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" 1 d1 G{1 6'l f,tldz t[a V fl 1?uf gu L.t1 Aid eariufi 2 'rqun1nil RornrFril 2ss7 in 2U. t' Although the case detection rate was 77% for national level, Magwayregion (45o/o) was included in lowest five regions for it in 2}l.t'There are five districts in Magway region. There aremagway, Minbu, Pokokku, Gangawand Thayet. n Magway district, there were 2,633 TB notified cases in 20l which is the highest member in Magway region. Although DOTS strategy have been launched to all townships in 2003, tuberculosis remains as a major public health problem in this area.n Magway region is located in central area of Myanmar where is distant from the capital cities.moreover, most ofpopulation in Magway district based on the agriculture and they possessed low socio-economic stafus as well fuberculosis strikes on the poor and vulnerable group. n this study area, there were no previous documents related with family members of TB patient households although the studies related with tuberculosis were performed among the TB patient groups and at workplace such as industrialized area. This study aimed to identify the factors affecting the preventive behavior on fuberculosis, and association between socio demographic characteristics, knowledge, perception and preventive behavior on tuberculosis among the family members of tuberculosis patientin Magway region. Methods A cross-sectional study was conducted from Decemb er 201 3 to January 2014 in37 0 family members of TB patients' household who were 8 to 65 years old. The multi-stage sampling technique was applied and Magway district where the case detection rate was the highest under Magway region was purposivelyselecte d." A11 six townships were included in study area and two wards and ten villages from each township were selected by simple random sampling. The participants from each township were proportionally calculated by using primary data from the hospital. One family member from each TB patient household was randomly selected from each village. The data were collected by face to face interviews by 10 well trained research assistants from University of Community Health (Magway) in coordinating with researcher. The structured questionnaires were developed based on Health Belief Model (HBM) and composed of five parts: socio-demographic characteristic, knowledge paft, perception towards TB, cues to action (TB information), and preventive behavior on fuberculosis. Mean and standard deviation were calculated and used as a cut of point for knowledge, perception and preventive behavior components. The overall score for knowledge and perception parts were categorized into three levels: poor (< mean SD), fair (mean- SD There were 14 items in knowledge part and 15 items in perception part. The score for 8 items of preventive behavior part was classified by two levels: poor (<mean) and good (> mean).theunivariate analysis was used to describe descriptive statistics: mean, median, standard deviation, minimum and maximum number, and percentage of each independent and dependent variables. Chi-square tests and simple logistic regression were used for biv ariate analysis to identify association between each independent variables and preventive behavior on tuberculosis among the family members of TB patients. Multiple logistic regression using a backward stepwise (wald) method was performed to predict the significant

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? 1 "Gf1 Gf1 61 il q[?t rra v fl 1?uiru ur tji4 12oriufi 2 u,qunlfre.r RornrFril, 2557 Regarding with the knowledge about tuberculosis, it was assigned into three levels in which l4.6oh were high knowledge level and nearly three fourth of respondents were fair. About half of the respondents (44.9yo) knew that the bacteria is causal organism of tuberculosis infection and 30% of participants had right information and knew well that if coughing longs for more than 2 weeks, it would be a highly suggestive symptom of tuberculosis. There was about 15.7% of respondents who had good overall perception level and 255 (68.9%) and 57 (15.4%) had fair and poor perception on tuberculosis respectively. TabLe 2 showed thelevel of TB preventive behavior, perception on susceptibilities, severities, benefits and barriers towards tuberculosis among the family members of TB patients. Table 2 Number and percentage of level of preventive behavior, knowledge and perception on TB Level of Preventive behavior Vnff$bt$$ Mean-l 1.04, SD:2.993, Min: 4, Max-6 Knowledge about tuberculosis Mean-9.04, SD:2.214, Min: 3, Max: 14 Perception on tuberculosis Mean-58.14, SD:4.423,Mtn: 46, Max- 7l Perceived Susceptibitity Mean-l6.73, SD: 1.899, Min-10, Max:20 Perceived severitv Mean-20.26, SD: 2.lll, Min-14, Max:25 Perceived benefit Mean-l1.98, SD: l.l5l, Min-9, Max-15 Perceived barriers Mean-9.17, SD: 2.360, Min: 3, Max- l5 Froqucney Percent l5l 40.8 2r9 59.2 49 13.2 267 72.2 54 14.6 57 ls.4 zss 68.9 58 r5.7 43 rr.7 278 7 5.1 49 13.2 76 20.5 252 68.1 42 rt.4 27 7.3 307 83.0 36 9.7 56 15. 242 65.4 72 19.5

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" 1 G{1 61 frjq?t tta v n 1?r.iio,r ur "d1 tjid 12oriufi 2 u,qun-rftt, RonrFtil 2557 There was no association between overall perception level and TB preventive behavior among the family members of TB patients. As shown in table 4, perception on susceptibilities, severities, benefits and barriers towards tuberculosis didnot associate with TB preventive behavior in this study. Table 4 Association between perception level and preventive behavior on tuberculosis Perception level Level of preventive behavior Crude OR 95BA C sf OR Lower Upper a/t oa Perceived susceptibility 0.822 48 45 26 88.9 54.3 53. 1 6 t22 23 11.1 45.7 46.9 t.240 t.02r 0.654 0.563 2.269 t.47 5 0.534 0.705 Perceived severify 0.937 24 57.r 18 42.9 0.870 0.47 5 1.741 0.77 4 r49 59.1 103 40.9 0.943 0.636 1.s48 0.972 46 60.5 30 39.5 1 Perceived benefits 0.970 22 61.1 t4 3 8.9 1.080 0.540 2.211 0.805 181 59.0 r26 41.0 0.988 0.543 r.644 0.841 T6 s9.3 11 40.7 Perceived barriers 0.081 51 70.8 29.2 t.821 t.07 6 3.281 0.027 r36 56.2 43.8 0.962 0.447 1.083 0.108 32 57.r 42.9 The study also found that there was no association between TB preventive behavior and sources of TB information. However, the variables such as television, newspapers/magazines and volunteers which had p-value<o.l were become adjusted variables to predict significant factors for TB preventive behavior. The findings in table 5 showed the significant predictors for preventive behavior on fuberculosis after adjusting with other variables which had p-value less than 0.1. The knowledge level on tuberculosis andl monthlyy family income were significant predictors ofl tuberculo rlosis preventive behavior (OR- 7.594,95% C\ 22.021 for knowledge level and OR: 1.853,1-2.s88-95% C = - 1.160-2.960 for monthly family income).1 Family members of TB patients who had good knowledl :dge level on tuberculosis were 7.549 times more likely to have high TB preventive behavio{ compare( red to those who had poor knowledge level of

.Journal of Public Health and Developmen[ Vol. 12 No. 2 ftlau Flugust 2014 rberculosis. Besides, the respondents who got more nan 100,000 kyats for their monthly family income rad more likely to have high TB preventive behavior on tuberculosis than those who got less than or equal 100,000 kyats for their monthly family income. table 5 Multiple logistic regression for predictors of TB preventive behavior Varinbles Adjusted OR 95Ve C of OR p-value Lower Upper Monthly family income > 00000 <100000 Knowledge level on tuberculosis Perception on barriers Television No Yes Magazines and newspaper No Yes Person who give TB information (volunteers) No Yes 1.853 t.127 7.s49 0.910 1.826 1.492 1 t.397 1.502 1.160 2.960 0.010** 0.594 2.r37 0.7 15 2.5 88 22.021 <0.001'F:F'k 0.48s t.707 0.7 69 0.83 7 3.983 0.1 30 0.915 2.434 0.1 09 0.688 2.835 0.3 55 0.770 2.930 0.233 usslon n preventive behavior on tuberculosis, 59.2% f family members of TB patients had good level f TB preventive behavior. One study from Yangon, yanmar showed that nearly half of respondents did t delay to take treatment immediately for tubercu osis infection.'' Over half of respondents among ndustri ahzed area in Myanmar could contact for ning to check tuberculosis infection.'o Although the treatment successful rate by National Tuberculosis Programme reached the target in Magway region (81%), about 40.8"h of the family members of TB patient households had still poor preventive behavior on tuberculosis.'t Regarding to socio-demographic characteristics of respondents, it was found that the average age was 43.92 years old and the range of age was 18-65 years old. Majority of family members were female

? 1?d1 d1 o,l "ruqu tta v fl 1 riiru ur flid 12oriufi 2 urqun-rnil Rornrnrl 2557 (69.5%). The female respondents were included in these studies by comparing with female proportion (50.56%) of Myanmar in 20ll-20l2.l5Most of respondents were currently married, low educated level (illiteracy, primary school and middle school), farmers and no job people.more than half of respondents were low income group (s100000 kyats). t was prominently higher than national household poverty rate (21j%) and 26% of poverty incidence in 2009-2010. These could be revealed that tuberculosis can affect the society of low-socio economic status. t6't7 There was l4.g% of respondents' household which had more than one TB patient. t was higher than the results (6%) studied in Uganda.'* There was no previous studies concerning with household transmission in this area although the mobile teams of NTP are screening TB infection especially among the contact persons of TB patients.l6because ofonly 14.6% of respondents who had good knowledge on tuberculosis, it could be explained that the knowledge level of respondents in current study was lower than the result of one sfudy in Yangon, Myanmar-t' t could be explained that people and communities with TB has been lagging behind although advocacy' communication and social mobili zationwere implemented in the community in Myanmar. Although nearly half of respondents knew about the cause of disease,it was higher than the knowledge of general population of Metro Manila, Philippines and of the non-medical students university of Belgrade.*''e Mostly family members knew that smoking is the predisposing factor of tuberculosis and taking medicine regularly, full course from health personnel should be used for cure of TB. These findings were higher than that of general population in Philippines. About one third of responrdents knew about coughing more than two weeks which was nearly result with one study in the general population in Serb ra.'o The knowledge about BCG vaccine was nearly the same as Moe Thaw's study (nearly 40%)in Yangon, Myanm at-tt t could be explained that the knowledge on preventive measured by vaccination was still low although the Expanded Programme on mmunization (EP) is performing on the whole country. This study showed that only 22.7%had good level of overall perception on tuberculosis. t was lower than those of one study among Myanmar migrants in Thai (45.3%). Likewise the family members of TB patient household in current study had low knowledge about tuberculosis, they could not change their perception towards fuberculosis because of socio-cultural factors and economic condition of their family. Nearly half of respondents (47.8%) and (5.1%) perceived agree and strongly agree about dismissal from the job if they suffer from TB. t was higher perception than the study in a growing industria\zed atea in Myanmar (32.g%).'o Despite of these two differences, the perception about stigmatization which was the effects of severity was noted among the community. All respondents accepted that tuberculosis lead to be died if it was not treated and it should be cured by taking regularly correct medicine, right dose, correct interval and length of time for treatment while Moe Thaw's study'' showed that 9S% had the perception that early TB treatment could speed up recovery' Therefore, they perceived well on the benefits of the treatment as they could see not only the effects of complication but also those of proper treatment in their suffoundings-

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? 1 Gf1 d1 61 "rurdu ua s n r eu7m.l u1 flid 12oriufi 2 'ror*n1nil RonrFrel 25sz perception on tuberculosis. There was also no association between overall perception and preventive behavior on tuberculosis in one study among Myanmar migrants in Thailand.'t tt this study, there was no association between all source of information and preventive behavior on tuberculosis (p-value >0.05). However, television, magazines and newsp aper, volunteers which had p-value less than 0.1 were included in multiple logistic regression to predictive associated factors. After performing this test, these sources of information could not become predictors for TB preventive behavior. However, television was contributed to be avatlable TB information to take treatment in Moe Thaw's sfudy.t' n this sfudy, when the people who are either educated or non-educated in the community watched television or read newspaper and magazines, they wanted to be skip this information part.the cues to action could not influence TB preventive behavior to change their practices. Recommendations The result of this study revealed that more than gather information for improvement of their behavior on health. Therefore, it is recommended that Ministry of Health should be extended to the coordination and collaboration with intersectoral organi zations to attract the community for information from media which can be got more knowledge about tuberculosis especially about major clinical feature and vaccination for tuberculosis. Health education from media should be strengthened to improve the knowledge level in the community and health volunteers should be considered for TB control programme. Collaboration with supportive agencies should be strengthened to improve the living standard of the community.this study can be applied for TB public health intervention and national control programme for fuberculosis. Acknowledgements express my special thanks to china Medical Board (CMB) for financial support during studying in this programme. would like to express my sincere and deep gratitude to the participants who gave valuable contributions to this study. half of respondents had good preventive behavior on tuberculosis and about one sixth of them had good overall knowledge and perception. There was significant association between knowledge level and TB preventive behavior. The income of TB patients' family was significant predictors for TB preventive behavior. Therefore, the knowledge of family members of TB patients could influence to their preventive behavior and the property of TB patient household related with TB prevention because the vulnerable group for TB is low socio-economic society. All of References l. Cox H, Kebede Y, Allamuratova S, smailov G, Davletmuratovaz, Byrnes G, et al. Tuberculosis recuffence and mortality after successful treatment: mpact of drug resistance. PLoS Med. 2006; 3( l0): 183 6-1843. 2. Centers for disease control and prevention. Data and Statistics. [online] Available from http:ll www.cdc.gov ltbl statistics. laccessed 2013 September 221. participants got TB information from government health staffs but the media could not influence to

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T " 1 6f1 6f1 6 1 rra U fl 1 UTm.J L[1 "ftt6fu Ai{ 12ot7ufi 2 'rqrnlfnr RonrFtu 2557 20. Vukovic D, Nagorni-Obradovic L, Bjegovic V. Knowledge and misconceptions of tuberculosis in the general population in Serbia. Ernopean Journal of Clinical Microbiology & nfectious Diseases. 2008; 27(9):76r-7. 21. Thwin HT. Preventive behaviors of tuberculosis i among Myanmar migrants at Muang district, i Phuket province, Thailand [M.P.H. Thesis in i Public Health Program in Health Systems Dei velopment]. Bangkok: College of Public Health Sciences, Chulalongkorn University; 2008.