KNOWLEDGE, ATTITUDES, PRACTICES TOWARDS TUBERCULOSIS TRANSMISSION AMONG MIGRANT SOMALI POPULATION IN KISENYI SLUM, KAMPALA DISTRICT, UGANDA

Abstract

Background: Tuberculosis (TB) is major cause of morbidity and mortality worldwide and in the recent years, multidrug resistant TB (MDR TB) has proved to be a potential global public health catastrophe. Refugees and slum populations are a vulnerable population to TB. Coming from Somalia, a country with high burden of MDR TB and living in slums where the living conditions are poor has made the Somalis in Kisenyi Ward in Kampala district, Uganda very prone to getting MDR TB. This influx of refugees could set back Uganda‟s efforts towards TB infection control. Objective: The objective of this study was to assess knowledge, attitudes, and practices towards TB transmission among migrant Somali population living in Kisenyi slum, Kampala, Uganda. Methods: This was a community based cross-sectional study utilizing both qualitative and quantitative methods of data collection. It was conducted between June and July 2017 among the Somali migrant population living in Kisenyi, the biggest urban slum in Uganda. Quantitative data was collected on knowledge, attitudes, and practices on health seeking behaviours regarding TB while qualitative data was collected on practices regarding TB treatment adherence and social implications of a positive TB diagnosis. Survey data was entered into a computer using EPI data software version three and analyzed using STATA/SE14.0. Modified Poisson regression analysis was used to determine associations between dependent and independent variables. Qualitative data was analyzed manually using content analysis. Results: The study included total of 410 respondents in the community survey, 8 key informants and 3 in-depth interviewees. The mean age of the respondents survey was 29.3(±11.5) with two hundred fifty nine (63.2%) of them were male. For the quantitative component, forty-two percent of the respondents had adequate knowledge about TB. Inadequate knowledge was apparent in questions relating to TB signs and prevention. Attending school (secondary and higher) [Adj PR: 2.00, CI: 1.34-2.99], being a student as an occupation [Adj PR: 1.39, CI: 1.08-1.79] and contact with household member with TB [Adj PR: 0.64, CI: 0.45-0.93] and having a positive attitude [Adj PR: 1.44, CI: 1.14-1.81] were associated with adequate knowledge about TB. Attending school (secondary and higher) [Adj PR: 1.76, CI: 1.13-2.74], contact with household member [Adj PR: 0.59, CI: 0.387-0.91], contact with relative or neighbor [Adj PR: 0.56, CI: 0.34-0.92], xi

and having adequate knowledge [Adj PR: 1.60, CI: 1.20-2.21] were associated with having a positive attitude towards TB. A positive TB diagnosis was mainly associated with fear of death and stigma from family and community; this was reported to have a negative impact on both the health seeking and treatment adherence behaviors. Majority of the respondents preferred to seek medical care from a healthy facility; nonetheless, migrants experienced challenges in accessing health care such as language barrier, migration status and financial difficulties among others. Conclusion: The study found that 42% of the participants had adequate knowledge regarding TB. A positive TB diagnosis was mainly associated with fear of death and stigma from family and community. Although majority of the respondents preferred to seek medical care from a healthy facility, there existed challenges that affected both the health seeking and treatment adherence behaviors such as language barrier, stigma, migration status and financial difficulties among others. Therefore, strengthening TB awareness, addressing TB stigma and language barrier would contribute to a reduction spread of TB and encourage treatment adherence among the migrants.