers in becoming a part of the RNTCP / DOTS programme. To identify the Information Needs and the Preferred Sources of the Beneficiaries for receiving messages related to TB. To map the Media habits/preferences of the Beneficiaries.
1.4
METHODOLOGY
The Baseline was carried out based on a sample survey in the states/districts where RNTCP has been implemented. In consultation with CTD, WHO and the World Bank, the following approach was formulated: Coverage A multi stage random sampling procedure was used for the Baseline Survey. Officials of Central TB Division, RK Swamy/BBDO and Centre for Media Studies, unanimously decided upon all the scope, sample category, size etc. Selection of States The States were classified into three categories on the basis of RNTCP coverage. Coverage 1 2 3 >80% 50-80% <50% Maharashtra, WB, Nagaland Haryana, UP, Bihar, Jharkhand, MP, Orissa, AP, Karnataka, Manipur, Chattisgarh, Mizoram, Uttaranchal States Delhi, Rajasthan, Kerala, HP, Gujarat, TN, Arunachal, Sikkim
This was followed by a zone-wise plotting of the states. Zone 1 2 3 4 North South East West States Delhi, Himachal Pradesh, Haryana, Uttar Pradesh, Uttaranchal Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, Bihar, Jharkhand, West Bengal, Orissa, Mizoram, Nagaland, Manipur, Arunachal, Sikkim Gujarat, Madhya Pradesh, Chattisgarh, Maharashtra, Rajasthan,
From each zone, a minimum of 2 states were identified: Zone 1 2 3 4 North South East West Himachal Pradesh, Uttar Pradesh Tamil Nadu, Andhra Pradesh West Bengal, Manipur Chattisgarh, Maharashtra, Gujarat States
The selected sample of 9 states ensured range of coverage of RNTCP as well as representation of all four zones. 5
Selection of Districts For selection of districts, only RNTCP-covered districts were considered for random selection. Thus two districts from nine states were chosen. The selected 18 districts are as follows: Sl. no. 1 2. 3. 4. 5. 6. 7. 8. 9. Tamil Nadu Maharashtra Gujarat Chattisgarh Uttar Pradesh Himachal Pradesh West Bengal Manipur State Andhra Pradesh District Mehbubnagar, Medak Viluppuram, Cuddalore Aurangabad, Solapur Amreli, Jamnagar Bilaspur, Raipur Meerut, Sitapur Una, Hamirpur Nadia, North 24 Pgns. Imphal, Churachandpur
Selection of Location Since the mass media activities for RNTCP would be directed towards the Rural and the Urban Poor - two rural clusters and two urban slums within each of the selected districts were selected. Of the two rural clusters, it was decided that one would be within a distance of 10 kilometers from the District Headquarters (DHQ) and another in the range of 25-50 kilometers. Of the two urban slums one would be in the DHQ and the other in another town. Selection of Respondent Three specific respondent categories were derived from the terms of reference for the study. They are: i) Beneficiary households, ii) Opinion leaders and iii) Health service providers. Sample Size State 9 9 9 District 9*2=18 9*2=18 9*2=18 Category Household Opinion Leader Health Service Providers Respondents/district 80*18 10*18 12*18 Total 1440 180 216
Convenient sampling was done for each group. While covering the desired respondent category and numbers from Beneficiaries, equal gender representation was to be ensured. The sample of opinion leaders would include Pradhans, ANMs (Auxiliary Nurse Male), AWW (Aanganwadi Worker), Mahila Mandal representatives, NGO workers, Religious Leaders and Teachers. Private and Public health care providers who are Registered Medical Practitioners (RMP) would be contacted for the survey. Where it was not possible to access private practitioners, it was decided to interview public practitioners. The break-up quota followed is as follows: State District 1 Urban Slum HH 50 US1 25 12M 13F
US1
District 2 Urban Slum HH 50 R 5 US1 25 13F 12M

Urban Slum 2, R1 Private Doctors
Rural HH 30 R1 15 8F R2 15 7F
Doctors Opinion Leaders 12 Pvt. 6 (R&U) Pub - 6 U 5 10
Rural HH 30 R1 15 7F R2 15 8F
Doctors 12 Pvt. 6 (R&U) Pub 6

Male Pub
Opinion Leaders 10 U 5 R 5
US2 25 12F
US2 25 13F
13M 7M 8M
Urban Slum 1 , US2 Female, Pvt.
12M 8M 7M
Rural 2, M
Rural 1, R2
Public
Doctors, F
1.5
CHOICE OF INDICATORS RATIONALE
The indicators (Process & Impact Indicators) for the study were chosen so as to measure the level of Knowledge, the Attitude that the audience have towards the issues and also their Practices. These indicators or markers will be measured at the baseline to create a benchmark, monitored at a regular interval after the launch of the campaign and finally be evaluated at the end line study to see the impact of the campaign on a whole. In addition to quantitative assessment of the KAP - the indicators would also provide additional learning and better insights for design of the mass media campaign through qualitative assessment of issues such as stigma, which has been built into the baseline process.
1.5.1 INDICATORS
The indicators to assess the Knowledge of the audience (the community and opinion leader) included understanding whether TB is perceived by them as a common problem, their scientific understanding of the disease, who are prone to TB, how it can be diagnosed, the correct and surest way of diagnosis, cure and availability of services in their vicinity. The perception of the Opinion leaders and community is also tested with regards to the Sputum Smear Test and DOTS The knowledge of Health Service Providers is measured through their recognition of Sputum Smear Test as the surest method of diagnosis vis--vis other tests, their appreciation of TB being a threat to the community, DOTS as a facility and information about involvement in the scheme. The Attitude indicators were designed to assess the approach of the audience towards the disease, and towards the patient that influences treatment. The attitude indicators were also designed to test the mindset of the beneficiaries with regards to the stigma associated to the disease and the infected, and whether it differs with gender of the infected, the acknowledgement of the fact that it can happen to anybody. The preferences of the community with regards to treatment and health delivery system, their comfort level with private and public practitioners and the attitude DOTS as a method of treatment were considered while setting the indicators. The assessment of attitude of the HSPs includes their preferred method of diagnosis of TB and way of thinking about DOTs. The Practice indicators assessed the actual actions undertaken by the audience in coping with the disease. These included assessment and reliance of the beneficiaries and the HSP on the existing method of diagnosis and treatment, the individual and social stigma and discrimination practiced towards the infected patients. The practices of opinion leaders were also assessed by their intervention and initiative taken for the community for treatment of TB and DOTS. The practice of HSP also considered the precaution taken while treatment, reference to the available public health facilities, and the regimen followed. These indicators represented in a matrix form given below.
Indicator Matrix
Beneficiaries Knowledge 1. 2. 3. 4. 5. 6. 7. 8. 9. Attitudes 1. 2. 3. 4. 5. 6. Is TB common problem /disease in ones community. TB-How? What? Why? Cure? Information source Availability of Service (Public/Pvt.) Smear Test Full Course DOTS is free Is DOTS problematic because of the Practitioners (Awareness) Completely curable Denial / Indifference/Acknowledgement Stigma (All Affected) Gender Bias (Affected Women) end to a patient with 3 weeks Pvt. Vs Public HSPs. (Preference for treatment-short or long) No specific assured cure Comfort levels with Public Health (in context with TB also) Individual risk perception TB is diagnosed with X-ray Seeking treatment from Government health Centers Who accompanies TB infected for treatment Patient care environment (Are they given proper treatment) 1. TB is not in my consideration set (What would they recommend to a patient with 3 weeks of cough. Multiple answers to be sought. X Ray is the method for Diagnosis Acceptability of DOTS Willingness to play active role in DOTS 1. 2. 3. 4. 5. HSPs Is TB a common problem/disease in ones community? How do they diagnose TB Treatment categorization-regimen Are HIV+s prone to TB Schemes involving Private 1. 2. 3. 4. 5. 6. 7. Opinion Leaders (O/S) Is TB becoming a problem for the community/country Is TB Curable? Awareness regarding Programme at national level/among their vicinity Smear Test is the best way to diagnose TB DOTS is free It is the surest way to complete cure Advantages of completion of the treatment (At individual & Community level both)
1. 2. 3. 4. 5. 6. 7.
Towards detected cases Gender Social Status Towards completion of disease Capabilities of affected are handicapped About DOTS as the method of treatment TB is a poor mans disease
2. 3. 4.
Practice
1. 2. 3. 4.
1. 2. 3. 4. 5. 6.
Comfort levels with X-ray as method to diagnose TB Vs. Smear Test Behavioral pattern of Technicians Practicing DOTS or not No. of TB patients Private Practitioners treat in a year Precautions taken while treating a TB patient Private Practitioners referring patients to public HSPs. Their reasons of referrals (Fear of losing patients, Better drugs, better facilities etc)
1.
If TB is detected, then acceptability of patient at home/community level (Assess all patients with special reference to women) Who is accompanying TB infected (ANM/ANW- Their methods of interacting with public: Behavior pattern) Advocacy towards RNTCP/Patient friendly environment Ensure implementation of DOTS
2.
3. 4.
1.6
TOOLS FOR STUDY
For the study it was agreed that essentially the study be quantitative. Three, pre-coded structured questionnaire were prepared for three identified respondent group on the basis of the indicators outlined in the previous section. Nonetheless some statements were measured on a 5-point scale to acquire the precise feeling of the respondent on the issues. (Sample questionnaire attached in Annexure-I)
1.7
LIMITATION
Limited lead & process Time Availability of HSPs Logistic difficulties eg. Manipur.
10
CHAPTER II RESPONDENT PROFILE

On the basis of the sample category and size the actual numbers being covered in each state is as follows: Table 2.1 Sample covered
Category Household Opinion Leader HSP AP 160 19 23 TN 160 20 24 MAH 161 21 25 GUJ 162 20 24 CH 160 20 24 UP 160 19 24 HP 161 19 24 WB 160 20 24 MAN 160 22 19 TOTAL 1444 180 211
2.1
SOCIO DEMOGRAPHIC PROFILE OF RESPONDENTS:
2.1.1 Age-sex composition

Graph-2.1
Household by sex
49% 51%
As per the methodology the investigators attempted to maintain 50:50 ratio among male female respondents. The representation from
Male
Female
rural and urban slums was also as decided.
Table 2.2 : Urban rural representation of Household.

State (1) Andhra Pradesh (2) Tamil Nadu (3) Maharashtra (4) Gujarat (5) Chattisgarh Urban slum 103 107 101 102 101 Rural 57 53 60 60 59 State (6) Uttar Pradesh (7) Himachal Pradesh (8) WB (9) Manipur 98 100 99 100
(in numbers)
Urban slum Rural 62 61 61 60
11
Graph-2.2
Household male female by age (%)
1.2 15 Male 26.8 30.5
26.5
0.4 8.7 Female 24.3 36.1
Majority of the respondents across the states were from the age group of 26-35 years followed by the age group of 18-25 years. Very few respondents in both the categories were 55 years and above.
30.5
0 18-25 26-35 20 36-45 40 46-55 60 55 and above
Graph-2.3
Categories of Opinion Leader
Community Leader 22%
NGO Worker 2%
Pradhan 13%
ANM 6% AWW 11%
Religious Leader 6%
Teacher 40%
Among the opinion leaders teachers community leaders and Panchayat Pradhans were mostly contacted. Table 2.3: HSP category
AP Private Doctors Public Doctors 73.9 26.1 TN 66.7 33.3 MAH 48.0 52.0 GUJ 50.0 50.0 CHA 50.0 50.0 UP 54.2 45.8 HP 45.8 54.2 WB 50.0 50.0 MAN 52.6 47.4 (in %) TOTAL 54.5 45.5
In the health service providers category almost equal number was covered except in Andhra Pradesh and Tamil Nadu where there was confusion in labeling a public doctor as public when s/he is interviewed in their private clinic. 12
Table 2.4: Level of Education

Household Illiterate Literate but no schooling Less than Primary Primary but less than middle Above Middle but less than Xth Xth XIIth Graduate and above AP 5.0 1.3 5.6 10.6 13.1 12.5 35.0 16.9 TN 12.5 5.0 8.8 18.8 15.0 20.6 11.9 7.5 MAH 15.5 2.5 9.3 8.7 24.2 18.6 14.9 6.2 GUJ 21.6 2.5 11.7 19.8 19.1 11.1 8.0 6.2 CHA 36.3 4.4 10.0 15.0 8.8 13.8 6.3 5.6 UP 35.6 5.0 5.6 14.4 14.4 7.5 6.3 11.3 HP 45.3 3.7 3.1 6.8 10.6 16.8 9.9 3.7 WB 27.5 6.3 13.8 13.1 20.6 8.1 6.3 4.4 MAN 5.0 3.1 1.9 6.3 5.0 31.9 24.4 22.5
(in %) Total 22.7 3.7 7.7 12.6 14.5 15.7 13.6 9.3 99.8
About 23% of the household respondents across the states were illiterate followed by respondents of Xth standard and XIIth standard. About 22% of the respondents in Manipur were graduates and above. Table 2.5: Level of Education
Opinion Leader
AP TN MAH GUJ
(in %) State
CHA UP HP WB MAN Total
Illiterate Literate but no schooling Less than primary Primary but less than middle Above Middle but less than Xth Xth XIIth Graduate & above
0 0 0 0 5.3 5.3 15.8 73.7
0 0 0 0 25.0 5.0 20.0 50.0
0 0 9.5 0 14.3 23.8 9.5 42.9
0 0 0 5.0 15.0 30.0 25.0 25.0
5.0 0 0 0 15.0 20.0 30.0 30.0
5.3 0 0 31.6 10.5 15.8 10.5 26.3
10.5 0 15.8 10.5 0 31.6 26.3 5.3
0 0 0 0 5.0 0 15.0 80.0
0 4.5 0 0 0 9.1 9.1 77.3
2.2 0.6 2.8 5.0 10.0 15.6 17.8 46.1
On contrary to the respondents from household the opinion leaders were mostly literates and majority were graduates and above. Table 2.6 : Educational Qualifications of Health Service Providers
AP MBBS BAMS BUMS Others (BEHMS) Diploma/ DAMS /DHMS RMP BHMS 69.6 17.4 ------4.3 ---8.7 TN 66.7 4.2 -----25.0 ---4.2 MAH 60.0 12.0 8.0 4.0 12.0 ---4.0 GUJ 58.3 20.8 ------16.7 ---4.2 CHA 58.3 25.0 ------12.5 4.2 ---UP 54.2 20.8 4.2 ---8.3 4.2 8.3 HP 55.8 29.2 ----8.3 8.4 8.3 --WB 83.3 ------8.3 -8.3 63.2 15.8 -----5.3 5.3 10.5 (in %) MAN Total 62.1 16.1 1.4 1.4 11.4 2.4 5.2
More than half of the doctors contacted in each state were MBBS qualified. Quite a good number were BAMS.
13
Table 2.7: Occupation Household

Agricultural labour Unskilled worker/nonAgriculture labourer Business/shop owner Housewife Government servant Student Landowner/Farmer Weaver Skilled Worker Pvt. Service Unemployed/Retired Driver Priest Advocate Social Worker NR 26.3 41.9 10.0 11.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 9.4 38.8 5.0 1.9 0.0 0.0 0.6 0.0 0.0 0.0 0.0 0.0 0.6 0.0 13.7 31.7 2.5 11.8 0.0 0.0 5.6 1.2 3.1 0.6 0.0 0.0 0.0 0.62 13.0 27.8 4.9 8.6 0.0 0.0 1.2 3.7 3.1 0.6 0.6 0.6 0.0 0.0 8.8 40.6 2.5 6.9 0.0 0.0 0.6 0.0 0.6 0.6 0.0 0.0 0.0 0.63 6.9 38.8 9.4 11.3 0.6 1.3 1.3 0.6 0.0 0.0 0.0 0.0 0.0 0.0 7.5 31.1 3.7 6.2 0.0 0.0 3.1 3.1 3.1 0.0 0.0 0.0 0.0 0.0 10.6 43.1 0.0 6.3 1.9 0.0 0.0 1.9 3.8 0.0 1.3 0.0 0.0 0.63 26.3 22.5 9.38 19.4 0.0 0.0 1.3 4.4 2.5 0.0 0.0 0.0 0.0 0.0 AP 4.4 6.25 TN 18.8 25.00 MAH 9.3 19.88 GUJ 15.4 19.75 CHA 18.1 20.63 UP 7.5 22.50 HP 5.6 36.65 WB 7.5 23.13 MAN 3.8 10.63
(in %) Total 10 20.5 13.6 35.1 5.3 9.3 0.3 0.2 1.5 1.7 1.8 0.2 0.2 0.1 0.1 0.2
Except for Manipur where the highest percentage of respondents was from the business/ shop owners category, in case of rest of the states most of them were housewives. Next to the housewives the highest category of respondents were unskilled worker/ non-agricultural labourers, in case of all the states except Andhra Pradesh where 26.3% of the respondents were business/shop owners and Manipur where they were housewives. Table 2.8: Nature of Dispensing
AP TN 37.5 58.3 12.5 MAH 28 28 48 GUJ 45.8 83.3 29.2 CHA 41.7 100 0 UP 62.5 45.8 16.7 HP 95.8 62.5 4.2 WB 20.8 79.2 0 MAN 52.6 47.4 5.3 (in %) Total 46.4 64.5 14.2
Dispensing GP Prescribing GP Consultants
34.8 73.9 8.7
In most of the states prescribing physicians were contacted. This was more with private practitioners. However the government doctors who dispense medicines did the same from the center where they practice.
14
Table 2.9 : Household Income

Level of income NR <2000 2001-4000 4001-8000 8001-10,000 10,001 and above AP 0.0 2.5 27.5 45.6 23.1 1.3 TN 0.0 18.8 50.6 21.9 6.9 1.9 MAH 0.6 46.6 42.2 7.5 1.9 1.2 GUJ 0.6 21.6 51.2 16.0 6.2 4.3 CHA 0.0 48.8 37.5 8.8 3.1 1.9 UP 0.6 53.1 33.8 10.0 0.6 1.9 HP 0.0 54.7 28.0 13.0 2.5 1.9 WB 0.0 81.9 17.5 0.6 0.0 0.0 MAN 0.0 38.1 51.9 6.3 3.8 0.0
(in %) Total 0.2 40.7 37.8 14.4 5.3 1.6
The household income of 78% of the respondents across the states was less than Rs 4000/- per month (40.8% reported less than Rs 2000/- per month).
15
CHAPTER III KNOWLEDGE ATTITUDE AND PRACTICE ABOUT TB AND DOTS

3.1 TB IS COMMON
Graph-3.1
Mentioned TB spontaneously as frequently suffered disease in family or neighbourhood (%)
100
100 90 70 80 60 50 40 30 20 10 0 AP
47
48
71
26
28
25
42
15
15
12 11
13
20 16
19
20
21
10
TN
MAH
GUJ
3 0
CHA
UP
HP
WB
Household
Opinion Leader
Health Service Provider
Table 3.1 Heard of TB

Of those who did not mention TB spontaneously Household Opinion Leader AP 99.2 100.0 TN 100.0 100.0 MAH 98.7 100.0 GUJ 98.7 100.0 State CHA 100.0 100.0 UP 100.0 100.0 HP 100.0 100.0 WB 100.0 100.0
Although TB did not come spontaneously in the respondents mind when they spoke about the frequently suffered diseases in their community, almost all of them mentioned that they have heard of TB. However Tuberculosis is still viewed as a problem in the community in Andhra and West Bengal as we find that more than 20% respondents mentioning TB spontaneously while listing the frequently suffered diseases. TB as a problem was spontaneously identified by more than 70% HSPs of Tamil Nadu and West Bengal. This was well supported by the fact that almost all the doctors interacted with come across TB patients in their practice.
8 5
MAN
(in %) MAN 100.0 100.0
47
16
Table 3.2 Getting TB Patients

States
Getting TB Patients AP 95.7 TN 100.0 MAH 100.0 GUJ 91.7 CHA 95.9 UP 100.0 HP 95.9 WB 100.0 MAN 100.0
(in %)
Total 95.8
Graph 3.2
Number of patitnets per month (%)
MAN WB HP UP CHA AH TN AP 1 3 2 2 7 6 4 3 9 10 23 62
In Uttar Pradesh and Maharashtra the average number of patients visiting the doctors clinic per month was quite high compared to the other states. The doctors contacted at Sitapur (UP) district hospital mentioned that they come across about 150 patients per day, which is too high than the average figure of the state. Although low in number out of the total patients doctors could clearly recall average number of female patients visiting their clinic.
13 16
35
20 TB Patients
40
60 Female patients
80
3.1a
Prevalence of TB in family or neighbourhood
Very low percentage of household and opinion leaders mentioned about someone in the family or neighbourhood whom they knew had TB. TB in female was comparatively less known by our respondents. Table 3.3 Prevalence of TB in the family or neighbourhood
AP Household Opinion Leader 15.6 26.3 TN 11.9 0.0 MAH 5.6 23.3 GUJ 8.0 0.0 CHA 3.8 15.0 UP 20.0 26.3 HP 5.6 5.3 WB 5.6 15.0 (in %) MAN 20.0 27.3 (in %) MAH 66.7 33.3 GUJ 92.3 7.7 CHA 66.7 33.3 UP 65.6 34.4 HP 44.4 55.6 WB 66.7 33.3 MAN 68.8 31.2
Table 3.4 Sex wise distribution of patients

AP Male Female 53.7 46.3 TN 65.0 35.0
17
3.2
AWARE ABOUT THE SYMPTOMS
In all the states the most mentioned symptom was a cough that persists for three weeks, followed by fever. However it was alarming to know that still quite a high percentage of both general population and community leader associate coughing up blood as a symptom of TB indicating their ignorance about the graveness of the symptom. Graph-3.3
Symptoms mentioned by House Hold (%)
400 350 300 250 200 150 100 50 0
AP TN MAH GUJ CHA UP HP WB MAN A cough that persists for three weeks Weight Loss Loss of appetite Any other** Coughing up blood Night Sweats All the above Cant Recall/mention any of the symptoms Fever Constant tiredness Breathlessness
Graph-3.4
Symptoms mentioned by Opinion Leaders (%)
450 400 350 300 250 200 150 100 50 0
AP TN MAH GUJ Coughing up blood Night Sweats All the above Cant Recall/mention any of the symptoms CHA UP HP Fever Constant tiredness Breathlessness WB MAN A cough that persists for three weeks Weight Loss Loss of appetite Any other**
18
HSPs in all the states mainly come across Pulmonary TB patients. Graph -3.5
Pulmonary TB (%)
100 80 60 40 20 0 100 100 92 100 100 96 92 96 95
100 80 60 40 17 20 0
AP TN MAH GUJ CHA UP HP WB MAN
Graph -3.6
Lymph Glands TB (%)
96 64 46 21 13 54 26 75
AP
TN
MAH GUJ CHA
UP
HP
WB
MAN
Graph -3.7
Spinal TB(%)
100 80 60 40 20 0 13 48 21 29 21 11 83 71
Graph -3.8
Bone TB (%)
100 80 60 28 40 20 0 0
AP
92
75
33
29 11 4
17
AP
TN
MAH GUJ CHA
UP
HP
WB
MAN
TN
MAH GUJ CHA
UP
HP
WB
MAN
Graph -3.9
Abdominal(%)
71 52 38 40 20 0 30 8 21
Graph -3.10
Genetic TB (%)
100 80 60
75
100 80 60
42
40 20 0 8 8.3 4.2 8.3 5.3
5
AP TN MAH GUJ CHA UP HP WB MAN
AP
TN
MAH GUJ CHA
UP
HP
WB
MAN
19
However, a very small percentage of doctors mentioned having come across genetic TB. HIV-TB and MDR TB was also quite common among the doctors across the states. Graph -3.11
100
Graph -3.12
100 90 80 70 60 50 40 30 20 10 0
HIV-TB(%)
64 44
MDR TB (%)
76 79 67 79 79
100
80
60
53 42 26
40
25 4 13 0
MAH GUJ CHA UP
26 17 17
20
0
AP TN HP WB MAN
AP
TN
MAH GUJ CHA
UP
HP
WB
MAN
Surprisingly doctors from all the states except Chattisgarh informed that PLWH had visited their clinic for treatment of TB. MDR-TB was quite commonly known among the doctors. The knowledge of Sputum culture sensitivity for identifying MDR-TB varied from state to state. 3.2a Symptoms mentioned by HSPs
Almost all the doctors contacted mentioned a cough that persists for three weeks as the main symptom they look for in a pulmonary TB suspect. Quite significantly, a considerable percentage of doctors look for coughing up blood as a symptom. Table 3.5 Symptoms mentioned by HSPs
AP 87.0 39.1 43.5 56.5 65.2 8.7 26.1 17.4 0 TN 95.8 8.3 62.5 54.2 37.5 8.3 33.3 37.5 4.2 MAH 100.0 21.7 65.2 91.3 60.9 13.0 21.7 73.9 4.3 GUJ 100.0 29.2 25.0 100.0 83.3 16.7 50.0 75.0 4.2 CHA 100.0 8.3 83.3 95.8 37.5 45.8 25.0 4.2 0.0 UP 100.0 60.9 73.9 91.3 78.3 21.7 13.0 65.2 17.2 HP 100.0 27.3 90.9 95.5 77.3 22.7 13.6 50.0 18.1 WB 100.0 26.1 95.7 91.3 60.9 13.0 13.0 47.8 0.0 MAN 100.0 77.8 94.4 100.0 16.7 0.0 0.0 22.2 0.0
(in %)
Pulmonary TB A cough of 3 weeks Pain in the site Coughing up blood Fever Weight loss Night Sweats Constant tiredness Loss of Appetite Any other
Total 98.0 31.9 69.6 85.8 58.3 11.8 25.0 46.6
Table 3.5a
Breakup of Private and Govt. doctors looking for coughing up blood

AP 80.0 20.0 TN 60.0 40.0 MAH 40.0 60.0 GUJ 33.3 66.7 CHA 40.0 60.0 UP 52.9 47.1 HP 45.0 55.0 WB 50.0 50.0 MAN 52.9 47.1
(in %)
Coughing up blood Private Practitioner Govt. Doctor
Total 50.0 50.0
20
3.3
MYTH ABOUT MODE OF SPREAD STILL EXIST
Although more than one third of the respondents across all the states identified cough of an infected person as a mode of spread of TB, fairly high percentage also felt that TB is spread by sharing dishes and clothing of an infected person. More than one third of opinion leaders in all the states except UP mentioned the right mode of spread of TB. Misconception about the same prevailed with more than one-fourth respondents in UP and HP. Graph -3.13
From Infected person through cough (%)
Graph -3.14
Talking(%)
100 80 60 40 20 0
100 90 80 70 60 50 40 30 20 10 0
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
Household
Opinion leader
Household
Opinion leader
Graph -3.15
By sharing dishes of the infected person(%)
Graph -3.16
By sharing bedding or clothing of the infected person(%)
100 90 80 70 60 50 40 30 20 10 0
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
100 90 80 70 60 50 40 30 20 10 0
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
Household
Opinion leader
Household
Opinion leader
Our survey also found that about 15% of the community was unaware of the mode of spread of TB. Few associated spread with unsafe sex, defecation at open field, unhygienic living condition and even inheritance.
21
3.4
PERCEPTION ABOUT WHO ARE PRONE TO TB

Graph-3.17
80
Prone to TB (in %)
Household
36 37
60
Opinion Leader
40
28 31
34
28 16 9 4 5 2 2 2
Family members of TB Patients Poor
21
20
15
11 5 3
0
Persons having Those living in low immunity congested locality Malnourished Children Women HIV+ person Any one
Both the household and opinion leaders had varied opinion about people who are prone to TB. Those living in congested locality and unhygienic conditions and persons having low immunity were identified by most of the respondents. However respondents from Gujarat, Chhattisgarh and West Bengal mentioned malnourished people to be more prone to TB. Interestingly male respondents in some states mentioned people smoking tobacco to be prone to TB. Graph -3.18
Rich people do not get TB (%)
DK/CS SD D NAND A SA
0 10 20 30 40 50
Graph -3.19
Women are more prone to TB (%)
0 5 10 15 20 25 30
Male
Female
Opinion
Male
Female
Opinion Leader
Responses on the above statements indicates that a few respondents both among household and opinion leaders feel that TB is a poor mans disease and are still not clear about women being more prone to TB or not.
22
Graph -3.20 Respondents also tried to link smoking, lungs and chest getting affected to proneness to TB. Interestingly few also pointed out that old person, people with mental tension, people taking oily food, people practicing unsafe sex, people suffering from asthma, non-vegetarian persons and, factory workers are more prone to TB.
DK/CS SD D NAND A SA 0 10 20 30 40 50 60
TB usually affects the lungs/chest (%)
Male
Female
Opinion Leader
3.4a
Perception of Health Service providers
More than two-third of the doctors feel that people living with HIV are prone to TB. Table 3.6
YES
HIV + People (PLWA) prone to TB

AP 65.2 TN 95.8 MAH 100 GUJ 95.8 CHA 66.7 UP 87.5 HP 95.8 WB 62.5
(In %) MAN 89.5
3.5
TB IS CURABLE
Graph -3.21
TB is completely curable (%)
Graph -3.22
Only medicine can cure TB completely (%) DK/CS
SD D NAND A
DK/CS SD D NAND A SA 0 20 40 60 80
SA 0 20 40 60 80
Male
Female
Opinion Leader
23
Majority of the respondents in both the categories feel that TB is completely curable and agreed that only medicine can cure TB completely. Majority also felt that once cured a TB patient can lead a normal life. Graph -3.23
Once cured a TB patient can lead a normal life (%)
DK/CS SD D NAND A SA 0 10 20 30 40 50
Except for doctors in Himachal Pradesh and Tamil Nadu, in rest of the states majority of the doctors opined that TB in PLW HIV is curable.
Male
Female
Opinion Leader
Table 3.7 TB curable in HIV + people

AP YES 78.3 TN 37.5 MAH 72.0 GUJ 66.7 CHA 58.3 UP 87.5 HP 12.5 WB 66.7
(in %) MAH 89.5
3.6 AVAILABILITY OF TB RELATED HEALTH FACILITY IN THE VICINITY

More than one third of the household respondents in Gujarat, Uttar Pradesh, West Bengal and Manipur mentioned of having a TB treatment facility in their vicinity. Similar trend was seen among the opinion leaders also. Table 3.8: TB Hospital in the Vicinity
TB Hospital in their vicinity Household Opinion Leader HSP AP 20.6 5.3 28.6 TN 15.6 15.0 42.9 MAH 16.8 9.5 50.0 GUJ 31.5 25.0 91.7 CHA 6.9 5.0 75.0 UP 36.3 36.8 46.2 HP 6.8 5.3 90.9 WB 30.6 20.0 83.3 (in %) MAN 35.6 45.5 90.0
More than half of the private practitioners informed that public health services for TB patients are available in their locality.
24
3.7
PREFERENCE FOR SYSTEM OF MEDICINE
When probed on the system of medicine for treatment, there was a clear preference for Allopathic system of medicine in all the nine states except in Andhra where Ayurvedic system was equally preferred among the Household respondents. Table 3.9: System of medicine preferred
Allopathic System of medicine preferred by general community U R T AP 58.8 41.2 53.1 TN 67.1 32.9 98.8 MAH 62.1 37.9 87.0 GUJ 63.9 36.1 95.7 CHA 65.8 34.2 95.0 UP 60.4 39.6 93.1 HP 59.1 40.9 85.1 WB 62.7 37.3 93.8
(in %)
MAN 62.1 37.9 95.6
Government Hospitals and Private Practitioners both were preferred by respondents for place of treatment across all the states. However about 70% of urban respondents in Andhra preferred Ayurvedic treatment centers. The opinion leaders in HP, WB and Manipur preferred government health center. Table3.10 : Preferred center for treatment
AP Government Hospital Private practitioner Registered Medical Practitioner ISM & H Traditional Healers HH OL HH OL HH OL HH OL HH OL 33.1 21.1 28.1 78.9 6.3 24.4 8.1 TN 73.8 30.0 26.3 70.0 MAH 23.0 28.6 75.2 78.4 0.6 1.2 GUJ 62.3 35 37.7 65.0 CHA 41.9 40.0 58.1 60.0 UP 20.6 31.6 71.3 63.2 7.5 5.3 0.6 HP 57.8 84.2 41.6 15.8 WB 86.3 65.0 12.5 35.0 1.3 -
(in %)
MAN 84.4 90.9 15.6 1.1 -
Urban slum respondents had a clear preference for government hospitals for treatment while respondents from rural had a mixed response.
25
Graph 3.24
Urban Rural Preference for Government Hospital among the community (%)
100 90 80 70 60 50 40 30 20 10 0
32
35
31
25
36
49
42
68
65
69
75
55
65
51
58
AP
TN
MAH
GUJ
CHA
UP
45
HP
WB
MAN
Urban
3.7a
Why not to a Government Hospital?
Amongst those who do not prefer Government hospitals the chief reasons put forth were Distance from residence, Non-availability of medicine and Unfriendly behaviour of staff . The Opinion Leaders however cited varied reasons for not going to Government hospitals. Nonavailability of medicine emerged as one major reason followed by distance from the place of stay. Table 3.11: Reasons for not going to Govt. Hospital
Why not to Government Hospital Non availability of health personnel Far from place of stay Unfriendly behaviour of staff Non availability of medicine Lack of diagnostic facility Long waiting hours Any Other **
AP TN MA H GUJ CHA UP HP WB
63
37
Rural
(in %)
MAN
HH OL HH OL HH OL HH OL HH OL HH OL HH OL
25.0 0.0 30.2 22.2 20.8 16.7 15.6 44.4 6.8 11.1 1.6 0.0 0.0 5.6
21.4 30.4 4.8 13.0 14.3 13.0 32.1 30.4 16.7 8.7 1.2 0.0 0.0 4.3
9.5 12.0 26.4 28.0 19.6 16.0 10.6 16.0 5.6 8.0 16.2 0.0 9.6 4.0
17.3 27.3 14.5 13.6 22.7 18.2 12.7 22.7 13.6 4.5 13.6 0.0 5.4 13.6
9.0 11.8 32.8 47.1 11.5 11.8 19.7 23.5 0.8 0.0 2.5 0.0 0.0 5.9
7.3 25.0 19.3 10.0 24.8 25.0 30.3 35.0 6.9 0.0 2.3 0.0 7.4 5.0
2.7 16.7 8.8 16.7 14.2 33.3 43.4 33.3 7.1 0.0 11.5 0.0 12.4 0.0
18.4 25.0 15.8 0.0 7.9 8.3 28.9 8.3 5.3 33.3 15.8 0.0 7.9 25.0
0.0 0.0 37.9 100.0 13.8 0.0 13.8 0.0 6.9 0.0 0.0 0.0 0.0 0.0
**Unaware of Govt. facilities, Facilities not proper, not reliable, No surveillance, Treatment is not good,
26
3.8
DIAGNOSIS OF TB SUSPECT
On being suspected of having TB, household respondents in all the states except Tamil Nadu indicated that a doctor should be consulted immediately. Table 3.12 TB Suspect
AP Should consult a doctor Immediately M F 64.3 72.4 TN 49.3 55.3 MAH 54.2 95.9 GUJ 99 98.4 CHA 100 100 UP 100 97.5 HP 100 100 WB 62.2 60.3 (in %) MAN 100 100
Govt. Hospital was preferred for diagnosis as well as treatment by household respondents with minor variations across the states. According to most of the opinion leaders a TB suspect should go to a govt. hospital for his/her diagnosis and treatment. DOT /TB center was mentioned by quite a few. All the respondents from WB suggested DOT/TB center as a place for treating TB. Graph 3.25
Should go for Diagnosis of TB-Household (%)
90 80 70 60 50 40 30 20 10 0
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
Private Centre
Govt. Hospital
DOTS/TB Centre
Graph 3.26
Should go for Diagnosis of TB-Opinion leaders (%)

100 80 60 40 20 0 AP TN MAH GUJ CHA UP HP WB MAN
Private Centre
Govt. Hospital
DOTS/TB Centre
27
3.8a
Method of diagnosis
Although sputum test was identified by majority of the respondents as a method of diagnosing TB, about 60% of the respondents still recognize X-ray as a reliable method for diagnosing TB. Graph -3.27
Sputum test is the most reliable diagnosis of TB (%)
DK/CS
SD
Graph -3.28
X ray is not a reliable method of diagnosing (%)
DK/CS
SD
D
D
NAND
NAND
A SA
0 10 20 30 40 50 60
A SA
Male
Female
Opinion Leader
10
20
30
40
Male
Female
Opinion Leader
3.8b Diagnosis of TB by HSP

Doctors also confirmed that they advise sputum test and chest X-ray for diagnosing Pulmonary TB. On further probing majority of HSPs chose Sputum test for diagnosing Pulmonary TB as they felt that it is the most reliable method. About 22% of the HSP still chose X-ray. Graph -3.29
Mentioned Sputum & X-Ray (%)
100 80 60 40 20 0 100
Graph -3.30
Only one test- 'Sputum' (%)
92 83
80 60 40 20 0
95
78 54 53 60 66
65
75 48
67
67 54
18 10
AP TN MAH
23 9
GUJ CHA UP HP WB MAN
AP
TN
Mah
Ch
UP
HP
WB
Man
28
Table 3.13 Investigation For Pulmonary TB

Mentioned Sputum Mentioned X-ray Mentioned Mantoux Skin Test Mentioned Sputum & X-Ray Mentioned Sputum & Skin Mentioned X-Ray& Skin Only one Mentioned Sputum Mentioned X-ray Mentioned Mantoux test 65.2 21.7 13.0 83.3 12.5 4.2 48.0 48.0 4.0 75.0 20.8 0 66.7 29.2 0 66.7 20.8 4.2 54.2 33.3 4.2 91.7 4.2 4.2 94.7 0 0 AP 42.9 25.0 10.7 17.9 0 0 TN 48.4 25.8 3.2 9.7 9.7 0 MAH 25.0 17.9 0 53.6 0 0 GUJ 39.4 9.1 0 9.1 6.1 0 CHA 0 3.1 0 53.1 0 0 UP 12.0 8.0 0 60.0 0 0 HP 36.4 4.5 4.5 22.7 0 0 WB 0 0 0 65.5 0 3.4
(in %)
MAN 22.2 0 0 77.8 0 0 Total 29.8 13.0 2.4 46.2 2.4 0.5 71.1 21.8 3.8
Table 3.13a
Private Doctors Public Doctors
Breakup of Private and Public doctors advising only Sputum test when given only one choice (in %)
AP 80.0 20.0 TN 65.0 35.0 MAH 33.3 66.7 GUJ 33.3 66.7 CHA 31.3 68.8 UP 37.5 62.5 HP 23.1 76.9 WB 45.5 54.5 MAN 55.6 44.4 TOTAL 46.0 54.0
Table 3.14
Sputum Reliable X-Ray Reliable
Why
AP 46.7 33.3 20.0 TN 82.4 11.8 5.9 MAH 50.0 50.0 0 GUJ 78.3 21.7 0 CHA 66.7 29.2 0 UP 66.7 23.8 4.8 HP 65.0 35.0 0 WB 91.3 4.3 4.3
(in %)
MAN 100 0 0
Mantoux test Reliable
3.8c
Practice related to sputum test
Majority of the doctors mentioned that they advise Sputum test every time or most of the time if they suspect the patient to be TB infected. Except in TN, doctors refer them to government hospitals for sputum test. However very few doctors face problems in getting sputum test done. Table 3.15 Frequency of Sputum test for TB suspect
AP Every time Most of the time Occasionally Never 4.3 73.9 17.4 4.3 TN 54.2 20.8 25.0 0 MAH 40.0 20.0 36.0 4.0 GUJ 83.3 4.2 4.2 8.3 CHA 33.3 29.2 37.5 0 UP 37.5 58.3 0 0 HP 62.5 16.7 12.5 0 WB 79.2 16.7 4.2 0
(in %)
MAN 31.6 52.6 10.5 0
29
Table 3.16 Where sent for Sputum Exam

AP Govt. Hospital Private Labs Both 47.8 26.1 26.1 TN 16.7 83.3 0 MAH 64.0 36.0 0 GUJ 75.0 16.7 0 CHA 20.8 37.5 41.7 UP 54.2 41.7 0 HP 75.0 4.2 8.3
(In %) WB 58.3 41.7 0 (In %) MAH 24.0 GUJ 16.7 CHA 8.3 UP 4.2 HP 0 WB 25.0 (In %) MAN 0 MAN 26.3 15.8 47.4
Table 3.17 Problem for sputum Examination

AP Yes 0 TN 0
Table 3.18 What are the problems

AP Time consuming Not economical Difficult to collect first morning sputum No facility available 0 0 0 0 TN 0 0 0 0 MAH 0 0 33.3 66.7 GUJ 0 25 75 0 CHA 0 100 0 0 UP 0 0 0 100 HP 0 0 0 0
WB 16.7 66.7 16.7 0
MAN 0 0 0 0
3.9
TREATMENT OF TB
Majority of the respondents preferred government hospital for seeking treatment for TB except for West Bengal where households mentioned DOTS center. Graph-3.31
Should go for Treatment of TB-Household (%)
Private Centre
Govt. Hospital
DOTS/TB Centre
Similar trend was noticed among the opinion leaders.
30
Graph-3.32
Should go for Treatment of TB-Opinion leader (%)
Private Centre
Govt. Hospital
DOTS/TB Centre
Majority of the respondent strongly disagreed to the statement that completing full course of TB treatment is not essential. They were also quite aware that the disease becomes untreatable once a patient stops taking medicine in between. Graph -3.33
Completing the full course of TB treatment is not essential(%)
DK/CS DK/CS SD D NAND A SA
0 10 20 30 40 50 60 70
Graph -3.34
If a person stops taking medicine in between, then the disease becomes untreatable(%)
SD D NAND A SA
0 10 20 30 40 50
Male
Female
Opinion Leader
Male
Female
Opinion Leader
Majority of the opinion leaders rightly identified the duration of treatment as six months. Table 3.19 Duration of Treatment
How long it takes to get cured < Three months Three months Six months Nine Months One year < One year DK/CS 5.3 0.0 31.6 0.0 10.5 0.0 52.6 0.0 0.0 30.0 5.0 30.0 10.0 25.0 9.5 28.6 23.8 9.5 9.5 14.3 4.8 10.0 25.0 20.0 10.0 15.0 10.0 5.0 0.0 20.0 45.0 5.0 10.0 20.0 0.0 10.5 0.0 15.8 26.3 31.6 15.8 0.0 0.0 31.6 36.8 0.0 10.5 15.8 5.3 0.0 5.0 60.0 5.0 15.0 15.0 0.0 9.1 18.2 18.2 13.6 0.0 27.3 13.6 AP TN MAH GUJ CHA UP HP WB (in%) MAN
31
3.9a
Treating Pulmonary TB
Except for Manipur and Gujarat, more than half of the HSPs treat Pulmonary TB on their own. Allopathic was the preferred system of medicine for treating patients of Pulmonary TB. The average duration of treatment mentioned by majority (55.5%) of the physicians was 69months. However about 30.5 % of the HSPs could not mention any specific duration as they felt that the duration varies for different patient. Table 3.20 Treat Pulmonary TB
AP Yes 95.7 TN 100 MAH 68.0 GUJ 33.3 CHA 62.5 UP 50.0 HP 50.0
(in %)
WB 62.5 MAN 15.8
Table 3.21 System of Medicine followed

AP Allopathic Homeopathy Traditional Unani Ayurvedic 13.6 16.7 5.9 72.7 13.6 TN 79.2 4.2 MAH 82.4 11.8 GUJ 100.0 CHA 100.0 UP 91.7 8.3 HP 100.0
(in %)
WB 80.0 6.7 6.7 6.7 MAN 66.7 33.3
Table 3.22
MDR-TB
AP TN 80.0 40.0 MAH 57.9 47.4 GUJ 40.0 20.0 CHA 31.3 100 UP 57.1 9.5 HP 73.7 15.8 100 16.7
(in %)
WB 33.3 16.7 MAN 100 20.0
MDR TB Sputum culture sensitivity Treats MDR-TB
Our survey also found that the doctors treat MDR-TB patients. Most of them could correctly identify the test to diagnose MDR-TB. In most of the states, doctors look for positive sputum turning negative to confirm whether the patient is cured or not. While treating patients, the difficulties mainly faced by doctors in most of the states were that (i) People hesitate to come for treatment and (ii) They do not reveal previous history of TB in their family easily. More than two-third of the patients that went for treatment of TB completed the treatment, except in WB where it was as low as one-fourth.
32
Table 3.23 Symptoms of Cure

AP Improvement in symptoms Positive sputum turning -ve Improvement in X-ray Treatment completed All 13.3 50.0 23.3 10.0 3.3 TN 6.5 51.6 12.9 9.7 19.4 MAH 21.5 39.3 25.0 3.6 10.7 GUJ 22.3 44.4 16.7 16.7 0 CHA 25.7 40.0 31.4 2.9 0 UP 36.6 30.0 23.3 10.0 0 HP 31.0 31.0 13.8 17.2 6.9 WB 34.1 34.1 29.5 2.3 0
(in%)
MAN 57.2 42.9 0 0 0
Table 3.24 How many completed treatment (in a year)

AP Average number of patients % Amongst them completed treatment
59 69.2
(in%)
CHA
10 90.0
TN
34 63.1
MAH
62 85.1
GUJ
34 68.9
UP
433* 79.9
HP
112 72.6
WB
85 25.2
MAN
11 89.8
* Sitapur district hospital reported to treat around 150 TB patients per day
Table 3.25 Difficulties in treating

AP People hesitate to come Non availability of anti TB Drugs No pathology or X-ray lab available in the vicinity People do not reveal previous history of TB easily Poverty Failure cases Illiteracy 57.1 42.3 36.8 23.1 23.1 15.4 13.3 27.8 23.1 35.3 25.0 TN 50.0 MAH 26.3 GUJ 23.1 CHA 73.3 UP 33.3 HP 23.1 WB 47.1
(in%)
MAN
33.3
66.7
3.10
PRECAUTIONS
The general population did have some clue about how to control spread of the disease. When asked about it they pointed out that covering face while coughing and using separate utensils was the major precautions that patients and their family took to control the spread the infection. Table 2.26 Precautions
Precautions Cover face Separate utensils Not to spit anywhere Isolate the patient Avoid Non veg. NO precautions DK/CS Maintain Cleanliness AP 55.6 2.8 38.9 0.0 0.0 0.0 2.8 0.0 TN 29.4 20.6 32.4 0.0 0.0 2.9 14.7 0.0 MAH 15.4 30.8 0.0 30.8 7.7 0.0 7.7 7.7 GUJ 15.0 25.0 5.0 20.0 25.0 0.0 0.0 10.0 CHA 33.3 16.7 16.7 0.0 0.0 16.7 16.7 0.0 UP 22.0 43.9 19.5 4.9 7.3 0.0 2.4 0.0 HP 27.8 50.0 11.1 11.1 0.0 0.0 0.0 0.0 WB 28.6 23.8 28.6 19.0 0.0 0.0 0.0 0.0
(in %)
MAN 22.0 41.5 19.5 7.3 2.4 0.0 7.3 0.0
33
Both the household respondents and opinion leader opined that TB patient should be kept in isolation to prevent spread of infection. However they also knew that brief exposure to TB patient rarely infects a person. Graph -3.35
TB patient should be kept in isolation to prevent spread of infection (%)
0 10 20 30 40 50
Graph -3.36
Brief exposure to TB patient rarely infects a person (%)
0
Male
Female
Opinion Leader
Male
10
Female
20
Opinion Leader
30
40
3.10a
Precautions taken by HSPs
More than half of the doctors in all the states felt that TB do not pose any risk either to their own health or to other patients visiting them. However, they wear mask & gloves and maintain distance from the patients. Majority of the doctors in UP and HP on the other hand mentioned that they do not take any precautions for protecting themselves. Only few doctors in some states mentioned that patients avoid visiting them because they treat TB patients. Precautions suggested by doctors to their patients varied from state to state. The three most commonly advised precautions include cover face while coughing, use separate utensils and not to spit anywhere. Table 3.27 TB constitutes any risk to health of other patients
AP Yes Precautions to protect oneself Maintain Distance Wear mask & gloves None Any other Other patients avoid visiting you because you treat TB patients 34.5 62.1 3.4 --4.3 29.6 51.9 3.7 14.8 20.8 10.7 53.6 32.1 3.6 12.0 29.7 16.2 8.1 45.9 8.3 71.0 22.6 6.5 --12.5 25.0 58.3 4.2 -19.2 19.2 61.5 ---58.3 4.2 37.5 --12.5 81.0 9.5 4.8 4.8 -8.7 TN 16.7 MAH 40.0 GUJ 41.7 CHA 20.8 UP 4.2 HP 8.3
(in %)
WB 16.7 MAN 31.6
34
Table 3.28: Precaution suggested to avoid spread of TB

AP Cover face while coughing Use separate utensils Not to spit any where Isolate the patient Any other 24.0 36.0 36.0 4.0 TN 33.3 44.4 18.5 0 3.7 MAH 51.4 5.7 22.9 14.3 5.8 GUJ 43.4 23.9 21.7 6.5 4.4 CHA 16.0 32.0 40.0 4.0 8.0 UP 39.5 16.3 30.2 9.3 4.7 HP 38.1 4.8 50.0 0 7.2
(in %) WB 42.9 2.9 20.0 34.3 --MAN 66.7 4.8 19.0 9.5 ---
3.11 Gender bias/Stigma & Discrimination

Going contrary to our hypothesis that there still exists considerable gender bias in society, related to treatment of TB, a high percentage of responses seem to indicate that people are willing to take care of a TB patient irrespective of their gender. [Is there a tendency towards being politically correct?] Graph -3.37
Willing to take care of male relative (%)
0 10 20 30 40 50 60
Graph -3.38
Not willing to take care of female relative (%)
0 10 20 30 40 50
Male
Female
Male
Female
Graph 3.39
Treatment of a female TB patient is always delayed(%)
DK/CS SD D NAND A SA Male Opinion Leader Female
10
15
20
25
35
More than half of the household respondents opposed to the statement that treatment of female TB patient is delayed. On contrary it was interesting to note that more than one third of the opinion leaders feel that treatment is delayed. Table 3.29
Household Allowed to attend
AP TN GUJ MAH CHA UP HP WB
(in%)
MAN
84
63.2
55.6
53.8
100
78.1
55.6
55.6
56.3
Beneficiary household also claimed that they have experienced no stigma attached to the TB patients and the patients were allowed to take part in social activities. Graph-3.40
Individual attitude of Opinion leaders(%)
Send your daughter in law to her parents house for treatment if she had TB to protect your family members Marry off your son to a girl who you know had TB
9 36 32 34 12 21 0 5 10 15 20 25 30 35 40
Isolate your family member having TB from your household
Marry off your daughter to a boy knowing that he had TB If you suspect TB in one of your female family member you will wait for sometime before taking her to a doctor. Share a meal with a person you know had TB
As many as two-thirds of the opinion leaders feel hesitant to marry off their wards to a person who had TB although majority of them opined that a person can lead a normal life once cured. (refer pg. 23-24 TB is curable) According to the opinion leaders however, discrimination still exists in the society. They pointed out that workers loosing jobs, difficulty in marrying off daughter who had TB and discrimination against students having TB still exists. Nonetheless non- participation in social functions and sending women TB patient to her maternal home was not very common. Nonetheless
36
Graph-3.41
Practices(%)
Husbands / in-laws accompany female TB patient to the hospitals/DOTS centre. Daily wage labourer suffering from TB looses their job.
66 63 23 36 56 11 18
Children of TB infected parents are asked to discontinue school.
Children with TB are asked to discontinue studies.
It is difficult to marry off a daughter who has/had TB.
Married female TB patient is sent off to her parents house A family with TB patient is not allowed to participate in any social function
10
20
30
40
50
60
70
From the HSPs perspective also it was noticed that quite a significant percentage of them observe difference in concern in the family of female TB patient in Tamil Nadu, Maharashtra, Chattisgarh, Himachal Pradesh and West Bengal. Table 3.30: Difference in Concern Noticed
(in %)
MAN
Total 19.4
Yes
0.0
20.8
36.0
8.3
45.8
0.0
25.0
33..3
0.0
Table 3.31: Who accompanies a TB Patient?

Household Alone Parents In laws Friend Whosoever was available Spouse I DK/CS
(in %)
MAN
Total 9.1 29.9 4.5 2.6 14.9 21.4 6.5 11.7
8.0 20.0 4.0 8.0 36.0 16.0 4.0 4.0
5.3 15.8 5.3 0.0 5.3 57.9 5.3 5.3
11.1 22.2 0.0 0.0 11.1 22.2 22.2 11.1
0.0 23.1 0.0 7.7 30.8 15.4 15.4 15.4
16.7 16.7 0.0 0.0 33.3 0.0 0.0 33.3
12.5 12.5 9.4 3.1 9.4 21.9 6.3 25.0
22.2 11.1 11.1 0.0 11.1 44.4 0.0 0.0
22.2 44.4 11.1 0.0 11.1 11.1 0.0 0.0
3.1 71.9 0.0 0.0 3.1 6.3 6.3 9.3
The respondents from the household claimed that generally parents and spouse accompanied the TB patient to the hospital. Female patients in rural areas were accompanied by their parents and spouse mainly.
37
3.12
KNOWLEDGE ABOUT DOTS /DOT CENTER
Among those who mentioned having heard about DOT center there was not much gender wise difference except for UP. Although the percentage of respondents spontaneously mentioning DOT as a center for treatment was meager, on probing they could recall and remember the facilities specifically associated with DOT center. We found a wide variation on the issue. Except in West Bengal and Manipur around one-third of the opinion leaders claimed to have heard about DOT center. In West Bengal quite interestingly all the opinion leaders have mentioned DOT center. Graph-3.42
Heard/ mentioned about DOT Centre(%)
100 90 80 70 60 50 40 30 20 10 0 AP TN MAH GUJ CHA UP HP WB MAN
HH
OL
HSP
Except for AP, more than two-third of the doctors have heard of DOTS and mostly among them opined that DOTS is good. Doctors in most of the states, other than AP and some in TN, informed that DOT service is available in their locality.
3.13
FACILITIES AVAILABLE AT DOT CENTER
Free diagnosis followed by free medicine was spontaneously indicated as special facilities or features available in DOTS center. However the opinion leaders contacted in Himachal Pradesh had no clue about the facilities.
38
Table 3.32: Facilities provided at DOT centre

(in %)
MAN
Free diagnosis (spontaneous) Free medicines (spontaneous) Uninterrupted supply of medicines All the above
DK/CS
HH OL HH OL HH OL HH OL HH OL
29.5 25.0 29.5 25.0 11.4 22.7 50.0 6.8 0.0
20.0 30.0 20.0 30.0 42.9 27.3 14.3 10.0 40.0 30.0 20.0 0.0 9.1 14.3 45.5 28.6 18.1
26.8 30.0 23.9 10.0 18.3 10.0 19.7 10.0 11.3 40.0
33.0 40.0 27.5 45.0 1.1 10.0 11.0 24.2 5.0
37.5 21.4 28.1 28.6 25.0 21.4 3.1 6.3 28.6
27.8 13.9 16.7 13.9 27.8 100.0
34.5 28.1 37.9 25.0 9.4 6.9 25.0 17.2 12.5
16.7 50.0 33.3 16.7 50.0 33.3
Peoples perception about DOTS being the sure way of complete cure varied from state to state. However more than 50% from all the states except HP and Chhattisgarh were aware that medicines are for free under DOTS. Table 3.33 About DOTS
Household DOTS is sure way of complete cure Medicines are provided free under DOTS AP 48 56.0 TN 25 50.0 GUJ 83.3 50.0 MAH 68.6 76.4 CHA 8.5 9.6 UP 73.3 73.3 HP 10.4 6.25 WB 28.7 60.6 MAN 0 50.0
(in %)
Total 30.7 34.4
It was surprising to know that very few among the opinion leaders actually had the correct idea about free medicine and DOTS being surest way of cure for TB. Table 3.34
Opinion Leader (%) Medicine is provided free under DOTS DOTS is the surest way of cure for TB. SA 17.2 13.3 A 11.1 11.7 NAND 4.4 6.1 D 2.2 2.8 SD 0.6 DKCS 64.4 66.1
Majority of the opinion leaders in 6 out of 9 states showed their keenness to become a DOT Provider. The reason mainly cited by them for so, was to serve the community, free and good quality drugs and the role of DOT provider to protect the patients family and community from TB.
39
Table 3.35 Would like to become a DOT Provider

Yes
(in %)
MAN
26.3
45.0
23.8
80.0
80.0
73.7
84.2
85.0
90.9
Table 3.36 If yes Why?

AP TN GUJ MAH CHA UP HP
(in %)
WB MAN
To serve the community Free & good quality drugs Financial Incentive Protects the patients family and community DOTS is the surest way to complete cure
40.0
39.1 21.7 4.3 26.1
45.5 27.3 9.1 18.2
50.0 21.9 9.4 18.8
59.3 7.4 3.7 25.9 3.7
40.6 15.6 12.5 21.9 9.4
31.0 21.4 11.9 21.4 11.9
36.4 27.3 18.2 15.2 3.0
57.7
38.5 3.8
60.0
8.7
Those who are not interested in becoming DOT provider mentioned lack of time as a reason for it. Table 3.37 If No Why?
(in %)
MAN
Lack of time NO idea about DOTS center
50.0 50.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0 100.0
3.13a HSPs and DOTS

Except for TN and Manipur, in rest of the states overwhelming percentage of HSPs knows about the DOTS regimen and among them most of them follow it for treating TB patients. On contrary, not a single doctor in AP mentioned that they know about DOTS regimen. Table 3.38 DOTS Regime
(in %)
MAN
Knows DOTS regime Follows the same
----
37.5 22.2
76.5 92.3
100.0 75.0
86.7 92.3
91.7 63.6
100.0 83.3
80.0 83.3
33.3 100.0
Table 3.39 About DOTs

(in %)
MAN
Dots is good DOTS is Bad DOTS available in locality Aware of the scheme to involve private practitioners
20.0 -------
40.0 6.7 46.7 13.3
73.9 26.3 89.5 63.2
94.4 -88.9 50.0
93.8 -87.5 75.0
73.7 -78.9 68.4
85.7 -85.7 33.3
81.0 -90.5 71.4
100 -100 8.3
40
Most of the doctors except in AP, TN and Manipur are aware of the schemes to involve private practitioners in DOTS programme. Majority of government doctors in all the states, excluding AP are involved in DOTS scheme. Those not involved mentioned more workload, not practicing allopathic system of medicine as reasons for not being a part of it. While doctors in Maharashtra, UP and HP gave no reasons for it. Table 3.40 Involvement in DOTS
(in %)
MAN
Involved in DOTS (only govt. doctors) If no, why Ayurvedic doctor Continuing from my residence Work load is more We have special deptt. for treating TB Being a lady Not interested Dk/cs
100
92.3
58.3
83.3
90.9
46.2
75.0
88.9
--50.0 --50.0 --
---------
-------100
20.0 20.0 20.0 20.0 --20.0
50.0 ---50.0 ---
--------
------100
-------100
----100 ---
3.13b Interested to become DOTS Provider

More than half of the private practitioners in 7 out of 9 states are interested in becoming a part of DOTS programme. Most of them showed their interest for it because free diagnosis is provided under it while some feel that DOTS is the surest way to complete cure. Table 3.41 Interested in DOTS
(in %)
MAN
Yes
28.6
66.7
50.0
33.3
91.7
84.6
81.8
66.7
80.0
41
Table 3.42 If Yes, why

(in %)
MAN
Free diagnosis Right drug in right doses Uninterrupted supply of drugs Make patient feel s/he is wanted Ensure treatment under direct observation Ensure that patients do not loose their wage Retrieve the default patient DOTS is the surest way to complete cure Others
0 12.5 12.5 0.0 0.0 0.0 0.0 25.0 0.0
23.9 21.7 17.4 4.3 8.7 13.0 6.5 4.3 0.0
11.1 11.1 0.0 11.1 22.2 0.0 11.1 11.1 22.2
10.0 20.0 20.0 0.0 10.0 0.0 0.0 10.0 30.0
28.1 6.3 3.1 28.1 3.1 6.3 3.1 21.9 0.0
27.5 17.5 17.5 2.5 10.0 0.0 5.0 20.0 0.0
32.1 10.7 7.1 7.1 7.1 3.6 10.7 14.3 7.2
30.8 26.9 11.5 0.0 11.5 0.0 3.8 11.5 3.8
29.4 0.0 17.6 41.2 5.9 0.0. 0.0 0.0 5.9
* Social service, free distribution of medicine
Table 3.43 If no, why?

(in %)
MAN
Not practicing Allopathic system of medicine Own practice will get affected Fear of infection Very few TB suspects visit their clinic Dont know about DOTs DK/CS
0.0 0.0 30.0 70.0 0.0 0.0
0.0 33.3 0.0 0.0 16.7 50.0
20.0 60.0 0.0 0.0 0.0 20.0
37.5 37.5 0.0 0.0 25.0 0.0
0.0 0.0 0.0 0.0 0.0 100
0.0 50.0 0.0 0.0 0.0 50
0.0 100 0.0 0.0 0.0 0.0
0.0 50.0 0.0 0.0 0.0 50
0.0 0.0 0.0 0.0 0.0 100
Own practice getting affected was one of the reasons put forth by the doctors for not being interested in DOTS.
3.14
INITIATIVE TAKEN BY OL, NGO AND HSP
The opinion leaders claimed that they have advised the patients and their families patient to go to a government hospital. DOT center was also suggested by Opinion leaders of Maharashtra, West Bengal, and Andhra Pradesh as the place for seeking treatment.
42
Table 3.44
What do you Advice To go to the Govt. Hospital DOT center Isolate the patient Proper food intake Nothing
(in %)
MAN
62.5 37.5 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0
40.0 50.0 0.0 10.0 0.0
0.0 0.0 0.0 0.0 0.0
75.0 0.0 25.0 0.0 0.0
80.0 0.0 0.0 20.0 0.0
100 0.0 0.0 0.0 0.0
60.0 40.0 0.0 0.0 0.0
71.4 14.3 0.0 0.0 14.3
Only few respondents in some states did take some initiatives like organizing camps and lectures to make people aware about DOTS. Table 3.45
Have you taken any initiative Yes 0
(in %)
MAN
23.8
15.0
5.0
5.3
25.0
Table 3.46 If yes what?

(in %)
MAN
Organised Camps Organised Lectures Monthly Meeting Advised the patient
60.0 20.0 20.0
33.3 33.3 33.3
100.0 100.0
60.0 20.0 20.0
43
CHAPTER IV INFORMATION SOURCES

4.1 INFORMATION SOURCES
Our survey probed for the source of information that the respondents had gathered on TB. Among the household hospital and television was identified as the principal source of information on TB. Friends and relatives also formed a major source among a few across all the states. The same among opinion leaders were Television and hospitals. Newspaper was also mentioned by quite a few in some states. Graph-4.1
Top three sources of information on TB -Household (%)
100 80 60 40 20 0
TV
Radio
Hospital
Friends/Relatives
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
Graph-4.2
Top three sources of information on TB -Opinion Leader (%)

100 80 60 40 20 0 TV Hospital Newspaper/magazine Radio Friends/Relatives Hoarding /Posters/placard/
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
44
4.2
VISIT BY A HEALTH PERSONNEL TO MAKE PEOPLE AWARE OF TB
Apart from mass media sources in most of the states, village health worker followed by doctor was recalled as the health personnel who visited the respondents to make them aware on TB. However a negligible number of opinion leaders across the states mentioned about any person who came to make the community aware about TB. Those who did among them majority mentioned about doctors, health workers and AWW,s. Graph-4.3
Top threeIPC sources of information on TB -Household (%)
100 80 60 40 20 0 AP Government Doctor Doctor / Nurse in Mobile Clinic Health Worker from NGOs Mahila Mandal TN MAH GUJ CHA UP Private Doctor Village Health Worker / Nurse from Govt. Hospital / Clinic Aanganwadi workers HP WB MAN
Graph-4.4
Top threeIPC sources of information on TB -Opinion Leader (%)
100 80 60 40 20 0
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
Government Doctor
Village Health Worker / Nurse from Govt. Hospital / Clinic
Aanganwadi workers
45
4.3
INFORMATION SOUGHT ON
When the respondents were probed on the kind of information they would like to have on TB, majority asked for prevention, precaution and treatment. Graph-4.5
More Information Sought for -Household (%)
60
40
20
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
Prevention & precaution Spread About Tb
Symptoms Availability of services
Treatment Rehabilitation
Graph-4.6
More Information Sought for -Opinion Leader (%)
60
40
20
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
Prevention & precaution
Symptoms
Treatment
Spread
Rehabilitation
About DOTS
46
4.4
INFORMATION SOURCE FOR HSPs
Journals is the most used source by doctors for updating knowledge while in few states CME was also mentioned as source commonly opted by practicing physicians for the purpose. According to one-fourth of the doctors in almost all the states television could be the best medium for generating awareness among the community about TB while in some states other materials like leaflets/ posters and organizing awareness camps were also mentioned by good number of doctors. Table 4.1: Update knowledge from
AP CME Journals Colleagues Professional bodies Medical Representative No need Workshop/ Seminar/ DOTS thearpy Through internet RNTCP Training Text book of medicine NR 13.3 33.3 20.0 13.3 16.7 3.3 0 0 0 0 0 0 TN 41.7 29.2 0 8.3 8.3 8.3 4.2 0 0 0 0 0 MAH 23.5 38.2 8.8 14.7 5.9 0 0 5.9 0 0 2.9 0 GUJ 24.1 35.2 9.3 20.4 1.9 0 3.7 1.9 1.9 1.9 0 0 CHA 58.3 8.3 25.0 0 4.2 0 0 0 0 4.2 0 0 UP 2.4 35.7 2.4 21.4 16.7 2.4 7.1 0 0 0 9.5 2.4 HP 10.3 17.9 41.0 17.9 5.1 0 0 0 0 7.7 0 0 WB 17.6 47.1 0 26.5 2.9 0 5.9 0 0 0 0 0
(in % )
MAN 0 68.4 0 0 0 0 31.6 0 0 0 0 0 Total 20.0 34.0 12.3 15.7 7.0 1.3 4.7 1.0 .3 1.7 1.7 0.3 (in % ) Total 25.4 8.7 9.9 14.8 19.1 5.3 11.1 3.4 0.4 1.5 .5
Table. 4.2: Best medium to generate awareness among the community about TB
AP Television Radio Newspaper/Magazine Leaflet, pamphlets, booklets, poster Awareness camp Nukkad Natak Community Meetings Health Workers NO Any other DK/cs 23.1 23.1 12.3 3.1 20.0 6.2 9.2 1.5 0 0 1.5 TN 30.8 4.6 18.5 9.2 15.4 3.1 18.5 0 0 0 0 MAH 30.0 11.7 11.7 8.3 16.7 5.0 10.0 3.3 1.7 1.7 0 GUJ 28.1 5.3 8.8 7.0 17.5 1.8 12.3 10.5 1.8 5.3 1.8 CHA 32.4 0 7.0 21.1 14.1 0 11.3 11.3 0 2.8 0 UP 22.7 4.5 3.0 25.8 22.7 13.6 4.5 0.0 0 3.0 0 HP 22.2 9.7 8.3 19.4 22.2 2.8 15.3 0.0 0 0 0 WB 16.7 6.7 5.0 15.0 26.7 15.0 13.3 1.7 0 0 0 MAN 22.0 14.0 16.0 16.0 16.0 0 4.0 2.0 0 0 2.0
47
CHAPTER V MEDIA HABITS

5.1 OWNERSHIP OF ASSET
About half the household respondents own a radio set while equal number of respondents (more than two- third) have television with cable and without cable connection. Similarly more than 60% opinion leaders in all the states except Chhattisgarh own a Radio set. Ownership of Television set with or without cable connection is comparatively low among the opinion leaders of Uttar Pradesh Table 5.1: Ownership of assets
Radio Television without cable connection Television with cable connection HH OL HH OL HH OL AP 51.9 63.2 16.9 5.3 73.8 94.7 TN 43.1 60.0 5.0 5.0 69.4 95.0 MAH 34.8 66.7 44.1 52.4 39.1 33.3 GUJ 36.4 70.0 30.2 20.0 40.1 75.0 CHA 39.4 40.0 48.8 55.0 15.6 25.0 UP 51.9 63.2 41.9 42.1 21.9 26.3 HP 48.4 63.2 69.6 63.2 5.0 21.1 WB 40.0 95.0 25.0 40.0 18.8 55.0 MAN 56.9 95.5 40.6 40.9 42.5 54.5
(in %)
Total 48.1 58.9 35.8 36.1 35.2 53.3
5.2
PREFERRED TIME SLOT FOR RADIO
Preferred time slot for listening radio in all the states was early morning (6-8 pm) while for watching television was late evening (7-9 pm) among majority of the respondents. Table 5.2: Top Two Preferred Slots for Listening Radio
Early morning Mid- morning Evening Late evening Night HH OL HH OL HH OL HH OL HH OL AP 71.8 57.1 7.8 TN 45.8 75.0 23.4 MAH 30.3 46.7 GUJ 38.8 60.0 CHA 33.1 60.0 20.0 19.4 26.7 22.0 19.1 18.8 20.0 23.5 19.5 18.1 32.8 32.4 30.7 29.7 UP 32.4 40.0 30.9 26.7 HP 37.1 52.9 18.1 WB 35.9 52.9
(in %)
MAN 32.7 40.5
48
5.3
PREFERRED RADIO STATION
Vividh Bharti came out as the most preferred station on radio among household. The opinion leaders preferred regional station. Table 5.3: Top Two Preferred stations of Radio
Vividh Bharti FM Regional station HH OL HH OL HH OL AP 72.6 52.6 66.7 47.4 0.0 TN 79.2 35.0 5.2 10.0 55.0 MAH 73.4 33.3 6.3 4.8 42.9 GUJ 50.6 40.0 1.3 0 35.0 CHA 75.7 10.0 41.9 5.0 40.0 UP 80.2 52.6 58.4 31.6 31.6 HP 52.8 52.6 46.1 57.9 0.0 WB 67.1 45.0 23.7 20.0 70.0 MAN 50.3 36.4 43.9 18.2 68.2 (in %) Total 65.5 39.4 34.8 21.1 47.1
News and film songs were the two top preferred programmes among the respondents in Radio. The opinion leaders identified news as the most preferred programme in the radio. Table 5.4: Top Two Preferred Radio Programme
News Drama / serials Film songs Folk Music Discussion on health HH OL HH OL HH OL HH OL HH OL AP 53.2 57.1 TN 23.8 47.6 MAH 38.1 52.6 GUJ 49.2 73.3 CHA 32.8 80.0 UP 43.6 60.0 HP 46.4 61.1 WB 43.2 59.4 18.8 24.5
(in %)
MAN 50.4 52.5 14.7 27.5
33.9
69.3 38.1
27.8 21.1
31.4 13.3
32.8 10.0
45.1 33.3
49.6 27.8
9.5 9.5 10.0
5.4
PREFERRED TIME SLOT FOR TELEVISION
Preferred slot for watching television for majority of the both the category of respondents in all the states was late evening Table 5.5: Top Two Preferred slot of watching Television
Early morning Afternoon Evening Late evening Night HH OL HH OL HH OL HH OL HH OL AP 22.6 29.4 TN MAH GUJ CHA UP HP 25.0 11.8 17.1 11.8 41.6 52.9 11.8 WB 30.8 22.3
(in %)
MAN 21.1
24.5 32.4
36.5 45.8 16.7 25.0
39.4 41.2 31.5 47.1
41.7 35.5 17.5 35.5
47.5 55.0 26.8 15.0
33.8 32.1 29.4 25.0
33.7 28.2
39.6 42.1 22.2
49
5.5
PREFERRED CHANNEL IN TELEVISION
On the other hand, on television Doordarshans National Network was singled out as the most preferred channel in all the states except Tamil Nadu, where Sun TV emerged as the preferred one. Among opinion leaders of West Bengal DD Regional channel was most watched channel. Graph-5.1
80 60 40 20 0
AP TN MAH GUJ CHA UP DD2 HP Sun TV WB MAN Raj TV Doordarshan (National) Doordarshan (Regional)
Top Two Preferred Channels -household (%)
Graph-5.2
60
Top Two Preferred Channels -Opinion Leader (%)
40
20
0 AP TN MAH GUJ CHA Sun TV Zee news UP HP WB MAN
Doordarshan (National) Aaj tak
Doordarshan (Regional) E Tv
Local cable channel
50
5.6
PREFERRED PROGRAMME IN TELEVISION
The households mentioned Drama/ serials and News as the two most favoured programmes on television. News emerged as the most preferred programme on television by most of the opinion leaders. Graph-5.3
Top Two preferred programmes-Household (%)
60
40
20
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
News
Drama / serials
Films
Graph-5.4
Top Two preferred programmes-Opinion Leader (%)
60
40
20
AP
TN
MAH
GUJ
CHA
UP
HP
WB
MAN
News
Drama / serials
Films
51
5.7
READERSHIP PATTERN
Except for Maharashtra, WB and Manipur, in rest of the states, the percentage of respondents reading one newspaper or the other was around one-third. While in Manipur, more than 85% read newspaper, only 23% respondents in WB are readers of newspaper. Except in Manipur male readership was high both in urban and rural areas. However almost all the opinion leaders read newspaper except in Uttar Pradesh where readership was about 60%. Graph-5.5
100 80 60 40 20 0 AP TN
Readership of Newspaper (%)
MAH Household
GUJ
CHA
UP
HP Opinion Leader
WB
MAN
Table 5.6: Readership among male female household

Male Female Male Female AP 53.6 31.9 39.3 20.7 TN 62.3 20.4 77.3 32.3 Mah 72.7 43.5 78.1 67.9 G 60.9 31.6 59.5 21.7 Ch 56.3 22.6 40.0 24.1 UP 45.8 14.0 54.5 13.8 HP 39.6 19.2 86.7 54.8 WB 30.0 6.1 34.4 27.6
(in %)
Man 91.7 86.5 76.7 83.3
URBAN RURAL
52

Baseline KAP Study Under RNTCP Project - CMS

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Baseline KAP Study Under RNTCP Project - CMS

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CENTRAL TB DIVISION, MINISTRY OF HEALTH & FAMILY WELFARE

R K SWAMY BBDO Advertising Pvt. Ltd.

Centre for Media Studies

A Baseline Report by CMS

A Baseline Report by CMS

A Baseline Report by CMS

A Baseline Report by CMS

A Baseline Report by CMS

THE RESEARCH COMPONENT

A Baseline Report by CMS

1.3.1 Statement of Aim

1.3.2 Specific Objective

A Baseline Report by CMS

A Baseline Report by CMS

A Baseline Report by CMS

District 2 Urban Slum HH 50 R 5 US1 25 13F 12M

Doctors Opinion Leaders 12 Pvt. 6 (R&U) Pub - 6 U 5 10

Doctors 12 Pvt. 6 (R&U) Pub 6

CHOICE OF INDICATORS RATIONALE

A Baseline Report by CMS

A Baseline Report by CMS

A Baseline Report by CMS

TOOLS FOR STUDY

A Baseline Report by CMS

CHAPTER II RESPONDENT PROFILE

SOCIO DEMOGRAPHIC PROFILE OF RESPONDENTS:

2.1.1 Age-sex composition

rural and urban slums was also as decided.

Table 2.2 : Urban rural representation of Household.

A Baseline Report by CMS

Community Leader 22%

ANM 6% AWW 11%

A Baseline Report by CMS

Table 2.4: Level of Education

0 0 0 0 5.3 5.3 15.8 73.7

0 0 0 0 25.0 5.0 20.0 50.0

0 0 9.5 0 14.3 23.8 9.5 42.9

0 0 0 5.0 15.0 30.0 25.0 25.0

5.0 0 0 0 15.0 20.0 30.0 30.0

5.3 0 0 31.6 10.5 15.8 10.5 26.3

10.5 0 15.8 10.5 0 31.6 26.3 5.3

0 0 0 0 5.0 0 15.0 80.0

0 4.5 0 0 0 9.1 9.1 77.3

2.2 0.6 2.8 5.0 10.0 15.6 17.8 46.1

Table 2.7: Occupation Household

Dispensing GP Prescribing GP Consultants

34.8 73.9 8.7

A Baseline Report by CMS

Table 2.9 : Household Income

(in %) Total 0.2 40.7 37.8 14.4 5.3 1.6

A Baseline Report by CMS

CHAPTER III KNOWLEDGE ATTITUDE AND PRACTICE ABOUT TB AND DOTS

Health Service Provider

Table 3.1 Heard of TB

(in %) MAN 100.0 100.0

A Baseline Report by CMS

Table 3.2 Getting TB Patients

Prevalence of TB in family or neighbourhood

Table 3.4 Sex wise distribution of patients

A Baseline Report by CMS

AWARE ABOUT THE SYMPTOMS

A Baseline Report by CMS