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Effect of Tuberculosis Education on Tuberculosis Prevention Practices among University Students in Nigeria

Abstract

Tuberculosis (TB) remains an important public health concern in Nigeria and may affect individuals, families, educational institutions, and communities. The disease is caused by Mycobacterium tuberculosis and is primarily transmitted through the air when individuals with infectious pulmonary tuberculosis release bacteria into the environment. University students may experience increased exposure to respiratory infections because of crowded lecture halls, hostels, shared facilities, social interaction, and limited awareness of tuberculosis transmission and prevention. Limited knowledge of TB symptoms, transmission routes, risk factors, prevention measures, early healthcare-seeking, and available diagnostic and treatment services may contribute to delayed recognition and inappropriate preventive practices. Tuberculosis education provides an opportunity to improve students' understanding of TB and promote behaviours that may reduce transmission and support early detection. Against this background, this study investigates the effect of tuberculosis education on tuberculosis prevention practices among university students in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Health Literacy Theory. The Health Belief Model explains how students' perceptions of susceptibility to tuberculosis, perceived severity, perceived benefits of preventive behaviours, perceived barriers, self-efficacy, and cues to action may influence their tuberculosis prevention practices. Social Cognitive Theory emphasizes observational learning, behavioural modelling, self-efficacy, reinforcement, peer influence, and environmental factors in shaping students' adoption of tuberculosis prevention behaviours. Health Literacy Theory emphasizes students' ability to obtain, understand, evaluate, and apply accurate information about tuberculosis transmission, symptoms, prevention, testing, treatment, and healthcare services. Collectively, these theoretical perspectives provide a suitable framework for explaining how tuberculosis education may influence tuberculosis prevention practices among university students in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise undergraduate and postgraduate students aged 18 years and above enrolled in selected public and private universities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, universities, faculties or departments, levels of study, and eligible students. Tuberculosis education will be assessed using indicators such as exposure to TB education sessions, frequency and duration of education, knowledge of TB transmission, symptoms, risk factors, prevention measures, ventilation, cough etiquette, respiratory hygiene, early healthcare-seeking, TB screening and testing, treatment adherence, stigma reduction, and available TB services. Tuberculosis prevention practices will be assessed using indicators such as respiratory hygiene, appropriate cough etiquette, avoidance of prolonged exposure to individuals with suspected infectious TB where appropriate, ventilation of shared spaces, timely healthcare-seeking for persistent respiratory symptoms, willingness to undergo appropriate TB screening or testing, adherence to recommended preventive measures, avoidance of stigmatizing behaviours, and use of reliable TB information when making health decisions. Data will be collected using structured questionnaires, standardized TB knowledge and prevention-practice assessment tools, scenario-based questions, university health-centre records where ethically and practically accessible, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize students' demographic and academic characteristics, previous TB exposure, sources of TB information, knowledge levels, and prevention practices. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of tuberculosis education on tuberculosis prevention practices. Where a quasi-experimental design is adopted, prevention-practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that tuberculosis education has a significant positive effect on tuberculosis prevention practices among university students in Nigeria. Students exposed to structured, evidence-based, practical, and sustained TB education are expected to demonstrate better knowledge and stronger prevention practices than students without comparable exposure. Education may improve students' understanding of TB transmission, symptoms, risk factors, respiratory hygiene, cough etiquette, ventilation, early healthcare-seeking, and appropriate screening and testing. It may also correct misconceptions and reduce stigma toward individuals affected by tuberculosis, thereby encouraging students to seek care promptly and support affected individuals appropriately. Practical education may improve students' ability to identify situations requiring professional assessment and distinguish reliable TB information from misinformation obtained through peers or social media. However, overcrowded living environments, inadequate ventilation, limited access to healthcare services, stigma, misinformation, financial barriers, and low perceived personal risk may reduce the effectiveness of education alone. The study therefore expects accessible, evidence-based, culturally appropriate, and sustained tuberculosis education, supported by effective university health services, to contribute significantly to improved tuberculosis prevention practices among university students in Nigeria. The study is expected to contribute to the literature on tuberculosis prevention, tuberculosis education, university student health, respiratory health, infectious disease prevention, health literacy, health education, stigma reduction, school and university health services, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Tuberculosis and Leprosy Control Programme, universities, university health centres, state ministries of health, healthcare professionals, public health practitioners, community health workers, student organizations, development partners, and policymakers regarding strategies for strengthening tuberculosis prevention among young adults. The study will also provide evidence-based recommendations for integrating tuberculosis education into university health programmes, improving students' access to accurate TB information and screening services, strengthening respiratory-health promotion, addressing TB-related stigma and misconceptions, improving ventilation and infection-prevention awareness in university environments, strengthening referral pathways, and developing sustainable university-based interventions that promote tuberculosis prevention and early healthcare-seeking across Nigeria.

Keywords: Tuberculosis education, tuberculosis prevention practices, university students, tuberculosis prevention, respiratory hygiene, TB awareness, infectious disease prevention, health education, health literacy, university health, Nigeria, public health.