title: Prevention and control of tuberculosis in workplaces: how knowledgeable are the workers in Bangladesh?
abstract: BACKGROUND
  The National Tuberculosis (TB) Control Programme (NTP) of Bangladesh succeeded in achieving the dual targets of 70 % case detection and 85 % treatment completion as set by the World Health Organization. However, TB prevention and control in work places remained largely an uncharted area for NTP. There is dearth of information regarding manufacturing workers' current knowledge, attitudes and practices (KAP) on pulmonary TB which is essential for designing a TB prevention and control programme in the workplaces. This study aimed to fill-in this knowledge gap.
  
  
  METHODS
  This cross-sectional survey was done in multiple workplaces like garment factories, jute mills, bidi/tobacco factories, flour mills, and steel mills using a multi-stage sampling procedure. Data on workers' KAP related to pulmonary TB were collected from 4800 workers in face-to-face interview.
  
  
  RESULTS
  The workers were quite knowledgeable about symptoms of pulmonary TB (72 %) and free- of-cost sputum test (86 %) and drug treatment (88 %), but possessed superficial knowledge regarding causation (4 %) and mode of transmission (48 %). Only 11 % knew about preventive measures e.g., taking BCG vaccine and/or refraining from spitting here and there. Knowledge about treatment duration (43 %) and consequences of incomplete treatment (11 %) was poor. Thirty-one percent were afraid of the disease, 21 % would feel embarrassed (and less dignified) if they would have TB, and 50 % were afraid of isolation if neighbours would come to know about it. Workers with formal education (AOR 1.92; 95 % CI 1.61, 2.29) and exposure to community health workers (CHW) (AOR 31.60; 95 % CI 18.75, 53.35) were more likely to have TB knowledge score ≥ mean. Workers with knowledge score ≥ mean (AOR = 1.91; 95 % CI:1.44, 2.53) and exposure to CHWs either alone (AOR = 42.4; 95 % CI: 9.94, 180.5) or in combination with print media (AOR = 37.35; 95 % CI: 9.1, 180.5) were more likely to go to DOTS centre for treatment . Only around 43 % had sputum examination despite having chronic cough of ≥ 3 weeks duration.
  
  
  CONCLUSIONS
  The workers had inadequate knowledge regarding its causation, transmission and prevention which may interfere with appropriate treatment-seeking for chronic cough including sputum test. NTP needs to be cognizant of these factors while designing a workplace TB prevention and control programme for Bangladesh.
authors.affiliation: Bangladeshi-Canadian Community Services, Toronto, Canada. qsislam@bangladeshi.ca.
authors.forename: Qazi Shafayetul
authors.initials: QS
authors.lastname: Islam
authors.affiliation: Health, Nutrition and Population Programme, BRAC, Dhaka, Bangladesh. akramul.mi@brac.net.
authors.forename: Md Akramul
authors.initials: MA
authors.lastname: Islam
authors.affiliation: Health, Nutrition and Population Programme, BRAC, Dhaka, Bangladesh. shayla.i@brac.net.
authors.forename: Shayla
authors.initials: S
authors.lastname: Islam
authors.affiliation: Centre of Excellence for Universal Health Coverage James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, 5th Floor(Level-6), ICDDR,B Building Mohakhali, Dhaka, 1212, Bangladesh. ahmed.sm@bracu.ac.bd.
authors.forename: Syed Masud
authors.initials: SM
authors.lastname: Ahmed
mesh_terms: D000293:Adolescent; D000328:Adult; D001500:BCG Vaccine / Q000627:therapeutic use; D001459:Bangladesh; D003150:Community Health Workers; D003371:Cough; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D066192:Manufacturing Industry; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control; D009786:Occupational Health Services; D010342:Patient Acceptance of Health Care; D013183:Sputum; D014376:Tuberculosis / Q000517:prevention & control; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000517:prevention & control* / Q000635:transmission; D017132:Workplace; D014944:World Health Organization; D055815:Young Adult
chemical_list: D001500:BCG Vaccine