Research Article
ISSN: 2574 -1241

DOI: 10.26717/BJSTR.2020.26.004332

Expert Consensus on the Essential Preventive
Knowledge of Tuberculosis for High SchoolStudents, Kathmandu, Nepal
Ram Sharan Gopali*1, Bijay Maharjan1 and Mika Kigawa2
Japan-Nepal Health and Tuberculosis Research Association, Kathmandu, Nepal

1

Kanagawa University of Human Services, Japan

2*Corresponding author: Ram Sharan Gopali, Japan-Nepal Health and Tuberculosis Research Association, Kathmandu, Nepal
ARTICLE INFO

Abstract

Received:

Background: School students play an important role in the prevention of TB at alllevels of community. However, there is no consensus on essential preventive messages tobe taught to the students. This study aims to develop consensus on essential information
about preventive measures of TB.
Method: It is qualitative research using three-round Delphi techniques among TB
experts to develop agreement on essential preventive measures to prevent TB and verify
their level of agreement.
Result: The essential knowledge to prevent TB is information about causative
agent, DOTS process and its importance, sign and symptoms, national strategic plans,
and psychosocial counseling. Nearly 91% of the experts agree that information aboutcausative agent of TB is most essential to be informed to the students.
Conclusion: Delphi method is an effective tool to develop consensus. The results canbe used for developing the IEC materials focusing school students and the communities.

Published:

February 25, 2020
March 05, 2020

Citation: Ram Sharan G, Bijay M, Mika K.
Expert Consensus on the Essential Preventive
Knowledge of Tuberculosis for High SchoolStudents, Kathmandu, Nepal. Biomed J Sci &Tech Res 26(2)-2020. BJSTR. MS.ID.004332.

Keywords: Tuberculosis; Delphi; KJ Method; Consensus

Introduction
Tuberculosis (TB) remains a major public health problem. The
incidence rate of TB is 152 per 100,000 populations in Nepal andit has not declined as expected [1]. It is fundamental to prevent
new infections to shrink the burden of TB. Likewise, essential
and adequate knowledge of TB, its services including stigma anddiscrimination helps to break the barriers for TB diagnosis andtreatment services [2-4]. Community people including school
students need to be aware of preventive measures at all levels ofcommunities which could be essence to lower the burden of thedisease [5].

Objectives
The general objective of the study is to develop the consensus
on basic and essential information on preventive measures of TB
for high school students.

Methods

It is qualitative research that uses the Delphi technique to induce
the opinions of experts on knowledge to prevent TB and develop
the consensus with the most essential knowledge including levelof agreement. The Delphi technique consist of three-round survey
among the selected TB experts and agree in the essential knowledge
to prevent TB (Figure 1).

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Selection of Experts
A heterogeneous group of twenty-two experts who haveknowledge and experience in the field of a TB control program
were selected for the surveys. Critical case sampling method isused because the characteristics of the case make them critical[6]. They are more likely to yield the most important informationand have the greatest impact on the development of consensus on
essential knowledge to prevent TB among high school students.
The expert panel was selected for education and TB sector. The
district TB Leprosy officer (DTLOs) of Kathmandu and Bhaktapur
district and health workers of the Urban health clinic, school healthteachers, and female community health volunteers (FCHVs) of the
Kathmandu metropolitan city (KMC) ward 32, 10, 7 were selectedpurposively. Additionally, schoolteachers 2 from the public schools
and 2 from the private schools located and ward 7 and 32 wereselected purposively. The experts were selected based on thefollowing characteristics that make the participants a critical caseis (Table 1):

Figure 1: Steps of the research.

Table 1: Characteristics of the selected panel.
Experts

Characteristics

No. of Experts

District TB/Leprosy Officer

They have a clear understanding of nationalguidelines, plans, and policies related totuberculosis. They also have the problems andissues in the prevention of tuberculosis at thenational and district level2

Health Workers

TB Volunteers

School Teachers

Delphi Rounds

Total

Health workers from the DOTS clinic with
TB patients every day. They are familiar andexperienced with the problems and issues of
TB patients, including, their knowledge on
tuberculosis

TB volunteers are critical because they arefamiliar and experienced with the health-seeking
behavior, norms, and values of the community.
They are also aware of the knowledge gap on
tuberculosis in the community.
School teachers know the educational levelof the students as well as the depth of theknowledge they share about the prevention of
tuberculosis in the school.

4.2.1. First Round: After the selection of experts, each participant
was given a special code number. Then, the participants wereexplained about the research objectives, procedures, 3 rounds ofDelphi methods, including their roles and time required. Thereafter,
the research assistant distributed an open-ended questionnaire to
enumerate seven major preventive measures. After the distributionof the questionnaire sheet, at least 15 days were provided to theexperts to write the opinions. Then, the research assistant collected
the filled questionnaire. The first round of data was analyzed using
the Jiro Kawakita (KJ) method. To conduct KJ method analysis, theresearcher prepares black pens, many pieces of card-sized paper,
chart paper [7]. Each statement was written in pieces of paper.

10

6

4
22

Then, stick in chart paper based on resemblance of meaning of
the sentences. The investigator read the statements several times
to identify similar and/or close opinions. Each label contains asentence, which the researcher gets from the data. The KJ method
was applied to consolidate similar or connected information to getsummarized and categorized groups of items [8]. After that all theinvestigators reviewed the data, discussed within the team andprepared summarized 46 statements from 154 items. The summaryof each group was written down on the business card-sized paper
and placed on the top of each group. Lines and comments were
written to explain the interrelationship among groups. Afterthat sub-theme was prepared for the statements, based on thesummaries of the sub-theme, major theme of the sentences was
prepared.

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Second Round: In the second round, all the 46 items were sent
to all the experts to rank from 1 to 7 based on the importance ofeach item for the prevention of TB. The first ranked items were
given 7 score, 2 ranked was given 6 score. Similarly, the last ranked
was given 1 score while for the non-ranked item, no score wasgiven. The total points of each item were calculated. The items will
be arranged in the descending order based on the importance.
Third Round: In the third round, the new ranked items based on
the total score were redistributed to the experts and asked them, dothey agree or disagree with the ranking. If the experts do not agreewith the ranking, they were requested to provide new ranking. The
numerical value will be given from 1 to 7 based on the importanceof each item. The data was entered and analyzed in SPSS version
20.0. And then, the mean was calculated to indicate the group
opinion while the standard deviation will calculate to indicate thelevel of agreement. Each statement was analyzed quantitatively
by the percentage of agreement ratings, importance rankings andthe number of comments made for each of the statements, andqualitatively analyzed using the thematic analysis (Figure 2).

Figure 2: Three round of Delphi techniques.

Criteria for Consensus Level
The Delphi technique is based on gaining consensus among
the selected experts. Though there is variation in opinions andinterpretation among the experts and it is quite difficult to gain
100% agreement on all the statements. In fact, no standard methods
or guidelines exist for determining appropriate consensus level [9].
The consensus level is 70% of participants scored the item and noconsensus: item failed to meet either of the above criteria [10-12].

Ethical Consideration

Within the Delphi, participants were allowed to participate
voluntarily, and both written and informed consent was taken before
the inclusion in the study. The quasi- anonymity was maintained as
the participants know each other but their opinions and judgments

DOI: 10.26717/BJSTR.2020.26.004332

were strictly anonymous. Along with that the confidentiality of
the information, opinions, and judgments was strictly maintained.
Furthermore, the ethical approval was taken from Nepal HealthResearch Council (NHRC), Kathmandu, Nepal (Reg.No. 530/2018).

Results

Result of the Study
Background Information of the Experts: A total of 22
experts were included in the study. Among them, 2 are DTLO, 4
school health teachers, 6 Female Community Health Volunteers,
10 health workers. The gender-wise distribution indicates, 4 aremales and 18 are females. Likewise, 5 experts have up to 10 gradesof education, 7 has higher secondary/diploma level, 4 has bachelor
and 5 has master’s degree in education. Furthermore, 5 experts
have less than 10 years of experience, 5 participants have 11-15
years of experience, 3 has 16-19 years and 5 has more than 20 yearsof experience in tuberculosis (Table 2).

The response rate of the Experts in all the Three Rounds: In
all the three rounds of the Delphi technique, all the participants
were able to response which is quite good. It is possible for the 100
percent response rate due to timely and frequent follow up with theparticipants by the research assistant and investigators (Table 3).
The Major Theme, Sub-Theme and Statements for thePrevention of TB: A total of 154 items from 22 experts werecollected. The 154 items were grouped into 46 items using the KJ
methods (discussed in the methodology section). Again, these 46
items were divided into the sub-theme and then to major 7 themes
such as general introduction of TB, TB screening and diagnosis, risk,treatment of TB, prevention, and control, psychosocial support, andawareness (Table 4).

Ranking of the Seven Essential Statements in the Second
Round: All the 46 statements were distributed to all the experts
to rank on the basis of its importance. Table 5 shows the firstimportant statement is the general introduction of TB (agent andTypes) is same across all four groups while after the first ranked
statements there are variations in the statements as well as theirimportance across all the groups (Table 5).
Ranking of the Seven Essential Information for thePrevention of TB in the Third Round: In the third round, theexperts were given the statement to re-rank the statements. Table 6
shows the ranking between FCHVs and health workers is the same,
while up to the third rank it resembles schoolteachers too. However,
the ranking is quite different among the DTLOs, they are focusing
more on the national strategic plan and activities of NTP. It could
be due to the reason that they are at district level and perceive it isimportant to understand national programs at the community level(Table 6).

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Table 2: Background information of the experts.
The Profession of the Experts

Gender

Total

DTLO

Health Worker

FCHV

Health Teacher

Male

0

2

0

2
2

18

25-35

0

3

3

1

7

46-55

2

1

1

2

6

Female

2

36-45

8

0

>56

Age Group

5

0

1

6
2

Level of Education

4

1

0

8

0

1

Upto 10 grade

0

1

4

0

5

Bachelor

2

2

0

2

6

Higher secondary/
Diploma
Masters

0

6

0

1

1

Years of Experience

0

1

7

2

4

Less than 10

0

3

2

0

5

16-19

0

0

3

0

3

11-15

0

=>20 years

1

2

Total

6

2

10

Table 3: The response rate of the participants in all the three rounds.

1

3

0

5

1

6

9

4

22

S. N

Round

Frequency

Response Rate (%)

1

First

22

100

Third

22

100

2
3

SecondTable 4: Major theme, sub theme and statement for the prevention of TB.

22

100

S. N

Statements

Sub Theme

Major Theme

1

General introduction (Agent & types) of TB

1.1 General Introduction of TB

1.General Introduction
of TB

3

Sign and Symptoms of Tuberculosis

1.2 Sign and symptoms

1.1 General Introduction of TB

1. General Introductionof TB

Educate about the mode of transmission and droplet infection

1.3 Mode of transmission

1.General Introduction
of TB

6

Coordination with local bodies, community-based organizations, schools during theplanning and implementation of NTP

1.4 Activities of NTP

8

The criteria for the presumptive TB cases should clearly informed to the students

10

Location/address of the diagnostic facilities and laboratory center should be clearlymentioned

2

4
5

7

9

11

Present scenario of the tuberculosis

National strategic plans and activities of the National TB Programme

Effective monitoring of the National TB Programme and the TB patients

Methods and tools for the diagnosis for tuberculosis

Educate about the importance of TB screening for presumptive TB cases

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1.4 Activities of NTP

1.4 Activities of NTP
2.1 TB diagnosis
2.1 TB diagnosis
2.1 TB diagnosis

2.2 TB screening

1. General Introduction
of TB
1.General Introduction
of TB
1.General Introduction
of TB
1.General Introductionof TB
2.TB screening &Diagnosis
2.TB screening &Diagnosis
2.TB screening &Diagnosis
2.TB screening &Diagnosis
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Inform about the TB/HIV co-infection as well as screening

2.2 TB screening

2.TB screening &Diagnosis

Regular medical check up

2.2 TB screening

2.TB screening &Diagnosis

13

Educate about the TB screening for students with poor nutritional status

15

Educate students to follow a healthy lifestyle and adopt behavior like No smoking,No alcohol use, balanced diet, regular physical exercise

3. 1 Risk behaviors of TB

17

People having a disease like diabetes, hepatitis, blood pressure, heart disease, liverdisease

3.2 Risk Groups

19

Mitigation and prevention of air pollution

14
16
18

Importance of a balanced diet and nutrition

2.2 TB screening

3. 1 Risk behaviors of TB

Educate the students about safe drinking water and personal hygiene

3.3 Environmental factors

To give details of DOTS process and its importance

4.1 Treatment of tuberculosis

22

To educate students about address and institution, contact number of nearest DOTS
center

4.1 Treatment of tuberculosis

24

TB treatment is free of cost

20
21
23
25
26

TB is curable, should be treated for 6 to 8 months in DOTS

To inform about the drugs as well as possible side effects of each drug
TB patient should be treated with isolation

What is the meaning of DR and causes of MDR

3.3 Environmental factors

2.TB screening &Diagnosis
3.Risk
3.Risk
3.Risk

3. Risk
3. Risk

4.Treatment of TB

4.1 Treatment of tuberculosis

4. Treatment of TB

4.1 Treatment of tuberculosis

4. Treatment of TB

4.1 Treatment of tuberculosis
4.1 Treatment of tuberculosis

4. Treatment of TB
4. Treatment of TB
Treatment of TB

4.2MDR and XDR

4. Treatment of TB

Always cover your mouth when you cough and sneeze

5.1 Infection control

5. Prevention andcontrol30

Proper management of cough/sputum

5.1 Infection control

32

Proper housing

27

Available diagnostic and treatment facilities of MDR/XDR

29

Use of mask

28

31

33
34

BCG Vaccination

Educate the students about ways to prevent tuberculosis

4.2MDR and XDR

5.1 Infection control
5.2 Prevention andmanagement of TB
5.2 Prevention andmanagement of TB
5.2 Prevention andmanagement of TB

6. Psychosocial Support

39

Implement community awareness activities using mass media (Television, Radio,
newspaper, movies) as well as group methods

7.1 Community awarenessand mobilization

41

To organize regular community awareness activities in the community

Mobilize student and cured TB patients to increase awareness in the community

To engage private providers in community awareness activities

42

Educate the school students about tuberculosis in the local language by using theaudio-visual method

44

To orient and train schoolteachers on tuberculosis

46

5. Prevention andcontrol

6.2 Social Support

7.1 Community awarenessand mobilization

45

5. Prevention andcontrol

Inform about the social, economic impact of tuberculosis among patient
To organize health camps including door to door visit in the community

43

5. Prevention andcontrol

6. Psychosocial Support

37

40

5. Prevention andcontrol

6.1 Psychological support

Educate about the roles and responsibilities of family members, relatives, friends
towards TB patients38

5. Prevention andcontrol

Psychosocial counseling the TB patients to develop positive attitude towards TB
treatment

35
36

4. Treatment of TB

Include the information about tuberculosis in Nepal book of the course
Educate the school students using peer education methods

Inform the school student using new technology and methods

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6.2 Social Support

7.1 Community awarenessand mobilization
7.1 Community awarenessand mobilization
7.1 Community awarenessand mobilization
7.2 Health Education
7.2 Health Education
7.2 Health Education
7.2 Health Education
7.2 Health Education

6. Psychosocial Support
7. Awareness7. Awareness7. Awareness7. Awareness7. Awareness7. Awareness7. Awareness7. Awareness7. Awareness7. Awareness
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Table 5: Group-wise ranking of the seven essential statements in the second round.
S. N

Teacher

DTLO

FCHVs

HW

1

General introduction of
tuberculosis (Agent and types
of TB)

General introduction of
tuberculosis (Agent and types of
TB)

General introduction of
tuberculosis (Agent and types of
TB)

General introduction of
tuberculosis (Agent and types
of TB)

Psychosocial counseling theTB patients to develop positive
attitude towards TB treatment

Sign and Symptoms of Tuberculosis

A regular medical checkup by all
the person at least in a year

Include the information about
tuberculosis in Nepal book of thecourseTo give details of DOTS process
and its importancePresent scenario of the tuberculosis

To orient and train schoolteachers
on tuberculosis

Methods and tools of TB
diagnosis

6

BCG Vaccination

To inform about the drugs as wellas possible side effects of each drug

7

Educate the school students
about tuberculosis in the local
language by using the audiovisual method

Information on location, contacts
about the diagnostic facilities andlaboratory centres

2
3
4
5

Sign and Symptoms ofTuberculosis

Educate about the mode oftransmission and droplet
infection

National strategic plans andactivities of the National
Tuberculosis Programme

Psychosocial counseling theTB patients to develop positive
attitude towards TB treatment

BCG Vaccination

To give details of DOTS process andits importance

Include the information about
tuberculosis in Nepal book of thecourseEducate students to follow
a healthy lifestyle and adopt
behaviour like No smoking, No
alcohol use, balanced diet, regularphysical exercise
To give details of DOTS process
and its importance

The meaning of DR and causesof MDRTo give details of DOTS process
and its importance
National strategic plans andactivities of the National
Tuberculosis Programme

Table 6: Group-wise ranking of the seven-essential information for the prevention of TB in the third round.
Teacher

DTLO

General introduction of tuberculosis(Agent and types of TB)

National strategic plans andactivities of the National
Tuberculosis Programme

FCHV

Health Workers

General introduction of tuberculosis General introduction of tuberculosis(Agent and types of TB)(Agent and types of TB)

To give details of DOTS process andits importance

General introduction of tuberculosis(Agent and types of TB)

Methods and tools of TB diagnosis

To give details of DOTS process andits importance

Include the information about
tuberculosis in Nepal book of thecourseNational strategic plans andactivities of the National
Tuberculosis Programme

The meaning of DR and causes of
MDR

Methods and tools of TB diagnosis

Methods and tools of TB diagnosis

Psychosocial counseling the TB
patients to develop positive attitude
towards TB treatment

Psychosocial counseling the TB
patients to develop positive attitude
towards TB treatment

Sign and Symptoms of Tuberculosis

Include the information about
tuberculosis in Nepal book of thecourseInform about the social, economic
impact of tuberculosis among
patient

To give details of DOTS process andits importanceTo give details of DOTS process andits importance

Include the information about
tuberculosis in Nepal book of thecourseSign and Symptoms of Tuberculosis

Sign and Symptoms of Tuberculosis

To organize regular community
awareness activities in thecommunity

National strategic plans andactivities of the National
Tuberculosis Programme

National strategic plans andactivities of the National
Tuberculosis Programme

People having the disease likediabetes, hepatitis, blood pressure,heart disease, liver disease are
more risk for tuberculosis

The Difference in the Mean Score for Each Statement
Between Second and Third Round: There is high variations in
the mean score of each statement between the second and thirdround of the Delphi method. In the second round, the highest meanscore is around 3.5 for the statement general introduction of TB, as
well as most of the statements, got some score. In contrast to that,the mean score of each statement has concentrated among top 7
statements and most of the statement did not receive any scoring.

Include the information about
tuberculosis in Nepal book of thecourseHowever, there is minimal change in ranking of the statements.
This indicates there is high level of agreement in the ranking of thestatements (Figure 3).
Agreement Between Different Expert Groups: The
percentage of agreement for all the 46 statements is highest among
the female community health volunteers which are 89. 13%, it
reveals that all the FCHV agree with 89 % statements. Similarly,

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73.91 percent agreement among DTLOs, 71.73% of agreement
among teachers and health workers (Table 7).

Percentage of the Agreement for 7 Most Important
Information Among the Experts: Among all the experts, nearly
91% of the experts agree that the general introduction of TB
is most essential to be communicated at the community level
which is followed by message about DOTS and its importanceand sign and symptoms of TB. However, the information about

methods and tools of TB diagnosis is 6th essential in the ranking
but has the lowest percentage of agreement between the experts,
which indicates variation in the score given for the statement.
Furthermore, the group theme agreement, most of the statements
belong to the group one like general introduction of TB, signs, andsymptoms of TB, national strategic plans and activities. However,the 7 statement does not include items from the major them risk aswell as prevention and control (Table 8).

Figure 3: Difference in the mean score for each statement between the second and third round.

Table 7: Percentage of agreement between different expert groups.
S. N

Experts

Percent of Agreement

1

Teacher

71.73

3

Health workers

71.73

2

DTLOs

4

73.91

FCHVs

Table 8: Percentage of the agreement for 7 most important information among the experts.

89.13

S. N

Statements

Level of Agreement

1

General introduction of tuberculosis (Agent andtypes)

90.91

3

Sign and Symptoms of Tuberculosis

81.82

2
4
5
6
7

To give details of DOTS process and its
importance

Include the information about tuberculosis in
Nepal book of the course
National strategic plans and activities of the
National TB Programme
Methods and tools of TB diagnosis

Psychosocial counselling the TB patients todevelop positive attitude towards TB treatment

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86.36
77.27
72.73
68.18
72.73

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Discussion
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 likeagents, types is essential to be provided to the students, alongwith 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, theexpert might not be much aware of the infection control measuresat 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 befocused on prevention and control of TB rather than clinical andtreatment 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 isinadequate 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 theschool curriculum or the availability of information, education, andcommunication 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 healthworkers, 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 todetermine 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 highvariation 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 statementin the second and third rounds of the Delphi technique. In thesecond round, the statements have lower average meanwhile in thethird 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

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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. Whilein 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 thestudy 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 ofexpert’s opinions as well as there is no opportunity for participants
to elaborate on their opinions and agreement. Therefore, it does notmean that all the agreed statements are most essential information
for the prevention of TB. Instead, it can be used for structuring thediscussion at the National level and means for raising issues fordebate [19].
The participants involved in the study are from the urban areasof the country particularly the Kathmandu. So, the result of thestudy will be difficult to generalize. There are differences in thelevel 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 witheducational status, and TB training and/or orientation received[13]. Furth more, the essential information might vary on the basisof 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 highresponse rate was achieved because of regular follow up with theparticipants and sending reminders by research assistant [21,22].

Conclusion

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 thisinformation. 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 shouldbe implemented in the various context like urban-rural, ecologicaldistribution.

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Acknowledgement
The research was funded by Kanagawa University of Human
Services to Assistant Professor, Mika Kigawa. We would like to thankthe participants, Public health section, Kathmandu Municipality
and the National Tuberculosis Centre for making the study possible.

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ISSN: 2574-1241
DOI: 10.26717/BJSTR.2020.26.004332

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