Prevalence, Knowledge, Attitude, and Practice on Latent Tuberculosis Infection (LTBI): A Cross-sectional Study Among Medical Students at a Malaysian University

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Zarini Ismail
Lailatul Hazzliza Musa
Muslimah Ithnin
Nurul Azmawati Mohamed
Shalinawati Ramli
Nizam Baharom

Abstract

Introduction: Latent TB Infection (LTBI), although asymptomatic, can potentially develop into active TB. This study aimed to assess LTBI prevalence, knowledge, attitude and practices (KAP) among medical students in Negeri Sembilan, Malaysia. Materials and methods: A cross-sectional study was conducted involving 171 clinical-year medical students. A tuberculin skin test (TST) with a 10mm cutoff identified LTBI, confirmed by the QuantiFERON® TB Gold. A questionnaire included sociodemographics, TB exposure, and KAP on LTBI. The Kruskal-Wallis and Spearman correlation coefficients were employed to explore associations among the study variables. Results: LTBI prevalence among medical students was 0.6% (95% CI 0.000, 0.032). The mean of total correct answers for LTBI knowledge was 10.63, SD = 2.064 (range: 5–15), with only 36.8% of the students scoring higher than the median score. The mean total attitude was 36.59, SD = 3.362 (range = 16–40), with 49.1% having a total attitude above the median. The mean total scores for LTBI practice are 22.86, SD = 1.31 (range = 15–24), with 36.3% answering always to all the practice statements. Student's clinical years were associated with knowledge scores (p<0.001). Weak but significant positive correlations existed between knowledge score with age (p<0.001) and practice score (p<0.001). The attitude score was weakly and significantly correlated with practice score (p=0.004). While, the practice score also weakly but significantly correlated with clinical exposure hours (p=0.019). Conclusion: Though promising, the study highlighted knowledge gaps and suboptimal LTBI attitudes and practices among medical students. Comprehensive interventions are crucial to enhance medical students' KAP.

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Ismail, Z., Musa, L. H., Ithnin, M., Mohamed, N. A., Ramli, S., & Baharom, N. (2024). Prevalence, Knowledge, Attitude, and Practice on Latent Tuberculosis Infection (LTBI): A Cross-sectional Study Among Medical Students at a Malaysian University. Malaysian Journal of Medicine and Health Sciences, 20(6), 74–83. https://doi.org/10.47836/mjmhs.20.6.12
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Original Articles

References

World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: World Health Organization; 2018. Available from: https://apps.who.int/iris/handle/10665/260233.

Zellweger JP, Sotgiu G, Corradi M, Durando P. The diagnosis of latent tuberculosis infection (LTBI): currently available tests, future developments, and perspectives to eliminate tuberculosis (TB). Med Lav. 2020;111(3):170–83. https://doi.org/10.23749/mdl.v111i3.9983.

Ministry of Health, Malaysia. National Strategic Plan for Tuberculosis Control (2016–2020). Putrajaya: Disease Control Division (TB/Leprosy Sector); 2016. Available from: https://www.moh.gov.my/index.php/dl/55475675.

Ministry of Health, Malaysia. Programmatic Management of Latent Tuberculosis Infection. Putrajaya: Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division; 2020. Available from: https://www.moh.gov.my/index.php/database_stores/attach_download/347/350.

Ismail Z, Musa LH, Ithnin M, Mohamed NA, Baharom N, Ramli S, Pathmanathan SG. A systematic review of prevalence and risk factors of latent tuberculosis infection among medical and nursing students. Malays J Med Health Sci. 2022;18(6):270–9.

Abdullah M, Daut UN, Daud SA, Romli NA, Jalil MA, Muhammad N, et al. Latent tuberculosis infection among medical students in Malaysia. Asian Pac J Trop Med. 2019;12(4):181–4.

More BD, Doshi C, Baghel V, More AB. A study on knowledge, awareness and preventive practice about tuberculosis among medical students in Udaipur, India. Int J Basic Clin Pharmacol. 2019;8:2706.

Mohd Izham MN, Rahman NA, Haque M. Knowledge, attitude and practices related to tuberculosis among students in a public university in East Coast Malaysia. Adv Hum Biol. 2022;12(2):190–7.

Joshi R, Reingold AL, Menzies D, Pai M. Tuberculosis among healthcare workers in low- and middle-income countries: a systematic review. PLoS Med. 2006;3(12):e494. https://doi.org/10.1371/journal.pmed.0030494.

Chu H, Shih CJ, Lee YJ, Kuo SC, Hsu YT, Ou SM, et al. Risk of tuberculosis among healthcare workers in an intermediate-burden country: a nationwide population study. J Infect. 2014;69(6):525–32. https://doi.org/10.1016/j.jinf.2014.06.019.

Wong PM. Close to 3,000 medical students graduated in 2020, says minister. Free Malaysia Today. 2021 Dec 2. Available from: https://www.freemalaysiatoday.com/category/nation/2021/12/02/close-to-3000-medical-students-graduated-in-2020-says-minister/.

Chinenye NM. Evaluation of knowledge, attitude and practices of TB diagnosed patients in Rwanda towards TB infection: case of TB diagnosed patients in Kigali urban and rural health facilities. Int J Sci Res Publ. 2015;5(8):1–19.

Salame FM, Ferreira MD, Belo MT, Teixeira EG, Cordeiro-Santos M, Ximenes RA, et al. Knowledge about tuberculosis transmission and prevention and perceptions of health service utilization among index cases and contacts in Brazil. PLoS ONE. 2017;12(9):e0184061.

Mater AA, Mosharaf JAA. Knowledge, attitude, and practices of latent TB infection among healthcare workers, Aljazeera State TB Centers, Sudan. Int J Healthc Sci. 2018;5(2):379–83.

Alotaibi B, Yassin Y, Mushi A, Maashi F, Thomas A, Mohamed G, et al. Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 Hajj. PLoS ONE. 2019;14(1):e0210913. https://doi.org/10.1371/journal.pone.0210913.

Kinikar A, Chandanwale A, Kadam D, Joshi S, Basavaraj A, Pardeshi G, et al. High risk for latent tuberculosis infection among medical residents and nursing students in India. PLoS ONE. 2019;14(7):e0219131. https://doi.org/10.1371/journal.pone.0219131.

Trajman A, Wakoff-Pereira MF, Ramos-Silva J, Cordeiro-Santos M, Militão de Albuquerque MD, Hill PC, et al. Knowledge, attitudes and practices on tuberculosis transmission and prevention among auxiliary healthcare professionals in three Brazilian high-burden cities: a cross-sectional survey. BMC Health Serv Res. 2019;19(1):532. https://doi.org/10.1186/s12913-019-4231-x.

Shahbuddin HM, Mahamad UA, Marwan AA. Knowledge, attitude, practice and stigma of tuberculosis among healthcare providers in Hospital Ampang. Malays J Med Health Sci. 2020;16(8).

Janagond AB, Ganesan V, Vijay Kumar GS, Ramesh A, Anand P, Mariappan M. Screening of healthcare workers for latent tuberculosis infection in a tertiary care hospital. Int J Mycobacteriol. 2017;6(3):253–7. https://doi.org/10.4103/ijmy.ijmy_82_17.

Lamberti M, Uccello R, Monaco MG, Muoio M, Sannolo N, Arena P, et al. Prevalence of latent tuberculosis infection and associated risk factors among 1557 nursing students in a context of low endemicity. Open Nurs J. 2015;9:10–4. https://doi.org/10.2174/1874434601509010010.

World Medical Association. Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. Ferney-Voltaire: World Medical Association; 2023. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/.

Abu-Humaidan AH, Tarazi A, Hamadneh Y, Al-Leimon A, Al-Leimon O, Aljahalin M, et al. Knowledge, attitudes, and practices toward tuberculosis among Jordanian university students. Front Public Health. 2022;10:1055037. https://doi.org/10.3389/fpubh.2022.1055037.

World Health Organization. The End TB Strategy. Geneva: World Health Organization; 2015. Available from: https://apps.who.int/iris/rest/bitstreams/1271371/retrieve.

Wong YJ, Ng KY, Lee SWH. How can we improve latent tuberculosis infection management using behaviour change wheel: a systematic review. J Public Health. 2023;fdad051:1–20. https://doi.org/10.1093/pubmed/fdad051.

McDiarmid MA. Hazards of the health care sector: looking beyond infectious disease. Ann Glob Health. 2014;80(4):315–9. https://doi.org/10.1016/j.aogh.2014.08.001.

World Health Organization. WHO guidelines on tuberculosis infection prevention and control: 2019 update. Geneva: World Health Organization; 2019. Available from: https://apps.who.int/iris/bitstream/handle/10665/311259/9789241550512-eng.pdf.

World Health Organization. WHO guidelines on hand hygiene in health care. Geneva: World Health Organization; 2009. Available from: https://www.who.int/publications/i/item/9789241597906.

Seetan K, Ghraibeh S, Alsharei A, Khamees A, Alhasan B, Al-Shami K, et al. Assessment of knowledge, attitude and practices toward infection control measures among medical students. J Res Med Dent Sci. 2021;9(8):185–91.

Onyedibe KI, Shehu NY, Pires D, Isa SE, Okolo MO, Gomerep SS, et al. Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross-sectional study. Antimicrob Resist Infect Control. 2020;9(1):30. https://doi.org/10.1186/s13756-020-0693-1.

Mansor NR, Arifin K, Awang A, Jarmin R, Mohamed Z, Sahimi AS, et al. Biological risk and occupational safety among nurses. Asian J Environ Hist Heritage. 2019;3(2):11–8.

Vikke HS, Vittinghus S, Giebner M, Kolmos HJ, Smith K, Castrén M, et al. Compliance with hand hygiene in emergency medical services: an international observational study. Emerg Med J. 2019;36(3):171. https://doi.org/10.1136/emermed-2018-207872.

Knibbs LD, Morawska L, Bell SC, Grzybowski P. Room ventilation and the risk of airborne infection transmission in healthcare settings within a large teaching hospital. Am J Infect Control. 2011;39(10):866–72.

Granich R, Binkin NJ, Jarvis WR, Simone PM, Rieder HL, Espinal MA, et al. Guidelines for the prevention of tuberculosis in health care facilities in resource-limited settings. Geneva: World Health Organization; 1999.

Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005;54(RR-17):1–141. Available from: www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm.

van der Westhuizen HM, Kotze K, Narotam H, von Delft A, Willems B, Dramowski A. Knowledge, attitudes and practices regarding TB infection control among health science students in a TB-endemic setting. Int J Infect Control. 2015;11(4). https://doi.org/10.3396/IJIC.v11i4.030.15.

Sharma N, Basu S, Chopra KK, Sharma P. Awareness and perspectives on expansion of latent TB management among public-sector physicians and medical trainees in Delhi, India. Indian J Tuberc. 2020;67(2):208–12. https://doi.org/10.1016/j.ijtb.2020.02.003.