Correspondence

References
1 World Health Organization. Guidelines for the programmatic
management of drug-resistant tuberculosis. Emergency update
2008. WHO/HTM/TB/2008.402. Geneva, Switzerland: WHO,
2008. http://whqlibdoc.who.int/publications/2008/9789241547
581_eng.pdf Accessed June 2013.
2 Caminero J A, ed. Guidelines for clinical and operational management of drug-resistant tuberculosis. Paris, France: International Union Against Tuberculosis and Lung Disease, 2013.
3 World Health Organization. Treatment of tuberculosis: guidelines. 4th ed. WHO/HTM/TB/2009.420. Geneva, Switzerland:
WHO, 2009. http://whqlibdoc.who.int/publications/2010/9789
241547833_eng.pdf Accessed June 2013.
4 Bojorquez-Chapela I, Bcker C E, Orejel I, et al. Drug resistance
in Mexico: results from the National Survey on Drug-Resistant
Tuberculosis. Int J Tuberc Lung Dis 2013; 17: 514519.
5 Granich R M, Balandrano S, Santaella A J, et al. Survey of drug
resistance of Mycobacterium tuberculosis in 3 Mexican states,
1997. Arch Intern Med 2000; 160: 639644.
6 Blumberg H M, Burman W J, Chaisson R E, et al. American
Thoracic Society/Centers for Disease Control and Prevention/
Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003; 167: 603662.

Sociodemographic basis of tuberculosis

knowledge in Bolivia
Tuberculosis (TB) is a disease that disproportionally
affects the poor. Bolivia has an estimated population
of 10 million, mostly mestizo and indigenous Aymara
and Quechua people, 51.3% of whom live in poverty.1 In South America, Bolivia ranks highest in the
incidence of TB, with a rate of 131 cases per 100 000
population.2 Lack of knowledge about TB may play
an instrumental role in preventing symptomatic individuals from seeking medical attention. In this preliminary study (approved by the Tuberculosis Departmental Laboratory SEDES in La Paz and the
Research Ethics Committee of the London School of
Hygiene & Tropical Medicine), we assessed factors
associated with health-seeking behaviour and knowledge of TB among persons presenting to health centres. Face-to-face interviews with 20 adult patients
from each of the three participating health facilities
located in three geographically distinct regions of
Bolivia (El Alto, Achacachi and Caranavi) were conducted from 18 June to 26 July 2012. Interview data
were coded and analysed using Stata 12.1 (Stata
Corp, College Station, TX, USA).
The mean age of the patients interviewed was
26.9 years (1844); the majority (90%) were women.
The majority had completed either primary (43.3%)
or secondary (45%) school. Patients who lived less
than 30 minutes away from a health centre were more
likely to go there or visit a pharmacy if sick, while
those who lived 1 to 3 hours away practised home
remedies (P = 0.045). The most commonly identified
symptom of TB was persistent cough (60%). Overall,
61.7% of the interviewees knew that TB is a curable
disease, and 60% knew that it is an infectious disease. Adjusting for schooling, the data suggested a

1245

statistically significant association between location

and ability to identify cough as a symptom of TB (P =
0.02) as well as with knowing that TB is curable (P <
0.01). In addition, there was a statistically significant
association between completing secondary school and
knowing about the curability of TB, when adjusting
for location and age (adjusted odds ratio 8.27; 95%
confidence interval 1.1559.50).
This study represents the first time that healthseeking behaviour and understanding of TB has been
assessed in a Bolivian population. The association between education and knowledge about the disease
has been reported in other countries.3,4 In those settings, patients who knew about TB symptoms and its
curability and perceived diagnosis and treatment as
being free were more likely to seek medical attention
in the formal health sector.5 The association between
location and knowledge may be partly explained by
the activities of public health campaigns in El Alto.
Caranavi patients were less knowledgeable about TB
than those in El Alto, but more knowledgeable than
patients in Achacachi. This is possibly because Caranavi is highly endemic for TB.
This study had several limitations, including the
small sample size, the cross-sectional survey design,
and the use of convenience sampling, which prevents
us from generalising the findings to the general Bolivian population. Further studies exploring the sociodemographic determinants of TB knowledge across
all of Bolivia are needed to build on the findings of
this study and to assist with effective targeting of future public health campaigns.
Mary Punchak*
Pilar Hernandez
Christian Bottomley*
Carla Jemio
Mirtha Camacho
Ruth McNerney*
*London School of Hygiene & Tropical Medicine
London
UK
Pro Mundi Share Salut
Romualdo Herrera 770
La Paz
Laboratorio Departamental de
Tuberculosis SEDES La Paz
La Paz
Instituto Nacional de Laboratorios de Salud
La Paz, Bolivia
e-mail: mary.punchak@gmail.com
http://dx.doi.org/10.5588/ijtld.13.0432

Acknowledgements
The authors acknowledge the assistance of N Nina, Licenciada R
Casillo and J Melgarejo and other staff at the collaborating centres
and the patients who took part in this study. They also thank the
London School of Hygiene & Tropical Medicine Trust Funds for financing travel to Bolivia to carry out field research for this project.

1246

The International Journal of Tuberculosis and Lung Disease

References
1 World Bank. World development indicatorsBolivia, 2012.
Washington, DC, USA: World Bank. http://www.worldbank.
org/en/country/bolivia Accessed June 2013.
2 World Health Organization. Global tuberculosis control, 2012.
WHO/HTM/TB/2012.6. Geneva, Switzerland: WHO, 2012.
3 Salaniponi F M L, Harries A D, Banda H T, et al. Care seeking
behaviour and diagnostic processes in patients with smear-positive

pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis 2000;

4: 327332.
4 Storla D G, Yimer S, Bjune G A. A systematic review of delay in
the diagnosis and treatment of tuberculosis. BMC Public Health
2008; 8: 15.
5 Cuevas L E, Yassin M A, Al-Sonboli N, et al. A multi-country
non-inferiority cluster randomized trial of frontloaded smear
microscopy for the diagnosis of pulmonary tuberculosis. PLoS
Med 2011; 8(7): e1000443.

ERRATUM
IN THE ARTICLE entitled Waterpipe smoking: prevalence and attitudes among medical students in
London by M. Jawad, J. Abass, A. Hariri, K. G. Rajasooriar, H. Salmasi, C. Millett, F. L. Hamilton (Int J
Tuberc Lung Dis 2013; 17(1): 137140; http://dx.doi.org/10.5588/ijtld.12.0175), an error occurred in
the labelling of the last three lines of Table 2. It should have read as follows:

OR (95%CI)

P value

Prevalence:
ever
%

1.0
6.90 (2.9216.30)
14.85 (3.3565.89)

<0.01
<0.01

4.4
84.3
93.5

Ever smoker (n = 253)

Smoking status
Never
Former
Current

OR (95%CI)

P value

Prevalence:
current
%

1.0
0.76 (0.222.67)
5.16 (1.9213.87)

<0.67
<0.01

9.6
9.8
32.3

Current smoker (n = 54)

[http://dx.doi.org/10.5588/ijtld.12.0175-e]