There is a consensus in the essential knowledge about
prevention of TB to school students. The panel of the experts agrees that knowledge about general introduction about TB like agents, types is essential to be provided to the students, along with that knowledge about DOTS, signs, and symptoms of TB is important. Surprisingly, the final 7 most essential statement does
not include the prevention and control of the TB. The reasons could be the experts perceive it is clinical aspects, treatment is more important than the preventive activities. On the other hand, the expert might not be much aware of the infection control measures at the community level. The level of knowledge on TB infection control was poor among almost half of the health care workers [13]. It is recommended to the NTP that, the activities should be focused on prevention and control of TB rather than clinical and treatment parts. Knowledge and perceptions about tuberculosis
can stimulate, adopting TB prevention actions, service-seeking behavior and adherence to treatment of tuberculosis [14]. One of the statements that, experts agree is the inclusion of information related to tuberculosis in the Nepali book course. There is inadequate knowledge of TB and its transmission among school
students which encourages the change in behaviors among them
[15-17]. The reasons, maybe due to a paucity in the content of the school curriculum or the availability of information, education, and communication materials [14]. The emphasis needs to be given on increasing the knowledge, attitude, and practice of students about
TB and its transmission.
Another interesting finding is that there is quite similarity
between the statements of ranking between teachers and health
workers, FCHV which reveals similar level of understanding
about the TB between them. It also indicates it would be effective to mobilize the teachers about community activities. However, there are limited studies on the level of knowledge about TB among schoolteachers. So, it is necessary to carry out research to determine the level of knowledge among the schoolteachers. On the basis of mean rank of the statement, methods, and tools of TB diagnosis rank 6th. However, the level of agreement is lowest
among the top 7 statement. The reason for it could be a high
variation in the ranking of the statement between the experts. i.e some of the experts perceives it is the high importance and others as low importance. The majority of statements belong to theme 1 i.e general introduction of tuberculosis like sharing knowledge about agent, types of TB, sign, and symptoms, national strategic plans and activities. There is a variation in the mean for each statement in the second and third rounds of the Delphi technique. In the second round, the statements have lower average meanwhile in the third round of the mean has increased most some important listed statement while decreased among the lower-ranked statement in the second round which is expected. As in the third round ranked list of statements were distributed to the experts with controlled
feedback based on mean rank. That has resulted in the strong
consensus in the statements [18].
In the data analysis, the first round of Delphi used qualitative
data analysis techniques using the KJ methods. The information was analyzed with mostly same wording with minor editing and reduced number of items after summarising and grouping of the items. While in the second and third round descriptive statistics were used. Ascertaining the level of collective opinion often entails the use of descriptive and inferential statistics [19]. One of the aims of the study is to understand the essential knowledge about prevention
of TB to communicate school students and develop IEC materials on it. However, the agreed statements on the essentials knowledge on prevention of TB are limited to the aggregate representation of
expert’s opinions as well as there is no opportunity for participants to elaborate on their opinions and agreement. Therefore, it does not
mean that all the agreed statements are most essential information for the prevention of TB. Instead, it can be used for structuring the discussion at the National level and means for raising issues for debate [19].
The participants involved in the study are from the urban areas
of the country particularly the Kathmandu. So, the result of the
study will be difficult to generalize. There are differences in the level of knowledge and skills among the health workers, teachers, volunteers and DTLOs from rural and urban areas. The knowledge level in TB among health workers was significantly associated with educational status, and TB training and/or orientation received [13]. Furth more, the essential information might vary on the basis of ecological areas of the country. So, it is recommended to conduct
more research across different geographical areas in the country.
The response rate is for the survey is excellent despite potential chances of low response rate the survey [20]. Due to multiple feedback processes, along with long items and rounds increases the chances of low response rate in the Delphi survey [20]. A high response rate was achieved because of regular follow up with the participants and sending reminders by research assistant [21,22].
The essential knowledge for prevention of TB among school
students should include information about the agent, types of TB, DOTS process and its importance, sign, and symptoms, national strategic plans, including the elements of psychosocial counseling to TB patients. It does not mean, that it should only include this
information. The results can be used for developing the IEC
materials focusing school students as well as for further research. There is need for future research with other professional groups like (Doctors, Lab personal). Consequently, the research should
be implemented in the various context like urban-rural, ecological distribution.
The research was funded by Kanagawa University of Human
Services to Assistant Professor, Mika Kigawa. We would like to thank the participants, Public health section, Kathmandu Municipality and the National Tuberculosis Centre for making the study possible.