Abstract

PIP: The Tuberculosis Control Program began its reorganization in 1979, when the Honduran Ministry of Public Health designated tuberculosis as one of its priority problems. Administrative and logisitical problems faced by the program were exacerbated by the public's negative image of the disease and the consequent rejection of anything related to it, including medical diagnosis and treatment. A baseline investigation was carried out to determine the knowledge, attitudes and behaviors of the public, patients and patients' relatives regarding tuberculosis (TB). Sampled were 361 healthy adults, 75 tuberculosis patients, 55 relatives of patients, 20 health personnel, 12 nurses in 12 health centers, and 3 epidemiologists. Data was gathered using surveys (healthy population), focus groups (healthy population, patients) unstructured interviews (relatives, health personnel, nurses and epidemiologists) and focused interviews (relatives). The investigation confirmed the existence of social rejection toward TB. The disease is considered quite contagious, and is associated with extreme poverty, filth and malnutrition. The patients stated that this rejection is 1 of the greatest burdens of their disease; they considered themselves a danger to others and expressed feelings of guilt. The most recognized symptom was coughing and expectoration. A person with a persistent cough does not however, want to think of TB, except as a very remote possibility. Health personnel also fail to perceive a persistent cough as a respiratory symptom and possible indicator of TB. Cough syrups and bronchial decongestants are the most widely distributed medicines in rural health centers. Both the patients and the general population queried knew that TB is curable, although they doubted that the patient could recover his/her full health. Patients' fear was that the long period of treatment would inevitably lead to their neighbors discovering that they had the disease and rejecting them. The health system's capacity to diagnose and treat TB was also analyzed. Several problems were detected in the diagnosis of respiratory cases, e.g., difficulties leading to long delays in the collection and analysis of sputum samples and in the subsequent reporting of the findings. Moreover, instructions given to the patient are quite vague as to exactly what quality sputum is needed and how best to obtain it. These problems affect the number of patients who are diagnosed and treated, but seem to have little bearing on those already being treated. An education campaign was prepared based on these findings. Its goals were toinform the population at large that TB patients no longer transmit the disease, that they can be completely cured if treatment is begun promptly, and that a persistent cough lasting for more than 15 days may be a symptom. A pamphlet has been developed to better educate the patients and their relatives. It is concluded that an understanding of and familiarity with the client's perspective can help educational programmers identify exactly which facts or opinions must be reinforced or modified so that beneficial health services are utilized.