Tuberculosis (TB) remains a leading infectious cause of death globally and disproportionately affects low- and middle-income countries. In Sudan, prolonged conflict and weakened health infrastructure have been associated with rising TB incidence and challenges including recurrent disease, treatment nonadherence, and increased multidrug-resistant TB. Medical students are at elevated risk of exposure during clinical training and will influence future case detection and infection-control practice. No prior published study had assessed TB-related knowledge, attitudes, and self-reported preventive practices among medical students in Sudan, motivating this investigation at the University of Khartoum.
This descriptive cross-sectional study was conducted at the Faculty of Medicine, University of Khartoum, Sudan, between August and October 2024. The faculty provides a six-year MBBS program with clinical exposure introduced primarily in later years, making it an appropriate setting to evaluate preparedness for TB-related clinical responsibilities.
Eligible participants were undergraduate medical students in batches 95–98 (third to sixth years). First- and second-year students were excluded because their curriculum is mainly basic sciences with limited clinical exposure. The sampling strategy used proportional allocation across academic batches combined with convenience sampling; recruitment occurred via online dissemination (Google Forms) through WhatsApp groups, emails, and class representatives over four weeks. The total eligible population was 1,311; after applying finite population correction, the minimum required sample was 297. The investigators distributed questionnaires to roughly 340 students and obtained 311 completed responses (response rate 91.5%).
A validated, self-administered questionnaire collected sociodemographic data and assessed three domains: TB knowledge (10 items), attitudes (7-item Likert scale), and self-reported preventive practices (5 items). Knowledge items included etiology, modes of transmission, latent TB infectiousness, and tuberculin skin test (TST) interpretation. Preventive practice items addressed behaviors such as mask use when interacting with suspected or confirmed TB patients.
Analyses used SPSS version 29. Scores were summarized as means with standard deviations. Pearson correlation coefficients examined relationships among knowledge, attitude, and practice domains. Multiple linear regression models identified sociodemographic predictors of each domain, adjusting for sex, age group, and academic year. Model fit was reported using adjusted R² values and relevant parameter estimates with confidence intervals and p-values.
The mean knowledge score was 6.43 ± 2.52 out of 10 (64.3%). Correct responses were particularly common for TB etiology (94.9%) and recognition of airborne transmission (91.3%). Substantial gaps were identified in understanding that latent TB is non-infectious (29.3% correct) and in interpreting the tuberculin skin test (49.2% correct). Academic year emerged as the strongest predictor of knowledge scores; the knowledge model explained a substantial proportion of variance (adjusted R² = 0.474, p < 0.001).
Attitude scores averaged 27.90 ± 4.27 out of 35. Knowledge and attitude scores were weakly but significantly correlated (r = 0.179, p = 0.001), indicating that higher factual knowledge was associated with somewhat more favorable attitudes but that the relationship was modest. The regression model for attitudes explained little variance (adjusted R² = 0.029).
The mean self-reported preventive practice score was 19.55 ± 3.67 out of 25. Only 28.3% of participants reported consistently wearing a face mask when interacting with suspected or confirmed TB patients. Knowledge was not significantly correlated with practice scores (r = 0.090, p = 0.113). Attitude and practice scores showed a moderate correlation (r = 0.437, p < 0.001). The practice regression model accounted for minimal variance (adjusted R² = 0.018); female sex was the only sociodemographic variable that significantly predicted higher practice scores (B = 0.95, 95% CI: 0.09–1.80, p = 0.031).
Correlational analysis indicated a weak positive relationship between knowledge and attitudes, no significant relationship between knowledge and preventive practices, and a moderate positive relationship between attitudes and practices. Of the sociodemographic variables analyzed (sex, age group, academic year), academic year was most strongly associated with knowledge, while attitude and practice models explained very little variance. Female sex predicted a small but statistically significant increase in self-reported preventive practice scores.
In this single-institution sample of clinical-phase medical students, overall TB knowledge was moderate with clear strengths and notable gaps. High recognition of disease causation and airborne transmission contrasts with poor understanding of latent TB infectiousness and TST interpretation—areas directly relevant to screening, diagnosis, and infection control. The weak association between knowledge and attitudes and the lack of a significant relationship between knowledge and practices suggest that factual knowledge alone may not be sufficient to change preventive behavior. The moderate correlation of attitudes with practices implies that attitudinal factors may be more proximal determinants of self-reported preventive actions.
Contextual factors described by the authors—such as conflict-related disruption of teaching schedules, interrupted clinical rotations, and constrained infection-control resources—may have influenced both exposure to TB instruction and observed behaviors. The authors position their findings as an educational snapshot that can inform curriculum discussions, especially on reinforcing TB concepts that were poorly understood and on bridging knowledge–practice gaps through targeted educational and behavioral interventions.
The study used a stratified convenience sample within a single institution and relied on self-reported practices, which may limit generalizability and introduce response or social desirability biases. Because recruitment was convenience-based rather than random, selection bias is possible. The authors note the findings should be interpreted as an institutional educational assessment rather than a national estimate for all Sudanese medical students.
Medical students at the University of Khartoum demonstrated moderate tuberculosis knowledge with particular deficits in understanding latent infection and TST interpretation. Knowledge alone did not reliably predict self-reported preventive practices, and consistent mask use when interacting with TB patients was low. These results suggest curricular reinforcement on specific TB topics and interventions that address attitudes and behavior may be needed to improve infection-control practices before students enter independent clinical roles. The authors present these results as a basis for curriculum discussion and targeted educational strategies within the local training context.