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This review is an intellectual plot line of an article by Dr. Shiv Kumar Yadav et al., (2015) titled “Assessment of Knowledge and Treatment Seeking Behavior among Tuberculosis (TB) and MultiDrug Resistant Tuberculosis (MDR-TB) Patients”. The researchers used unmatched case control study to explore the knowledge on causes, mode of spread, duration of treatment among drug susceptible TB (controls) and MDR-TB (cases) participants. A pre-tested, standardized semistructured questionnaire was used to collect data which was presented in tables and graphs. In this review, attempt will be made to provide a constructive, supportive and fair assessment of the article based on how it is written. This study revealed that there is wide gap in knowledge and treatment initiation among drug susceptible TB and drug resistant TB patients. Furthermore, this review will analyze the structure, content and relevance of the article in addressing knowledge and health seeking behavior among MDR-TB and TB patients. Numerous articles (Finnie et al., 2011, Skordis-Worrall, Hanson & Mills, 2010; Mavhu et al, 2010; Yimer, Bjune & Alene, 2005) have focused on diagnosis and treatment initiation delays among TB patients. Therefore, this review will identify both the strengths and weaknesses of this article with respect to this subject area and will proffer some supportive suggestions for improvement. keywords: Drug Sensitive Testing, Health Seeking Behavior, Unmatched Case Control Study, Knowledge, Multi-Drug Resistant Tuberculosis, Drug Susceptible Tuberculosis, Treatment. Article structure and summary The article provides an abstract subdivided into context of the subject matter; setting and design; methods and materials; results and conclusion. Using purposive sampling technique, 68 cases were selected from the indoor ward of the Department of Pulmonary Medicine and 136 controls were drawn from patients registered for direct observed TB treatment in Surat District (rural and urban). The study was conducted between October 2013 and June 2014. Drug sensitivity testing was carried out at DTC Surat. A molecular technique in the form of cartridge based nucleic acid amplification test (CBNAAT) method was used to detect rifampicin resistance and susceptibility. Patient with rifampicin resistance TB were selected as cases and those with rifampicin sensitive TB were enrolled as controls. Participation in the study was voluntary and those willing to participate had their sputum samples tested for drug resistance and susceptibility without coercion. For the respondents who were less than 18 years of age, participation was granted only if reliable parent (mother or father or guardian) was accompanying the respondent. The parents also gave consent for the respondents. In a separate study on TB health seeking behavior, Skordis-Worrall, Hanson and Mills (2010) excluded children with TB from participating in the study. Historically, children with TB have not been given much attention by researchers, policy makers and clinicians as the disease was thought to be less prevalent in children. DOI: 10.21522/TIJPH.2013.06.03.Art008 ISSN: 2520-3134 This exclusion of children with TB and MDR-TB in most cases results in failure of interven tions to control epidemic TB. Children provide a significant pool of reservoir of TB and MDR-TB bacilli. Therefore, it is crucial that research efforts must also be redirected to identify, diagnose and treat TB in children. Being a case study, Yadav and colleagues state one of the study limitations as recall, interview and selection bias. Consequently, the findings of this study cannot be generalized. The article has links to references, citation, subjects and author allowing the reader to easily review and evaluate the article. The authors used Strengthening the Reporting of Observation Studies in Epidemiology (STROBE) checklist. STROBE relates to a collaborative initiative of epidemiologists, researchers, statisticians, journal editors involved in carrying out research and reporting of observational studies at an international level. The authors presented the following: study setting, duration, collection tool, sample technique, sample size factoring in confounding factors. Additionally, an outline of the selection of cases and controls and their inclusion and exclusion criteria, assumption and ethical consideration are presented. However, the article fell short of describing how missing data was addressed, the source of funding and the role of funders in the study. There is need to identify cases of TB and MDR-TB within the communities using active case finding approach. The study used a passive (health center based) case finding model. The article also failed to evaluate the relationship between patient, health system delay factors and MDR-TB using credible parametric or non-parametric tests. A statistical test like two-sided univariate analysis would have been significant to establish relationship among factors and demographics. No demographic data is given in this article. There questions probed from participants about their knowledge of TB were not exhaustive. The authors could have gathered information on modes of spread of TB (e.g. speaking, sharing of spoons, sneezing and coughing) and the participants’ knowledge on TB symptoms e.g. cough, cough up blood, weight loss, fever and night and difficulty in breathing.

texila international journal of public health

A Peer Review of the Assessment of Knowledge and Treatment Seeking Behavior among Tuberculosis and Multi-Drug Resistant Tuberculosis Patients: A Case Control Study