Fact Sheet - Survey of Knowledge, Attitude and Practices to assess the risk of Tuberculosis and HIV transmission among street vendors in Nepal

BRIEF DESCRIPTION OF THE SURVEY: In order to scale up HIV and TB interventions in both the informal sector and with migrants, understanding and addressing the vulnerabilities of street vendors is important. This survey took place in 12 districts in Nepal from August to September 2011 with data collected on socioeconomic profiles, knowledge and perceptions of TB and HIV, health seeking behaviour and atfitudes. The results of this study will inform TB and HIV programme priorities, identify the most effective communication channels and messages for advocacy and education and establish baseline levels to measure changes resulting from interventions. METHODOLOGY: This cross-sectional observational study surveyed street vendors from 36 districts where the Nepal Street Vendors Trade Union (NEST) has its network. The mean population of street vendors in each development region was determined and all districts with populations equal to or more than the mean population in their respective development regions were included (12). A snowball sampling method was then used to select respondents from each sub category within the proportionate sample distribution. The semi-structured questionnaire and methodology used were pretested in Kavre district and administered by trained interviewers to 1027 street vendors from the 12 selected districts. In-depth interviews were completed with district public health, TB and HIV services. Two focus group discussions were conducted in each district with male and female street vendors emphasising those with a history of or currently living with TB or HIV.Using these three instruments for data collection enabled triangulation and validation. Semi-structured questionnaires were entered and analyzed in SPSS, in-depth interviews and focus group discussions were recorded and later translated and analyzed. KEY FINDINGS: Knowledge and attitudes Basic awareness of both diseases is high- 98.6% of respondents had heard of TB and 97.9% had heard of HIV. 95% of respondents agreed that TB will be fatal if left untreated with 97% finding the same for HIV. 8% of respondents agreed that TB could not be cured while 83% agreed that HIV cannot be cured. The majority of respondents were able to correctly identify two key TB symptoms including cough lasting for more than two weeks with fever (77%) and blood in sputum (58%-60% of men and 55% of women). Other symptoms were less well known such as headache (23%), weight loss (24%), chest pain (33%), loss of appetite (26%) and weakness (23%). Knowledge levels of transmission of both TB and HIV were satisfactory with 81% reporting that droplets in air transmit TB and that unsafe sex transmits HIV. Women did have lower knowledge levels than men (77% compared to 83% for TB and 78% compared to 82% for HIV). The majority of respondents also rejected false sources of transmission such as sharing clothes (8%) and shaking hands (2%) for TB and droplets in air (15%), shaking hands and hugging (>1%) for HIV. Unfortunately, aside from contracting HIV through unsafe sex, few respondents were aware that sharing needles, infected blood transfusions and vertical transmission also transmit HIV with no difference between males and females regarding this.