Project – Knowledge, Attitudes and Practices Regarding Tuberculosis Prevention among Residents of Selected Communities in Mushin LGA, Lagos State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Tuberculosis (TB) remains one of the most important infectious diseases confronting global public health despite being both preventable and curable. The disease is caused primarily by Mycobacterium tuberculosis and is transmitted through the air when people with pulmonary TB cough, sneeze, speak or sing. According to the World Health Organization (WHO), an estimated 10.7 million people developed TB globally in 2024, while approximately 1.23 million people died from the disease, including people living with HIV. The African Region accounted for about one-quarter of global incident TB cases, demonstrating the continuing importance of TB control in sub-Saharan Africa. Nigeria is particularly significant because it accounted for approximately 4.8% of global incident TB cases in 2024 and remains one of the countries with the highest TB burdens worldwide (World Health Organization [WHO], 2025).

The prevention and control of TB depend not only on the availability of effective diagnostic and treatment services but also on what individuals and communities know and do about the disease. Knowledge of TB includes understanding its causes, mode of transmission, symptoms, risk factors, prevention methods and availability of treatment. Appropriate attitudes involve willingness to seek medical attention, acceptance of people affected by TB and rejection of misconceptions and stigmatizing beliefs, while preventive practices include cough etiquette, adequate ventilation, early testing, contact screening, adherence to preventive treatment where indicated and use of appropriate infection-prevention measures. The WHO emphasizes early recognition of symptoms, screening of people at increased risk, TB preventive treatment, infection-prevention measures and childhood BCG vaccination as important components of TB prevention (WHO, 2026).

The Nigerian situation makes community knowledge, attitudes and practices particularly important because the country carries a substantial proportion of the global TB burden. The WHO Global Tuberculosis Report 2025 estimated that Nigeria accounted for 4.8% of global incident TB cases in 2024, placing the country among the eight countries that collectively accounted for two-thirds of global TB incidence. The Nigerian response is guided by the National Strategic Plan for Tuberculosis Control, which emphasizes improved case finding, diagnosis, treatment, prevention and community engagement. Nevertheless, achieving these objectives requires more than providing health facilities and medicines. Individuals must recognize possible TB symptoms, understand that TB is infectious and treatable, know where appropriate services are available and be willing to use those services. Consequently, community-level knowledge and behaviour remain important determinants of successful TB control in Nigeria (WHO, 2025; National Tuberculosis and Leprosy Control Programme [NTBLCP], 2021).

Evidence from Nigerian communities demonstrates that awareness of TB does not necessarily translate into adequate knowledge or appropriate preventive behaviour. Balogun et al. (2019), in a study of 504 residents of two underserved urban communities in Lagos, including Idi-Araba in Mushin Local Government Area, reported relatively low mean knowledge, attitude and practice scores. The study found that increasing age, post-secondary education and professional occupation predicted better knowledge, while post-secondary education and good TB knowledge were associated with more positive attitudes. Importantly, good knowledge was also a predictor of good preventive practice. These findings suggest that simply having heard about TB is insufficient; communities require accurate and practical information that can influence attitudes and everyday preventive behaviour. This evidence is particularly relevant to Mushin LGA because it demonstrates that knowledge and behavioural gaps can exist even within urban communities located close to major health institutions (Balogun et al., 2019).

Attitudes toward TB constitute another important dimension of prevention because misconceptions and stigma may discourage individuals from recognizing symptoms, discussing the disease, supporting affected persons or seeking testing. Junaid et al. (2021), in a study among 317 residents of Surulere, Lagos State, found that although 91.8% of respondents were aware of TB, only a small proportion demonstrated very good overall knowledge when the detailed knowledge indicators were considered. The study also reported that only 37.1% had good preventive practices, while 22.7% expressed stigmatizing attitudes. Furthermore, better knowledge was significantly associated with lower stigma. Similarly, a comparative study of urban and rural communities in Lagos State found high awareness of TB but substantial gaps in knowledge and considerable TB-associated stigma, indicating that awareness alone does not guarantee appropriate attitudes and practices (Junaid et al., 2021; Ogbuabor et al., 2020).

Community-based interventions have demonstrated that improving knowledge and attitudes can contribute to better TB prevention efforts. Obiajuru et al. (2015) evaluated a community volunteer intervention in a peri-urban community in southwest Nigeria and found that training community volunteers to provide TB education and identify and refer TB suspects significantly improved respondents’ mean knowledge and attitude scores. The intervention increased the mean knowledge score from 10.6 to 16.0 and the mean attitude score from 5.8 to 7.0, although the improvement in preventive practice was not statistically significant. This finding is important because it indicates that knowledge and attitudes are modifiable through targeted community education, but improvements in knowledge may not automatically produce corresponding changes in practice. Therefore, assessing all three dimensions—knowledge, attitudes and practices—is necessary to understand the factors that influence TB prevention at community level (Obiajuru et al., 2015).

The relevance of examining TB knowledge, attitudes and practices is further strengthened by evidence from communities in Lagos where individuals who are directly exposed to TB may still demonstrate important preventive gaps. A study among TB treatment supporters attending Directly Observed Treatment, Short-course centres in Lagos Mainland found that only 22.5% of participants had good TB knowledge, 53.0% had positive attitudes and only 26.0% adequately protected themselves against TB infection. The study also found that education and relationship to the TB patient were associated with preventive practices. These findings indicate that preventive behaviour can remain inadequate even among persons who have direct contact with TB patients and therefore may have greater exposure to information about the disease. In an urban and densely populated setting such as Mushin LGA, where communities may experience overcrowding and close interpersonal contact, understanding residents’ knowledge, attitudes and practices is therefore important for strengthening community-based TB prevention, reducing stigma and promoting early detection and appropriate health-seeking behaviour (Oladele et al., 2023).

Mushin Local Government Area provides an important setting for studying TB prevention because previous research conducted within the LGA has already identified deficiencies in community TB knowledge, attitudes and practices. However, health knowledge and community practices can change over time as a result of public health campaigns, changing disease patterns, socioeconomic conditions and access to health information. Furthermore, previous studies have often focused on specific communities or particular categories of respondents, making it necessary to generate current evidence from selected communities within Mushin LGA. Assessing residents’ knowledge of TB transmission and prevention, their attitudes toward TB and affected persons, and their actual preventive practices can provide evidence for identifying behavioural gaps and designing interventions that are responsive to local needs. Such evidence is consistent with the Nigerian TB strategic approach, which recognizes community-based activities, case finding, awareness creation, early diagnosis and prevention as essential elements of TB control (NTBLCP, 2021; WHO, 2025).

1.2 Statement of the Problem

Tuberculosis continues to constitute a major public health problem despite the availability of effective diagnostic methods, preventive interventions and curative treatment. The WHO reported that approximately 10.7 million people developed TB worldwide in 2024 and 1.23 million died from the disease. Nigeria contributed about 4.8% of the global incident TB burden, placing it among the countries with the largest numbers of people developing TB. The persistence of such a high burden indicates that biomedical interventions alone have not been sufficient to interrupt transmission. Since TB is airborne and can spread from undiagnosed and untreated infectious individuals to others, delays in recognizing symptoms, failure to seek testing and inadequate preventive practices at community level can facilitate continued transmission (WHO, 2025; WHO, 2026).

A major concern is that community members may possess general awareness of TB without having sufficient knowledge to prevent infection or recognize appropriate actions when symptoms occur. Evidence from urban communities in Lagos illustrates this problem. Balogun et al. (2019) found relatively low knowledge, attitude and practice scores among residents of underserved communities, including Idi-Araba in Mushin LGA. Similarly, Junaid et al. (2021) found that although most residents of Surulere had heard of TB, important deficiencies existed in detailed knowledge and preventive practices, while stigmatizing attitudes remained present. These findings suggest that awareness campaigns may not necessarily result in accurate understanding, positive attitudes or consistent preventive behaviour. If such gaps persist, residents may fail to recognize prolonged cough and other symptoms as possible TB, may not seek appropriate screening promptly, or may engage in practices that increase the risk of transmission (Balogun et al., 2019; Junaid et al., 2021).

Another problem is the influence of stigma, misconceptions and social attitudes on TB prevention. Negative perceptions of TB may lead individuals to associate the disease with shame, poverty, undesirable social behaviour or other misconceptions, thereby discouraging disclosure and interaction with health services. Junaid et al. (2021) reported that 22.7% of respondents in Surulere expressed stigmatizing attitudes, while substantial proportions indicated unwillingness to show compassion to or support employment of people affected by TB. Evidence from Lagos treatment supporters has also shown inadequate knowledge and preventive practices among individuals caring for persons undergoing TB treatment. These findings are concerning because stigma and poor preventive practices can affect not only people already living with TB but also their household members, caregivers and wider community networks. Consequently, understanding the attitudes and practices of residents is necessary for identifying behavioural and social barriers to TB prevention (Junaid et al., 2021; Oladele et al., 2023).

Although previous research has generated useful evidence about TB knowledge, stigma and preventive practices in Lagos, there remains a need for current, community-specific evidence from selected communities in Mushin LGA. The earlier study by Balogun et al. (2019) included Idi-Araba, Mushin, and established important gaps in residents’ TB knowledge, attitudes and practices; however, the findings cannot automatically be assumed to represent all selected communities in the LGA or the current situation several years later. In addition, the demonstrated improvement in knowledge and attitudes following community-based education in southwest Nigeria indicates that locally targeted interventions can produce meaningful changes, but such interventions must be based on accurate identification of existing gaps (Obiajuru et al., 2015). Therefore, the problem addressed by this study is the insufficient current evidence regarding the level of knowledge, nature of attitudes and actual preventive practices regarding TB among residents of selected communities in Mushin LGA, Lagos State. Without such evidence, public health planners may find it difficult to develop appropriately targeted health education, stigma-reduction and community TB prevention programmes (Balogun et al., 2019; Obiajuru et al., 2015).

1.3 Purpose of the Study

The main purpose of this study is to assess the knowledge, attitudes and practices regarding tuberculosis prevention among residents of selected communities in Mushin Local Government Area, Lagos State.

1.4 Objectives of the Study

The specific objectives are to:

1. assess the level of knowledge of tuberculosis prevention among residents of selected communities in Mushin LGA, Lagos State;
2. determine the attitudes of residents towards tuberculosis and its prevention;
3. assess the preventive practices adopted by residents against tuberculosis infection and transmission;
4. determine the relationship between residents’ knowledge of tuberculosis and their preventive practices

1.5 Research Questions

The following research questions will guide the study:

1. What is the level of knowledge of tuberculosis prevention among residents of selected communities in Mushin LGA, Lagos State?
2. What are the attitudes of residents towards tuberculosis and its prevention?
3. What preventive practices are adopted by residents against tuberculosis infection and transmission?
4. Is there a relationship between residents’ knowledge of tuberculosis and their preventive practices?

1.6 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between residents’ knowledge of tuberculosis and their preventive practices regarding tuberculosis in selected communities in Mushin LGA, Lagos State.

1.7 Significance of the Study

The findings of this study will be useful to residents of Mushin LGA because they will provide information on important aspects of TB prevention, including transmission, symptoms, early detection, screening, infection prevention and appropriate health-seeking behaviour. By identifying existing misconceptions and behavioural gaps, the study may help community members understand the practical measures required to reduce TB transmission and protect themselves, their families and other members of the community.

The study will also be useful to healthcare workers, particularly community health officers, nurses, environmental health personnel, medical practitioners and TB control workers. Information on residents’ knowledge, attitudes and practices can assist health workers in designing health education messages that respond to specific misconceptions and behavioural challenges within the communities. The findings may also support more targeted community sensitization, contact screening and referral activities.

The findings will be relevant to the Lagos State Ministry of Health, the Lagos State TB control programme and other public health agencies involved in TB prevention and control. Evidence concerning community-level knowledge, stigma and preventive practices may assist policymakers in strengthening community-based TB education, case finding, stigma-reduction strategies and preventive interventions. This is consistent with Nigeria’s national TB strategic direction, which emphasizes community participation, early diagnosis, treatment and prevention (NTBLCP, 2021).

Community leaders, religious leaders, traditional leaders, civil society organizations and community-based organizations may also benefit from the study. Such groups are important channels for health communication and community mobilization. Evidence from southwest Nigeria indicates that community-based education can improve TB knowledge and attitudes, suggesting that appropriately trained community structures can contribute to TB prevention and early identification of suspected cases (Obiajuru et al., 2015).

Finally, the study will contribute to the body of literature on TB prevention in urban Nigerian communities. It may serve as a reference for researchers, students and public health practitioners who intend to conduct further studies on TB knowledge, attitudes, stigma, preventive behaviour and community-based disease control. It may also provide baseline information for future intervention studies designed to evaluate the effectiveness of TB health education programmes in Mushin LGA and other densely populated urban communities.

1.8 Scope of the Study

The study will focus on knowledge, attitudes and practices regarding tuberculosis prevention among residents of selected communities in Mushin Local Government Area of Lagos State.

The study will specifically examine residents’ knowledge of the causes, mode of transmission, signs and symptoms, risk factors, diagnosis, treatment and prevention of TB. It will assess attitudes relating to TB, including perceptions of susceptibility, seriousness, preventability, treatment, people living with TB and TB-related stigma. It will also examine preventive practices such as cough etiquette, ventilation, early health-seeking behaviour, screening, contact investigation, avoidance of prolonged exposure to infectious persons and other relevant protective behaviours.

The study will be restricted geographically to selected communities within Mushin LGA, Lagos State. The target population will comprise adult residents who have lived in the selected communities for a specified minimum period. The study will not attempt to clinically diagnose respondents for TB; rather, it will assess their knowledge, attitudes and reported preventive practices.

1.9 Operational Definition of Terms

Attitude: The feelings, beliefs, perceptions and predispositions held by residents towards tuberculosis, people affected by TB and TB prevention measures.

Community: A geographically defined group of people living within the selected areas of Mushin Local Government Area, Lagos State.

Knowledge: The level of accurate information possessed by residents concerning tuberculosis, including its causes, transmission, symptoms, risk factors, diagnosis, treatment and prevention.

Preventive Practices: Actions and behaviours adopted by residents to reduce their risk of acquiring or transmitting tuberculosis, including appropriate cough etiquette, ventilation, screening, early health-seeking and other recommended protective measures.

Residents: Adults who live within the selected communities in Mushin LGA and meet the eligibility requirements for participation in the study.

Stigma: Negative beliefs, discriminatory attitudes, social rejection or unwillingness to associate with individuals because they are suspected of having or have been diagnosed with tuberculosis.

Tuberculosis (TB): An infectious disease caused mainly by Mycobacterium tuberculosis, most commonly affecting the lungs and capable of spreading through the air from an infectious person to others (WHO, 2026).

Tuberculosis Prevention: Measures designed to prevent TB infection, reduce progression from infection to disease and limit transmission, including screening, preventive treatment, vaccination, early diagnosis, appropriate treatment, ventilation, cough hygiene and infection-prevention measures (WHO, 2025, 2026).

Health-Seeking Behaviour: The actions taken by individuals when they perceive symptoms or risk of disease, including seeking information, screening, diagnosis and appropriate care from recognized health services.

Community-Based TB Prevention: TB prevention activities carried out within communities through health education, awareness creation, active case finding, referral, contact investigation and other interventions involving community members and health workers.

Project – Knowledge, Attitudes and Practices Regarding Tuberculosis Prevention among Residents of Selected Communities in Mushin LGA, Lagos State.