Knowledge, Attitudes, and Stigma: The Perceptions of Tuberculosis in Equatorial Guinea

Tuberculosis remains one of the major causes of morbidity and mortality in Equatorial Guinea, with an estimated incidence of 280 per 100,000 inhabitants, an estimated mortality rate of 96 per 100,000 inhabitants, and a treatment non-adherence rate of 21.4%. This study aimed to identify the factors associated to TB-related knowledge, attitudes, and stigma in order to design community intervention strategies that could improve TB diagnostic and treatment adherence in Equatorial Guinea. A nationwide cross-sectional survey of 770 household caregivers was conducted in Equatorial Guinea about TB knowledge, attitudes, and practices. Knowledge, attitude, and stigma scores were calculated through correct answers and the median was used as cut-off. Associated factors were analyzed calculating prevalence ratio (PR) and a 95% confidence interval (95% CI) through Poisson regression with robust variance. The percentage of women was 53.0% and median age was 46 years (IQR: 33-60). The percentage of caregivers with high TB related knowledge was 34.9%, with a bad attitude (52.5%) and low stigma (40.4%). A greater probability of having good knowledge was observed in those 45 years old or less (PR: 1.3, 95% CI: 1.1-1.6), those with higher education level (PR: 1.4, 95% CI: 1.1-1.8) and higher wealth (PR: 1.4, 95% CI: 1.0-2.0), while sex (PR = 0.8, 95% CI: 0.6-0.9), religion (PR = 1.4, 95% CI: 1.0-1.8), and good knowledge (PR = 1.4, 95% CI: 1.2-1.7) were associated with good attitudes. Wage employment (PR = 95% CI: 1.2-1.4), feeling well informed (PR = 0.7, 95% CI: 0.6-0.8), having good TB knowledge (PR = 1.3, 95% CI: 1.1-1.7), and some sources of information were associated with having lower TB-related stigma. This study found that a high percentage of caregivers in Equatorial Guinea lack important knowledge about TB disease and have bad attitudes and high TB-related stigma. Given the epidemiological situation of TB in the country, it is urgent to improve TB knowledge and awareness among Equatorial Guinea's general population.This study was funded by Instituto de Salud Carlos III (PI18CIII/00023) and the Fundación Estatal Salud, Infancia y Bienestar Social (FCSAI).S

A novel strategy based on genomics and specific PCR reveals how a multidrug resistant Mycobacterium tuberculosis strain became prevalent in Equatorial Guinea 15 years after its emergence.

OBJECTIVE: Molecular epidemiology techniques in tuberculosis (TB) can identify high-risk strains that are actively transmitted. We aimed to implement a novel strategy to optimize the identification and control of multidrug-resistant (MDR) TB in a specific population. METHODS: We developed a strain-specific PCR tailored from whole genome sequencing (WGS) data to track a specific MDR prevalent strain in Equatorial Guinea (EG-MDR). RESULTS: The PCR was applied prospectively on remnants of GeneXpert reaction mixtures owing to the lack of culture facilities in Equatorial Guinea. In 147 (93%) of 158 cases, we were able to differentiate between infection by the EG-MDR strain or by any other strain and found that 44% of all rifampicin-resistant TB cases were infected by EG-MDR. We also analysed 93 isolates obtained from Equatorial Guinea 15 years ago, before MDR-TB had become the problem it is today. We found that two of the scarce historical MDR cases were infected by EG-MDR. WGS revealed low variability-six single nucleotide polymorphisms acquired by this strain over 15 years-likely because of the lack in the country of a specific program to treat MDR-TB. CONCLUSIONS: Our novel strategy, which integrated WGS analysis and strain-specific PCRs, represents a low-cost, rapid and transferable strategy that allowed a prospective efficient survey and fast historical analysis of MDR-TB in a population

Rural–Urban Inequities in Tuberculosis-Related Practices in Equatorial Guinea

Abstract Background Tuberculosis (TB) is one of the leading causes of mortality from a single infectious disease agent. Equatorial Guinea is a country with high estimated TB incidence in 2021 (275 cases per 100,000 population) and low TB case detection (42%). Early diagnosis and prompt treatment are crucial for TB control. Failure to seek adequate health care increases the disease’s transmission and leads to poor treatment outcome, the mortality, even for easily manageable conditions. Information regarding community management of TB and treatment-seeking patterns in Equatorial Guinea is rare. The aim of this study was to explore differences in TB health-seeking behaviour among urban and rural population TB cases in Equatorial Guinea and the factors associated with this behaviour. Methods A national cross-sectional study of 770 household caregivers was conducted in 2020 in Equatorial Guinea using multistage stratified sampling. The 284 caregivers that reported having had a TB case in their family were included in this study. A practice index was created. Poisson regression with robust variance was performed with the practices index as dependent variable to assess the factors associated with the health-seeking behaviour. Results Most of the cases (65%) have had good TB health-seeking practices. However, 23.2% of TB cases reported having abandoned treatment before 6 months. A higher probability of having good TB practices was observed with being women, aged and living in rural area. Those who were TB cases themselves have heard about TB on the radio, and had high knowledge about TB, hand also good practices. Conclusions Disparities in tuberculosis health-seeking behaviour between rural and urban populations highlight the challenges existing in the fight against this infectious disease. The National Tuberculosis Control Program has to reinforce the health system needs to strengthen the follow-up of TB patients taking into account the population at risk of inappropriate TB behaviour. Trial Registration Not applicable

Treatment Adherence of Tuberculosis Patients Attending Two Reference Units in Equatorial Guinea.

Equatorial Guinea has one of the highest burden of tuberculosis (TB) in Africa. Incomplete adherence to TB treatment has been identified as one of the most serious remaining problem in tuberculosis control. The following study is aimed at determining the adherence to anti-tuberculosis treatment in Equatorial Guinea and its determinants, as well as at assessing the knowledge of the people about the disease. In this cross-sectional study, participants were recruited by non-probabilistic consecutive sampling amongst patients who attended the reference units for TB in Bata and Malabo between March and July 2015. Socio-demographic and clinical data were collected. Adherence to treatment and knowledge about TB were assessed by Morisky-Green-Levine and Batalla tests and a questionnaire on adherence related factors specifically prepared for this research. Descriptive statistics were computed to summarize the data and bivariate analyses by adherence profile were performed with χ2 test for categorical data. A total of 98 patients with TB were interviewed. 63.27% of interviewees had good knowledge about TB (Batalla test) while 78.57% of respondents were adherent according to the Morisky-Green-Levine test. A low educational level, lack of family support and lack of medical advice about the disease were significantly associated to lower adherence level. Patients with re-infection (due to relapse or treatment failure) and those who have suffered from drug shortages were also less adherents. The National Programme for TB Control should consider improving the early diagnosis and follow-up of TB cases, as well as the implementation of all components of DOTS (Directly observed Treatment, short-course) strategy all over the country

TB related clinical characteristics of the study population, Equatorial Guinea, May-July 2015.

<p>TB related clinical characteristics of the study population, Equatorial Guinea, May-July 2015.</p

Main features of the study population, Equatorial Guinea, May-July 2015.

<p>Main features of the study population, Equatorial Guinea, May-July 2015.</p

TB knowledge and adherence determinants, Equatorial Guinea, May-July 2015.

<p>TB knowledge and adherence determinants, Equatorial Guinea, May-July 2015.</p

TB knowledge and adherence profile and related determinants, Equatorial Guinea, May-July 2015.

<p>TB knowledge and adherence profile and related determinants, Equatorial Guinea, May-July 2015.</p

A novel strategy based on genomics and specific PCR reveals how a multidrug resistant Mycobacterium tuberculosis strain became prevalent in Equatorial Guinea 15 years after its emergence.

OBJECTIVE: Molecular epidemiology techniques in tuberculosis (TB) can identify high-risk strains that are actively transmitted. We aimed to implement a novel strategy to optimize the identification and control of multidrug-resistant (MDR) TB in a specific population. METHODS: We developed a strain-specific PCR tailored from whole genome sequencing (WGS) data to track a specific MDR prevalent strain in Equatorial Guinea (EG-MDR). RESULTS: The PCR was applied prospectively on remnants of GeneXpert reaction mixtures owing to the lack of culture facilities in Equatorial Guinea. In 147 (93%) of 158 cases, we were able to differentiate between infection by the EG-MDR strain or by any other strain and found that 44% of all rifampicin-resistant TB cases were infected by EG-MDR. We also analysed 93 isolates obtained from Equatorial Guinea 15 years ago, before MDR-TB had become the problem it is today. We found that two of the scarce historical MDR cases were infected by EG-MDR. WGS revealed low variability-six single nucleotide polymorphisms acquired by this strain over 15 years-likely because of the lack in the country of a specific program to treat MDR-TB. CONCLUSIONS: Our novel strategy, which integrated WGS analysis and strain-specific PCRs, represents a low-cost, rapid and transferable strategy that allowed a prospective efficient survey and fast historical analysis of MDR-TB in a population