JIGJIGA UNIVERSITY INSTITUTE OF HEALTH SCIENCE DEPARTMENT OF NURSING

KNOWLEDGE, ATTITUDE AND PRACTICE ON THE WAYS OF TUBERCULOSIS

PREVENTION AMONG PATIENTS ATTENDING PUBLIC HEALTH FACILITIES IN
DHEGAHBOUR TOWN, SOMALI REGION ETHIOPIA, 2024

BY:

1. ABDELAHI MOHAMMED AHIMED R\0012\13

2.ADINAN AHMED BAKER R\0271\\13
3.ABDULEZIZ YUSUF AHMED R\0110\13
4.AMIR MUHYADIN AMAN. R/0452/13
5.ADANECH LULIE TADESE R/ 0244/13
6. HANIBAL DAGNE ASSEFA R/1481/13

A RESEARCH THESIS SUBMITTED TO JIGJIGA UNIVERSITY INSTITUTE OF HEALTH

SCIENCE, DEPARTMENT OF NURSING IN PARTIAL FULFILMENT OF DEGREE IN
BACHELOR OF SCIENCE IN NURSING

ADVISOR: - FATHIA BUDUL (PhD)

DECEMBER 2024

DHAGAHABOUR, ETHIOPIA
 JIGJIGA UNIVERSITY

INSTITUTE OF HEALTH SCIENCE

DEPARTMENT OF NURSING

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE ON THE WAYS OF

TUBERCULOSIS PREVENTION AMONG PATIENTS ATTENDING PUBLIC HEALTH
FACILITIES IN DHAGAHBOUR TOWN, SOMALI REGION ETHIOPIA,2024

BY:

1. ABDELAHI MOHAMMED

2. ADINAN AHMED

3. ABDULEZIZ YUSUF

4. AMIR MUHYADIN

5. ADANECH LULIE

6. HANIBAL DAGNE

A RESEARCH THESIS SUBMITTED TO JIGJIGA UNIVERSITY INSTITUTE OF HEALTH

SCIENCE DEPARTMENT OF NURSING IN PARTIAL FULFILMENT OF BACHELOR OF
DEGREE IN SCIENCE IN NURSING

ADVISORS: FATIHA BUDUL(Phd)

DECEMBER 2024

DHAGAHBOUR, ETHIOPIA
 APPROVAL SHEET

JIGJIGA UNIVERSITY

Directorate of Graduate Studies

On behalf of Jigjiga University Institute of Health Sciences, Nursing department, we the advisors
of this research with the title of “Assessment of Knowledge, Attitude and Practice on the ways of
TB prevention among patients attending public health facilities in Dhagahbour Town, Somali
Region Ethiopia. Towards” read and confirm as MSc. thesis for the student and recommend that
it can be submitted as fulfilling the thesis requirement for degree of BSc. in Nursing.

Name: 1. Fathia Budul (MSc, PhD) Signature: _______________ Date: ____________

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 STATEMENT OF THE EXAMINERS
As a member of the board of examiners of the BSc. thesis open defense examination, we the
evaluators of this research entitled “Assessment of Knowledge, Attitude and Practice on the
ways of TB prevention among patients attending Health Facilities in dhagahbour town, Somali
region Ethiopia” read, evaluated, and recommend to be accepted as fulfilling the BSc thesis
requirements.

Chair person

Name: _______________________ Signature: ____________ Date: ____________

External Examiner

Name: _______________________ Signature: ____________ Date: ____________

Internal Examiner

Name: _______________________ Signature: ____________ Date: ____________

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 STATEMENT OF THE AUTHORS
We declare that we are conducted the thesis titled" Assessment of Knowledge, Attitude and
Practice on the ways of TB prevention among patients attending health facilities in dhagahbour
town at Dhagahbur with commitment and integrity. We declare this thesis is conducted honestly
and transparently, reporting findings without falsification of data. We also assure that any
materials and sources taken from others were correctly cited and referenced in the paper and all
ethical considerations were considered starting from data collection to preparation of the
document.

Candidates

1. Abdelahi Mohammed Signature: ________________ Date: _____________

2. Adinan Ahmed Signature: ________________ Date: _____________

3. Abduleziz Yusuf Signature: ________________ Date: _____________

4. Amir Muhyidin Signature: ________________ Date: _____________

5. Hanibal Dagne Signature: ________________ Date: _____________

6.Adanech Lulie Signature Date

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 Acknowledgement

First, we thank the Almighty God who made it possible for us to come to the end of this thesis.
We would like to express our great thanks to Jigjiga university collage of medicine and Health
Science department nursing for its help on adjusting and scheduling programs and giving
chance to conduct this research thesis.

We would also like to express our heartfelt gratitude to our advisor, Mr. Fathia budul (Mph)for
her encouragement and constructive comments for the success of this research thesis .

Lastly, we would like to extend our appreciation to those who have helped us a lot in giving
additional advice and support for the completion of this thesis.

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TABLE OF CONTENT

Contents Pages

Acknowledgement.......................................................................................................................................5
TABLE OF CONTENT.....................................................................................................................................6
LIST OF TABLES AND FIGURES......................................................................................................................9
1. LIST OF TABLES........................................................................................................................................9
2. LIST OF FIGURES......................................................................................................................................9
ACRONYMS AND ABBREVIATIONS.............................................................................................................10
ABSTRACT..................................................................................................................................................11
CHAPTER ONE............................................................................................................................................12
1 INTRODUCTION......................................................................................................................................12
1.1. BACKGROUND................................................................................................................................12
1.2 STATEMENT OF PROBLEM..............................................................................................................14
1.3 Significance of Study........................................................................................................................15
CHAPTER TWO...........................................................................................................................................16
LITERATURE REVIEW..............................................................................................................................16
2.1 Knowledge.......................................................................................................................................16
2.2 Attitude............................................................................................................................................18
2.3 Practice............................................................................................................................................19
CHAPTER THREE........................................................................................................................................20
OBJECTIVES................................................................................................................................................20
3.1. General Objective...........................................................................................................................20
3.2. Specific Objectives..........................................................................................................................20
CHAPTER FOUR..........................................................................................................................................21

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METHODS AND MATERIALS.......................................................................................................................21
4.1. Study Setting...................................................................................................................................21
4.2. Study design and Period.................................................................................................................22
4.3. Source and Study Population..........................................................................................................22
4.3.1 Source population.....................................................................................................................22
4.3.2 Study Population.......................................................................................................................22
4.4 Inclusion and Exclusion Criteria.......................................................................................................22
4.4.1 Inclusion criteria.......................................................................................................................22
4.4.2 Exclusion Criteria......................................................................................................................22
4.5 Sample size determination..............................................................................................................22
4.6 Sampling Techniques and Procedures.............................................................................................23
4.7. Data collection tools and procedures.............................................................................................24
4.8. Study Variables...............................................................................................................................25
4.8.1 Dependent Variable..................................................................................................................25
4.8.2 Independent Variables..............................................................................................................25
4.9 Operational Definitions....................................................................................................................25
4.10 Data Quality Assurance..................................................................................................................26
4.11 Data Processing and analysis.........................................................................................................26
4.12 Ethical Clearance...........................................................................................................................27
4.13. Dissemination of result.................................................................................................................27
CHAPTER FIVE............................................................................................................................................27
RESULT.......................................................................................................................................................27
5.1 Socio-demographic Characteristics..................................................................................................27
5.2 Level of Knowledge about TB..........................................................................................................30
5.3 Attitude towards TB.........................................................................................................................33
5.4 Practices toward TB.........................................................................................................................35
CHAPTER SIX..............................................................................................................................................36
DISCUSSION...............................................................................................................................................36
CHAPTER SEVEN........................................................................................................................................39
7 CONCLUSION AND RECOMMENDATION.................................................................................................39
7.1 CONCLUSION...................................................................................................................................39

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 7.2 RECOMMENDATIONS......................................................................................................................40
REFERENCES..............................................................................................................................................40

LIST OF TABLES AND FIGURES

1. LIST OF TABLES
1.Table 1:age-sex distribution of study participants
2.Table1b:sacio-demographic data study participants
3.Table2: knowledge about TB prevention
4.Table2b:summary of attitude toward ways of TB prevention
5.Table3 :level of practice toward TB prevention among study participants

2. LIST OF FUGURES
1.Figure1: map of degahbourTown

2.Figure2: schematic representation of sampling procedure

3 Figure3 : age distribution of study participants

4. Figure4: occupational status of study participants

5 Figure5: marital status of study participants

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 ACRONYMS AND ABBREVIATIONS

AIDS Acquired Immune Disease Syndrome

AOR Adjusted Odds Ratio

DOTS Direct Observed Treatment Short course

CI Confidence Interval

HIV Human Immune Virus

KAP Knowledge, Attitude and Practice

MDRTB Medication Drug Resistant Tuberculosis Bactria

OR Odds Ratio

PTB Pulmonary Tuberculosis

TB Tuberculosis

WHO World Health Organization

ABSTRACT

Background: - Ethiopia ranked 7th among the 22 high TB burden countries globally. TB was
the 3rd leading cause of hospitalization and the 1st leading cause of death in Ethiopia. Lack of
appropriate knowledge and attitude of peoples about PTB prevention affects the health seeking
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behavior of patients and sustain the transmission of the disease. Thus, this study aims to assess
the knowledge, attitude and practice among public health facilities in Dhagahabour Jerer zone,
Somali Region, Ethiopia.

Objectives: - This study was to assess knowledge, attitude and practice on way of TB prevention
among pulmonary TB patients visiting health facilities in dhagahabour town, jeerer zone,
Somali Region Ethiopia,2024.

Methods: - Facility based cross sectional study was conducted in dhagahabour town Jeerer zone,
Somali, Ethiopia. Closed ended questionnaire was used. The descriptive statistics like percent,
graphs, tables, mean and median was used to display the result. Trained supervisor and data
collectors were collected the data.

Result: - A total of 185 patients’ data was included in the analysis. Most of the patients knew
that TB transmission is through air droplet by crowded conditions (84.6%) and that PTB is
contagious (73.0%). Regarding to attitude toward tuberclulosis,49.945% (92) of study
participants stated that TB is a serious disease. And 134(72,48%) of study participants house had
window and also well ventilated.

Conclusion: the knowledge, attitude, and practice about TB is not sufficient. The finding of this
study revealed 54% (96) of study had good knowledge about the TB, and 48.1% (89) of study
participants had good preventive practice in prevention of TB.

Key words: - knowledge, practice, attitude, prevention

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 CHAPTER ONE
1 INTRODUCTION

1.1. BACKGROUND

Tuberculosis (TB) is one of the most globally serious public health problems. Even though
tuberculosis (TB) is a treatable and preventable disease, it causes ill-health among millions of
people each year and ranks as the second leading cause of death from an infectious disease
worldwide, after the Human Immunodeficiency Virus (HIV). About one third of the global
population has been infected with Mycobacterium tuberculosis. With the increasing prevalence
of HIV infection the problem of TB is likely to be compounded in the years to come (1,2).

Even though the incidence of tuberculosis (TB) has decreased worldwide, it remains a global
health challenge. An estimated 10.8 million people developed TB in the year 2022 of which one-
quarter was from Africa. Especially, it is much worse in sub-Saharan prisons due to the added
problems of human immunodeficiency virus (HIV) and poverty (1).

Every year, about 10.8 million cases of active TB disease and 2million deaths occur globally. In
relation to these, 9.4 million incidents and 14 million prevalent cases occurred in 2010. Most of
the cases of active TB (7million) are in Asia and Africa (1-3). TB is the major Cause of death in
developing countries; it comprises 25% of avoidable adult Deaths. Most of these TB cases and
deaths occur among men (3). In 2011, 430,000 deaths were among men. But the burden of
disease among women is also high. In 2012, there were an estimated 2.9 million cases and 410
000 TB deaths among women, as well as an estimated 530 000 cases and 74 000 deaths among
children (4).

India alone accounts for one third global burden of TB and every year more than 1.8 million new
cases appear in the country. Approximately 220,000,people die from TB every year in India,
more than 1,000 every day and 100 million workers are lost (6,7).

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In Africa, more specifically sub-Saharan Africa faces the worst TB epidemic due to different
socio economical and low level of knowledge, attitude and practice on prevention of TB
infection throughout the continent (1).

In Kenya 2008 number of TB cases notified in 2006 was 115, 234 and the TB/HIV co-infection
rate stood at 52% of national prevalence (5).

Ethiopia ranks seventh among the world’s 22 high burden countries, which have an incidence
and prevalence rate of 300 and 470 cases per 100,000 populations, respectively (3).

Recently in Ethiopia the case detection was 50% for all forms of TB. Among all new TB cases,
30% were smear-positive; the directly observed treatment short course (DOTS) detection rate
remains low at 34% compared with other sub-Saharan countries. Among these 22% are in
Somali Region (3,4,5).

The DOTS effectiveness might be determined by the patients’ health-seeking behaviors, which is
related to patients’ demographic characteristics, knowledge of TB, health education, and
traditional beliefs. These are believed to have a crucial impact on treatment compliance and
treatment success rate (8, 9).

Studies showed that a low knowledge score was more likely to be observed among the illiterate,
females, rural residences, low income, and youngest age group. They also showed that less than
half of the respondents were aware of the diagnosis and free treatment of TB, which could act as
barriers to TB diagnosis and significantly affect the case notification rate (1–14).

1.2 Statement of Problem

Tuberculosis is a major killer disease particularly among HIV infected people with weakened
immune systems. A quarter of a million TB deaths are HIV associated with most of them in
Africa. The disease is a leading killer especially in Africa. If left unchecked within 20 years, it
will kill a further 35 million people. Global TB incidence is still growing at 1% a year due to the
rapid increase in Africa (2).

The global burden of tuberculosis (TB) remains enormous according to the World Health
Organization (WHO) 2013 report. In this report, there were an estimated 8.6 million incident

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cases of TB and 1.3 million people died from the disease. Among the deaths were an estimated
170,000 from Multi Drug Resistant Tuberculosis (MDRTB) (3).

Treatment defaulting has been the major reason for the low treatment success rate (11.4%) in
2010. The three Tuberculosis Management Units in Juba alone accounted for 46% of all
defaulters registered in South Sudan in 2010 according Tuberculosis Report (13).

Despite reaching geographical Direct Observed Treatment (DOT) coverage of 100% and
treatment success rate of 89%, TB case detection rate remains at 77% and the total number of all
cases detected annually has been decreasing (14).

The global focus of TB control programs is on early diagnosis and treatment of cases in high TB
and HIV-endemic areas. However, the low TB case detection rate and the emergence of multi-
drug-resistant strains have been a challenge (1,6).

Furthermore, it has been proven that the disease had a significant impact on social relations. This
occurs when there is stigma, discrimination, and several misconceptions that could contribute to
poor adherence and treatment compliance (15, 16).

Recently the population of Ethiopia has a population of believed reached more than one hundred
million according 2016 population projections. Moreover, 85% of the population resides in rural
areas that are far from health infrastructures.

Ethiopia developed the strategy to prevent since 1978 Alma-Ata declaration of primary health
care. Despite of different TB prevention strategy developed recently like stop TB strategy more
recently End TB strategy, there is progressively increase of disease transmission throughout the
country.

The different factors contributed for this progress of the disease like living condition, poverty,
nutritional status, low KAP on TB prevention, over crowdedness, increased burden of HIV/AIDS
and so on.

So assessment of knowledge, attitude, and practice (KAP) of patients toward TB prevention

especially in those regions like Somali region that have a low case detection (22%), will
contribute very important information for planning public health programs, problem

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identification, and planning intervention based on the gaps. Therefore, the objective of this study
is to assess patients’ knowledge, attitude, and health-seeking practice toward pulmonary
tuberculosis.

1.3 Significance of Study

The findings obtained from this study are expected to fill gaps related with knowledge, attitude
and practice on way of TB prevention. Again, it will also help to inform program managers to
consider the important contributing factors for knowledge, attitude and practice on way of TB
prevention while planning to improve tuberculosis program.
Such kind of study in this study area specifically never done previously so it will contribute for
effective utilization of resources by coming up with relevant, evidence-based recommendations
for addressing issues related with TB. Lastly, the findings will be a source of information for
those who are interested to conduct further studies on knowledge, attitude and practice on way of
TB prevention elsewhere.

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 CHAPTER TWO

LITERATURE REVIEW

2.1 Knowledge
According study done in Tanzania generally, participants were knowledgeable about modes of
TB infection. Despite this, there were many other factors that prevented their health seeking
behaviors. This included preference to going to pharmacies; using local medicine; fear of
TB/HIV association and HIV testing; belief in traditional medicine; self-medication; fear of
stigmatization and discrimination; fear of losing employment; high cost of accessing medical
services; delay in diagnosis; frequent misdiagnosis; and, taking more than one month (and up to
six months) before seeking appropriate medical treatments. Even after getting treatments some
patients preferred to stop medication in order to seek alternative health care; avoid severe side
effects (19).

According research done in South Sudan knowledge in TB: of the 102 patients interviewed; up
to 80.4% were not knowledgeable on cause of TB, 52% did not know correct signs and
symptoms of TB, 39.2% did not know overall treatment duration, 54.9% did not know the
importance of strict adherence to treatment. Knowledge on correct diagnosis was 87.3% and on
correct means of TB transmission was 79.4% (23).

According to research done in Kenya total of 211 outpatients were interviewed, 84 in urban and
127 in rural health facilities. Chest pain, coughs and weight loss were reported as the common
symptoms of TB. Most of the respondents (90.5%) indicated that TB transmission was airborne
while 94.3% stated that TB was curable and that medicines for treating TB were available
locally. There was significant association between place of residence and overall score on TB
knowledge/awareness (P= 0.012) where urban residents had a higher knowledge/awareness score
compared to their rural counterparts. Similarly, relationship between knowledge on whether TB
was infectious after a few weeks on treatment was statistically significant. The main question
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testing attitude was the perception of the respondents towards TB disease whereby the response
was either positive or negative. Patients residing in urban residence were 2.24 times more likely
to have knowledge on whether TB was infectious after a few weeks of treatment (24).

Many researches done on assessment of knowledge, attitude and practice on way of prevention
of tuberculosis. Among those the study conducted in Saudi Arabia on Assessment of Knowledge,
Attitudes and Practices Regarding Pulmonary Tuberculosis, most of participants (76.8%) had
general knowledge about TB disease and only 23.2% haven’t heard about TB before. The
majority of Saudi adults (74.9%) have inadequate knowledge about TB and only 25.1% have
good knowledge regarding TB (17).

According to the Study done on Knowledge and Practice of Private Medical Practitioners
Regarding Diagnosis and Treatment of Pediatric Tuberculosis in Mogadishu, the majority of the
them expressed that fever for more than 2 week (87.19%), cough for more than 2 week (89.74%)
and loss of weight (92.31%) will led them to suspect TB disease in children (18).

Also study conducted on Tuberculosis knowledge, attitudes, and practices in northern Ethiopian,
Out of 615, only 37.7% mentioned bacteria as a cause of TB while 21.7% related TB to exposure
to cold wind. About Eighty-eight per cent correctly mentioned the aerial route of TB
transmission and 27.3% had perceived stigma towards TB The majority (63.7%) were not aware
of the possibility of getting multi-drug-resistant strains when they would not adhere to treatment.
Overall, only 24% knew the basic elements about TB. who were urban residents were generally
more knowledgeable than rural residents (adjusted OR = 2.16). Illiterates were found to be less
knowledgeable (adjusted OR = 0.17) (20).

Other cross-sectional study on Assessment of Patients’ Knowledge, Attitude, and Practice

Regarding Pulmonary Tuberculosis in Eastern Amhara Regional State, Ethiopia also reveal that
the mean and median knowledge score of respondents about pulmonary TB was 6.81 and 7
percent , respectively. The majority of respondents had several misconceptions in all aspects of
the most infectious form of TB. About half of the respondents did not know the current free cost
of TB diagnosis and treatment. The 69.9% of respondents claimed that cost is the main reason
for not getting care. The TB control program needs to consider advocacy, communication, and
social mobilization for addressing the gap in the study sites (21)
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Other study in eastern Ethiopia ,on assessment of knowledge and practice on tuberculosis, reveal
that Only six (1.6%) study subject described the cause of TB as being bacterial, while a wind
locally known as ‘nefas’ was frequently mentioned (36.1%); nearly 75% of the correctly
described breath as a mode of TB transmission; 116 (30.7%) did not know any measures for TB
prevention and control; and half of the participants did not know that anti-tuberculosis drugs
were Provided free of charge. Significant predictors of TB knowledge were: incarceration in the
Jigjiga (OR 9.62, P < 0.001) and Dire Dawa (OR 2.14, P = 0.016) prisons, those who did not
consult and receive treatment for TB symptoms (OR 2.46, P < 0.001), and prisoners without a
past history of TB (OR 2.72, P = 0.002) (20). Those all shows the variation based on different
aspects (22).

2.2 Attitude
Study done in Saudi the attitude of respondents about TB was negative among most of them
while (17).

In Juba city Patients were offered health education on drug side effects in 93.1% of cases, on
HIV testing and counselling in 74.5% of cases. Disclosure of TB diagnosis by patient to family
or community did not occur in 91.2% cases. Family, community and employers offered support
to patients in 92.2%, 95.1% and 98% of cases respectively (23).

Study done in Kenya majority of the respondents (67.3%) indicated that the community had a
negative attitude towards TB patients while 89.6% stated that HIV positive people should be
concerned about TB. There was significant association between place of residence and overall
score on TB attitude (P= 0.022) where urban residents had a higher knowledge/awareness score
compared to their rural counterparts (24).

Research done on medical practitioners only 5 (12.82%) mentioned that they use history of TB
contact as a suspicion of pediatric TB. More than half of the practitioners 21(53.85%) relied on
CXR and ESR for the diagnosis of tuberculosis in children. None of the clinicians considered
Monteux test as a tool for investigation of TB in children (18).

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In Ethiopia about 41% had favorable attitudes according research done on KAP of TB prevention
rural residents and illiterates had less likely to have a favorable attitude (adjusted OR = 0.31)
(20).

2.3 Practice
In South Sudan according research done in Juba city 94.1% respondents were able to perform at
least one task to stop spread of disease, access to free TB test occurred in 100% of cases and for
free drugs in 99% cases (23).

In Kenya study showed that the majority of respondents (86.3%) normally went to government
clinics or hospitals for treatment in the event of sickness. Majority of the respondents (45%)
were young adults between 20-29 years. There was no significant relationship between overall
score on good practice and place of residence (P=0.061), although urban residents scored low
compared to their rural counterparts (24).

Most of participants had a good practice level but it needs to be increased. There was a
significant association between young age and high educational degree with good practice about
TB prevention (17).

About 60% of the patients did not knew or not recommended the appropriate regimens for extra-
pulmonary TB treatment, while 79.49% did not know the recommended treatment of TB/HIV
co-infection. Of the 48 prescriptions collected, only one prescription was correctly prescribed
according to the weight of the child. Only 18 (39 %) of the anti-TB drugs prescribed were Fixed
Dose Combination approved by the WHO (18)

About 55% respondents had a good practice. Rural residents and illiterate had less good practice
(adjusted OR = 0.35). Significant differences were also observed between the different study
subjects (20).

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 CHAPTER THREE

OBJECTIVES

3.1. General Objective

To assess knowledge, attitude and practice on ways of TB prevention among patients with
pulmonary TB visiting health facilities in Dhagahbour town, Jerer Zone, Eastern Ethiopia, 2024

3.2. Specific Objectives

 To assess knowledge on ways of TB prevention among patients with TB visiting health

facilities in Dhagahbour town, Jeerer Zone, Eastern Ethiopia, 2024
 To assess attitude on ways of TB prevention among patients with TB visiting health
facilities in Dhagahbour town, Jeerer zone, Eastern Ethiopia, 2024
 To assess practice on ways of TB prevention among patients with TB visiting health
facilities in Dhagahbour town, Jeerer Zone, Eastern Ethiopia, 2024

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 CHAPTER FOUR

METHODS AND MATERIALS

4.1. Study Setting

The study was conducted in Dhagahbour town which is one of the 6 town of Jeerer zone in
Somali Regional State. It is located 164.7kms from Jigjiga, capital of Somali Region and Faafan
zone as well. It is divided into 8 Keeble’s. By 2014 EFY, the total population of the town was
500,000. Regarding health facilities the town contains 1Health Centers, Health Posts and 1
General Hospital which are functioning now. Tuberculosis treatment service is being given in all
health centers and health posts by free of charge according to recommended schedule.

.
Figure 1: Map of Dhagahbur town

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4.2. Study design and Period

A facility based cross-sectional study design was conducted from August to December, 2024

4.3. Source and Study Population

4.3.1 Source population

All populations living in Dhagahabour town

4.3.2 Study Population

All populations of Dhagahbour town who attended the selected health facilities during data
collection period and responded to our questions

4.4 Inclusion and Exclusion Criteria

4.4.1 Inclusion criteria

Individuals having willing to participate and cooperate with our questions

Individuals greater than 15 years old

4.4.2 Exclusion Criteria

Individuals not willing participate in our study

Individuals less than 15 years old

4.5 Sample size determination

The sample size was determined using a single population proportion formula, considering a
confidence level of 95%, an estimated overall proportion of good knowledge about TB of 54%
because of three factors which gives high sample size, from research conducted on Community

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knowledge, attitudes and practices on pulmonary tuberculosis and their choice of treatment
supervisor in Tigray, northern Ethiopia (19) and a precision of 5%. So this generalizes as follow
 margin of error 5%(d=0.05)
 confidence level 95%(1.96)
 Non-response rate10%
n = (Z1-α/2)² p (1-p)/d2

= (1.96)2*0.54*0.46 = 382
(0.05)2
Since the above sample was taken from a relatively small population (N =
300), the required minimum sample was obtained from the above estimate
by making some adjustment.

N
n=
N
1+( )
p

Where: N= Sample size before adjustment

n= Sample size after adjustment

p= population of study (in this case 300 pulmonary TB patients found in town)

38 2
n=
Therefore, 38 2 = 382/2.28 = 168
1+( )
300

With adding 10% of non-response rate, the final sample size becomes 168+17=185

4.6 Sampling Techniques and Procedures

From the total of 3 public health facilities found in the Dhagahbour, 1 Health posts, 1 Health
centers and 1 Hospital was selected. A proportionally distributing sample size to their number of
confirmed pulmonary TB was used according to their capacity (hospital, health center and health
post). A separate sample unit was selected from each public facility. Finally, individual units was

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selected by a simple random sampling method from registration book each facility and all public
facilities sites was included in the study. (Refer figure 2 below).

Dhagahbour town
health office

01 Hospital 1 Health post 1 Health

center

Purposively
01 Hospital 1 Health 1 HC
posts

Proportional allocation of samples

01 Hospital 1 Health 1 HC
posts

Figure 2: Schematic representation of sampling procedure for health facilities of Dhagahbour

town, Jeerer Zone, Eastern Ethiopia 2024.

4.7. Data collection tools and procedures

We were used a semi-structured questionnaire that consisted of closed-end questions. The

questionnaire was prepared in English, then, it was translated into Somali Language and used for
data collection. Three supervisor diplomas on health fields and six data collectors who are grade
10 completed were recruited to collect data. On-site training was given for interviewers and
supervisors for 1 day. Cross-checking was conducted in sample facilities for consistency. The
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questions on the questionnaires include information on the socio-demographic characteristics of
the respondent, knowledge, attitudes, and health-seeking practice toward TB. Before the
administration of the questionnaire the subjects were informed about the objectives of the study
and 5% of the target population was asked to answer the questionnaires for validation.

The questionnaire contains 6 questions for knowledge part, 7 questions for attitude part and 5
questions for practice part. For each TB knowledge question, a score of one was given for a
correct answer, whereas a zero score given for incorrect and do not know responses. Questions
on the knowledge part are rated and a total score was obtained. The median score was then
computed. Therefore, those with a total score equal to or below the median was classified as
having poor knowledge, whereas those above the median was considered having good
knowledge. This also was applied for attitude and practice.

4.8. Study Variables

4.8.1 Dependent Variable

 knowledge, attitude and practice on prevention of TB

4.8.2 Independent Variables

 Age
 Sex
 Residence
 Educational status
 Economic status
 Living arrangement

4.9 Operational Definitions

Good knowledge: - it is information that an individual is aware of about something it. In this
study it was measured based on the ability of participants to correctly identify and respond to ,

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mode of transmission (5 questions), sign and symptom (5 questions), possible ways of
prevention ( 4 questions), treatment (2 questions). Each correct answer had one point.is those
above the median. Good knowledge: - knowledge score of 8 and above mark.

Poor knowledge is those with a total score equal to or below the median.

Pulmonary tuberculosis is tuberculosis that infect mainly lung

Attitude: - is the perception, outlook, or feeling of the participants regarding PTB prevention. It
was measured by feeling toward PTB patients.

Positive attitude: - those who have a supportive attitude about the prevention of PTB. are not
afraid of PTB.

Negative attitude: - The reverse of the above. Those who are afraid of PTB

Practice: - is the overt behavior, habit, or custom that a person does follow or carry out in his /her
daily life to prevent PTB. In this study practice was measured by (1 question) what an
individual’s doing is when faced or be PTB patient.

Desirable practice: - A practice which help the respondent to protect himself/ herself from TB
transmission. of the participant who share the right practice.

Undesirable practice: -practice of the participants who share wrong practice

Prevention: - the way of preventing the transmission of TB before acquiring the disease

Perception: - the one own thinking of or picturization of a certain phenomenon in this study
towards TB prevention perception.

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4.10 Data Quality Assurance

Data was assured by using properly designed, structured, interviewer administered and pretested
questionnaire. Again, the questionnaire was assessed for clarity and if there is any questions that
are difficult to understand and respond was rephrased before data was collected. Data collectors
were trained for one day before data collection on the objective and significance of the study.
Completed questionnaire was checked for consistency and completeness daily until data
collection completed, then correction was given if any inconsistency and incompleteness is
observed

4.11 Data Processing and analysis

Data was checked for completeness and consistency. Then, coded and analyzed using manual
calculators. Then, frequency distribution and percentages were computed to describe socio-
demographic and some other variables such as KAP toward TB was presented by tables and
figures

4.12 Ethical Clearance

Letter of permission for doing research was obtained from Jigjiga University Institute of health
Department Nursing and brought to the Hospital Administrative bodies. Data. Study participants
was asked for their consent before being asked to give information and written informed consent
was taken from every study participant. Information was given to all participants about the
objective, the contents of the study, as well as their right to refuse and discontinue the data
collection. No person was obligated to participate in the study without his/her consent.

4.13. Dissemination of result

The results of the study was disseminated to the responsible administrators: Jigjiga University
College-of medicine and health science department of Nursing as partial fulfilment of the
requirements for the Bachelor degree of nursing, Jeerer zone health department, Dhagahbour
town health office as well as health facility under it.

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 CHAPTER FIVE

RESULT

5.1 Socio-demographic Characteristics

This study was conducted on 185 persons to assess Their Knowledge, Attitude and practice
toward TB prevention. Among study participants,104(56.216%) were females and male patients
were 81(49.189%). all the respondents fall in the age range between 15 and 60 years old with 35
years being the mean age. majority of the respondents were Muslim religion flowers
181(97.84%). 69(37.3%) were from rural, and 71(38.38%) were illiterate. And 23(12.43%) were
employed. And the other funding was summarized under tables 1a,1b and 1

Table 1a: Age- Sex distribution of study participants.

Sex
Male Female
Age Frequency % Frequency % Total %
15-24 17 20.88 23 22.11 40 21.62%
25-34 19 23.08 24 23.07 43 23.24%
35-44 22 27.46 28 26.92 50 27.02%
45-54 16 20.88 22 21.15 38 20.54%
55-64 4 4.40 5 4.81 9 4.86%
>65 3 3.30 2 1.92 5 2.70%
Total 81 100 104 100 185 100%

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 Male Female

>65
55-64
45-54
35-44
25-34
15-24

30 25 20 15 10 5 0 5 10 15 20 25 30
Figure 3: - Age distribution of study participant

Tables 1b: Socio-demographic data of study participants.

Variable Frequency %
Occupational status -House wife 78 42.16%
-Gov’t employs 23 12.43%
-Merchant 57 30.81%
-Daily labor 21 11.35%
-others 6 3.25%

-Total 185 100%

Marital status -Single 25 13.51%

-Married 123 66.49%
-Divorced 13 7.03%
-Widowed 24 12.97%
-Total 185 100%
Educational status -Illiterate 71 38.38%
-Grade 1-8 68 36.78%
-Grade 9-12 34 18.38%
-College/University 12 6.46%

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 -Total 185 100%

Current area of residence -Rural 69 37.30%

-Urban 78 42.16%
-No response 38 20.54%
-Total 185 100%

Ethnicity -Somali 178 96.22&

-Others 7 3.78%
-Total 185 100%

-Muslim 181 97.84%

Religion -Orthodox 3 1.62%
-Others 1 0.54%
-Total 185 100%

Occupational status
90

80

70

60

50

40

30

20

10

0
House wife Gov't employs Merchant Daily labor Others

Figure 4: - Occupational status of study participants.

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 Marital status

13% 14%
7% Single
Married
Divorced
Widowed

66%

Figure 5: - Marital status of study participants.

5.2 Level of Knowledge about TB

From study participants most of the respondents heard TB 176(95.135%), Respondents regarding
mode of transmission about 74.05%(137)of the study participants said TB transmitted though air
droplet. Above half 55.677%(103) said TB is the communicable disease. Regarding sign and
symptoms 38.38%(71) of the study said cough of two weeks and above and weight
loss18.91%(35) were mentioned as a major signs and symptoms of TB. more information about
level of Knowledge is summarized in table 2 below.

Table 2: Knowledge about TB prevention among communities in Dagaghbour town

attending selected health Facilities in Dagahbour town

Question Response frequency persent

Have you ever heard about TB? Yes 176 95.135%

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 9

No 185 4.865%

Total 100%

Did you know PTB Cough>2wks Yes 71 38.378%

sign \symptoms
No 114 61.621%

total 185 100%

Ongoing fatigue Yes 29 15.675%

No 156 84.32%

total 185 100%

Shortness of Yes 53 28.6486%

breath
No 147 71.351%

total 100%

Weight loss Yes 35 18.91%

No 150 81.09%

Total 185 100%

Fever Yes 13 7.02%

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 No 172 92.97%

total 185 100%

Do you think PTB is curable disease? Yes 121 65.405%

No 64 34.595%

total 185 100%

Do you think withdrawal of anti- TB Yes 49 26.486%

medication has a problem ?
No 136 73.513%

total 185 100%

Do you think PTB is communicable? Yes 103 55.675%

No 82 44.324%

total 185 100%

Had you heard about the Through Yes 137 74.05%

mode of acquiring PTB air droplet
No 48 25.94%

total 185 100%

Through Yes 42 22.702%

shaking
No 143 77.297%
hands

total 185 100%

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 Through Yes 53 28.648%
sharing
No 132 71.351%
dish

total 185

Through Yes 43 23.243%

over
No 142 76.75%
crowded

Total

Through Yes 89 48.108%

coughing
No 96 51.891%

Total 185 100%

5.3 Attitude towards TB

Regarding to attitude towards tuberculosis, 49.945% of study participants stated that TB is
serious disease. Majority of study participants (49.189%) stated that continue friendship with
TB patient. Almost one-fifth (21.08%) of the Respondents said they would tell others if they had
TB .The attitude toward TB summarized in table 2.

Table 2b: Summary of attitude toward ways of TB prevention among Communities of

Dagahbour town attending selected health facilities

Question Response Frequency persent

Are you afraid of PTB patients? Yes 85 49.945%

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 No 100 54.054%

total 185

Would you continue friendship Yes 91 49.189%

with PTB patients?
No 94 50.81%

total 100 100%

Would you provide care to PTB Yes 81 43.78%

patients?
No 104 56.22%

total 185 100%

Would you tell others if you had Yes 39 21.08%

TB?
No 146 78.92%

total 185

Do you allow your daughter (son) Yes 119 64.32%

to marry a cured previously TB
No 66 35.68%
patients?
total 185 100%

Do you think that early diagnosis Yes 168 90.81%

and treatment of TB is important
No 17 9.19%
to control the severity and
transmission of TB? total 185 100%

Did you know Covering Yes 98 52.97%

mode of prevention mouth and
no 87 47.027%
of TB nose

Avoiding Yes 100 54.05%

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 sharng dish 45.945%

no 85

Through Yes 125 67.56%

good
no 60 32.43%
nutrion

Closing Yes 40 21.62%

window
no 145 78.37%

5.4 Practices toward TB

One hundred thirty four (72.48%) of study participants’ house had window and also well
ventilated open the window regularly. Almost 25 (13.5%) of study participants were vaccinated
their children. Two-third of the study participants ever received health education about TB. From
all study participants, two-third stated that they will cover their mouth during coughing if they
had TB as a measure to prevent further spread of the disease .Al the information about practices
toward TB prevention is summarized in table 5

Table3: Level of Practices toward ways of TB prevention among communities attendig selected
health facilities

Did you vaccine your Yes 25 13.5%

children early
no 160 86.5%

Would you use your Yes 134 72.43%

house well ventilated
no 51 27.57%

Would you get early Yes 175 94.59%

treatment if you
no 10 5.405%
cough by TB

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Do you think that Yes 182 98.37%
taking TB drug
no 3 1.63%
properly is important
in controlling TB?

Do you use TB Yes 100 54.05%

Prevention
no 85 45.94%
material/method

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CHAPTER SIX

DISCUSSION
This study showed that TB is familiar to the general community in the current study area, as the
majority (95.135%) of the study participants had indicated that they have heard of TB disease,
which is similar to previous studies done among pastoral communities in the Shinile area [16]
and middle and lower Awash valley of Afar region, Ethiopia [29], where 92.8% and 95.6% of
the study participants were aware of the disease, respectively. How ever, in accordance with
earlier studies in Somali region [16,34] and southwest Ethiopia [31] as well as in Afar re gion
[29], Kenya [35], and Pakistan [36], the respondents had limited information concerning bacteria
as a causative agent of TB. Instead, most of them perceived mainly either cold air or smoking
and chat chewing as the cause of TB, which is more or less similar with other studies [29,30,37].
Poor awareness regarding etiology of the dis ease may has a negative impact on patients’ attitude
to wards health-seeking behavior and preventive methods as most people with such believes may
not visit health facilities or they may consider various traditional alternatives.

Based on the results of this study, the respondents had basic knowledge about the common
signs/symptoms of TB and its modes of transmission, which agrees with previous studies in a
rural community in southwest Ethiopia [31], in northeast Ethiopia [29], and also in Iran [38] and
Philippines [39]. In this regard, it was reported that persistence cough for 2 or more weeks,
coughing up sputum and weight loss were the common sign and symptom of TB. Through the
air when a person with TB sneezes or coughs, and sharing cups with the patient were the
common perceived modes of transmission in different studies [29,40,41].

The reported basic communities’ knowledge about the symptoms and transmission methods of
TB has an important implication for the TB control program in the current study area in
particular and also in the country in general in that it could reduce diagnosis and treatment delay,
as well as the spread of the disease. Another important aspect noted in this study was that most
of the participants were aware of the prevention and treatment methods of TB, which is more or
less similar to a study performed by Melaku et al. [16].

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Accordingly, covering mouth and nose when a person with TB coughs or sneezes, using a
separate room for the pa patient, avoid sharing cups with the patient, early treat ment and good
nutrition as a prevention methods were similarly documented by earlier studies from Ethiopia
[16,31] and also from Pakistan [40]. Furthermore, re spondents’ knowledge regarding treatment
of the disease using modern drugs was very high compared to the results of previous studies
conducted in other parts of Ethiopia [30,31]. It is interesting to note, however, that association of
self-treatment options, traditional healers and praying to the treatment mode of the disease
cannot be neglected, which is in consistence with findings by Deribew et al. [30].

This may be due to, they may not suspect TB upon appearance of early symptoms
(cough,fever,etc) unless severe symptoms (hemoptysis,weight loss,etc)set in which can be
evidenced by finding of Geletal [34] as Somali pastoralists consider persistent cough a normal
phenomena ,not as potential symptoms of TB.in this study ,high overall TB knowledge was
significantly associated to educational status of the participants therefore, public awareness
program using media are crucial in educating the masses, over ,health education program to
raise communities knowledge of TB is mandatory.

It was also found out that participants from the current study area considered that TB is a very
serious disease in general and a very serious problem in their area.Further more, majority of the
respondents indicated that they would feel fear or scare and sadness or hopelessness if they
found they have TB. Similar feelings have been associated with TB in Pakistan[36,40].On the
other hand, a high proportion of the study subjects had no particular feeling towards people with
TB disease, which means that there is no discrimination against TB patients in the current study
area. More over,more than half the study subjects said that TB patients are mostly supported and
helped by the community. This is in contrast to many other studies conducted in the
country[16,30,37]and as well as in Kenya[35], India[41]and Pakistan[36,40].The perception of
TB as very dangerous disease resulting in fear might be due to the factors: relatively needed for
its treatment, its mortality in the community, the coughing up of blood associated with many
afflicted by the disease and comparison of TB with incurable tumors and cancer.

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 CHAPTER SEVEN

7 CONCLUSION AND RECOMMENDATION

7.1 CONCLUSION

In comparison to numerous national and international studies, the knowledge, attitude and
practice about tuberculosis were not sufficient. The findings of this study revealed 100 (54%)
of study participants had good knowledge towards ways of TB prevention and 89 (48.1%) of
participants had good preventive practice in prevention of TB.

7.2 RECOMMENDATIONS
We would like to recommend Dhagahbour town health facility managers and staffs in
collaboration with Dhagahbour town health bureau to provide health education about TB
transmission ways and how to prevent it's prevalence in the study area.

We also recommend the Communities of Dagahbour town to be open to health education and to
firmly apply prevention ways of TB.

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