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Impact of Tuberculosis Awareness on Tuberculosis Screening Practices among University Students in Nigeria

Abstract

Tuberculosis (TB) remains an important public health concern in Nigeria, with implications for individuals, households, educational institutions, and communities. University students may be exposed to factors that can facilitate the transmission of respiratory infections, including close social interaction, shared accommodation, overcrowded living conditions, and limited awareness of TB symptoms and prevention. Tuberculosis awareness provides students with information about the causes and transmission of TB, common signs and symptoms, risk factors, methods of prevention, availability of screening services, and the importance of early detection and treatment. Tuberculosis screening practices refer to behaviours related to seeking and utilizing appropriate TB screening services, particularly among individuals with symptoms or relevant exposure risks. Early identification of TB can facilitate timely diagnosis, treatment, contact investigation, and reduction of transmission within communities. In Nigeria, inadequate awareness, misconceptions about TB, stigma, fear of diagnosis, limited knowledge of available screening services, and perceived low personal risk may discourage university students from utilizing appropriate TB screening services. Effective TB awareness may improve knowledge and perceived susceptibility and encourage students to participate in appropriate screening. Against this background, this study investigates the impact of tuberculosis awareness on tuberculosis screening practices among university students in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains health-screening behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding students' decisions to utilize TB screening services. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping health behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from TB awareness may influence screening practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how TB awareness may influence TB screening practices among university students in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from undergraduate students in selected universities in Nigeria using a structured anonymous self-administered questionnaire and, where feasible, verification of screening attendance through available university health-service records. A multistage sampling technique will be employed to select states, universities, faculties or departments, academic levels, and eligible students. Where feasible, selected student groups will be assigned to intervention and comparison groups. Students in the intervention group will receive structured tuberculosis awareness education covering TB transmission, symptoms, risk factors, prevention, misconceptions, stigma, the importance of early detection, eligibility for screening, available screening services, and appropriate healthcare seeking. Tuberculosis screening practices will be assessed using indicators such as knowledge of available screening services, willingness to undergo screening when indicated, previous utilization of TB screening services, prompt presentation for screening when experiencing persistent TB-related symptoms, and adherence to recommended follow-up or referral. Descriptive statistics will be used to summarize students' sociodemographic characteristics, TB awareness, exposure to education, and screening practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of TB awareness on tuberculosis screening practices. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that tuberculosis awareness has a significant positive impact on tuberculosis screening practices among university students in Nigeria. Students exposed to structured TB awareness education are expected to demonstrate improved knowledge of TB transmission, symptoms, risk factors, prevention, and screening services. Education may increase students' recognition of persistent respiratory symptoms, improve perceived susceptibility, reduce misconceptions and stigma, and encourage timely utilization of appropriate screening services. However, awareness alone may not guarantee increased screening because students may continue to face barriers such as limited access to screening facilities, cost, inconvenience, fear of diagnosis, stigma, concerns about confidentiality, and inadequate university-based TB screening services. Consequently, TB awareness is expected to be most effective when supported by accessible and confidential screening services, appropriate referral systems, university health programmes, effective TB surveillance, and stigma-reduction initiatives. The study is expected to contribute to the literature on tuberculosis prevention, health education, screening behaviour, university health, infectious disease control, and public health in Nigeria by providing empirical evidence on the impact of tuberculosis awareness on tuberculosis screening practices among university students. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Tuberculosis and Leprosy Control Programme, Nigeria Centre for Disease Control and Prevention (NCDC), National Primary Health Care Development Agency (NPHCDA), National Universities Commission, university administrations, university health services, healthcare providers, public health practitioners, development partners, and policymakers regarding strategies for improving TB detection among young adults. The study will also provide evidence-based recommendations for strengthening university-based TB awareness programmes, expanding accessible screening services, improving referral systems, reducing TB-related stigma and misconceptions, strengthening campus disease surveillance, and promoting appropriate TB screening practices among university students across Nigeria.

Keywords: Tuberculosis awareness, tuberculosis screening practices, university students, tuberculosis, TB screening, infectious disease prevention, health education, early detection, disease awareness, university health, public health, Nigeria.