Knowledge, attitudes, and practices related to TB among the general population of Ethiopia: Findings from a national cross-sectional survey

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Introduction

Ethiopia is among the high-burden countries for tuberculosis (TB), TB/HIV, and drug-resistant TB. The aim of this nationwide study was to better understand TB-related knowledge, attitudes, and practices (KAPs) and generate evidence for policy and decision-making.

Materials and methods

We conducted a cross-sectional TB KAP survey in seven regions and two city administrations of Ethiopia. Eighty kebeles (wards) and 40 health centers were randomly selected for the study. Using systematic sampling, 22 households and 11 TB patients were enrolled from each selected village and health center, respectively. Variables with a value of p = < 0.25 were included in the model for logistic regression analysis.

Results

Of 3,503 participants, 884 (24.4%), 836 (24.1%), and 1,783 (51.5%) were TB patients, families of TB patients, and the general population, respectively. The mean age was 34.3 years, and 50% were women. Forty-six percent were heads of households, 32.1% were illiterate, 20.3% were farmers, and 19.8% were from the lowest quintile. The majority (95.5%) had heard about TB, but only 25.8% knew that TB is caused by bacteria. Cough or sneezing was reported as the commonest means of TB transmission. The majority (85.3%) knew that TB could be cured. Men, better-educated people, and TB patients and their families have higher knowledge scores. Of 2,483 participants, 96% reported that they would go to public health facilities if they developed TB symptoms.

Discussion

Most Ethiopians have a high level of awareness about TB and seek care in public health facilities, and communities are generally supportive. Inadequate knowledge about TB transmission, limited engagement of community health workers, and low preference for using community health workers were the key challenges.

Conclusions

Given misconceptions about TB’s causes, low preference for use of community health workers, and inadequate engagement, targeted health education interventions are required to improve TB services.

Related collections

Most cited references 48

Record: found
Abstract: found
Article: found

Is Open Access

Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review

Devra Barter, Stephen O Agboola, Megan Murray … (2012)

Background Tuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. Methods PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$). Results Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. Conclusion TB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment and care, both within and outside of Directly Observed Therapy Short-course (DOTS) programs. For many households, TB treatment and care-related costs were considered to be catastrophic because the patient costs incurred commonly amounted to 10% or more of per capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.

0 comments Cited 87 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study

Sushil Baral, Deepak Karki, James N Newell (2007)

Background Tuberculosis (TB) is a major cause of death. The condition is highly stigmatised, with considerable discrimination towards sufferers. Although there have been several studies assessing the extent of such discrimination, there is little published research explicitly investigating the causes of the stigma and discrimination associated with TB. The objectives of our research were therefore to take the first steps towards determining the causes of discrimination associated with TB. Methods Data collection was performed in Kathmandu, Nepal. Thirty four in-depth interviews were performed with TB patients, family members of patients, and members of the community. Results Causes of self-discrimination identified included fear of transmitting TB, and avoiding gossip and potential discrimination. Causes of discrimination by members of the general public included: fear of a perceived risk of infection; perceived links between TB and other causes of discrimination, particularly poverty and low caste; perceived links between TB and disreputable behaviour; and perceptions that TB was a divine punishment. Furthermore, some patients felt they were discriminated against by health workers Conclusion A comprehensive package of interventions, tailored to the local context, will be needed to address the multiple causes of discrimination identified: basic population-wide health education is unlikely to be effective.

0 comments Cited 86 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia: A Community Randomized Trial

Daniel G. Datiko, Bernt Lindtjørn (2009)

Background One of the main strategies to control tuberculosis (TB) is to find and treat people with active disease. Unfortunately, the case detection rates remain low in many countries. Thus, we need interventions to find and treat sufficient number of patients to control TB. We investigated whether involving health extension workers (HEWs: trained community health workers) in TB control improved smear-positive case detection and treatment success rates in southern Ethiopia. Methodology/Principal Finding We carried out a community-randomized trial in southern Ethiopia from September 2006 to April 2008. Fifty-one kebeles (with a total population of 296, 811) were randomly allocated to intervention and control groups. We trained HEWs in the intervention kebeles on how to identify suspects, collect sputum, and provide directly observed treatment. The HEWs in the intervention kebeles advised people with productive cough of 2 weeks or more duration to attend the health posts. Two hundred and thirty smear-positive patients were identified from the intervention and 88 patients from the control kebeles. The mean case detection rate was higher in the intervention than in the control kebeles (122.2% vs 69.4%, p<0.001). In addition, more females patients were identified in the intervention kebeles (149.0 vs 91.6, p<0.001). The mean treatment success rate was higher in the intervention than in the control kebeles (89.3% vs 83.1%, p = 0.012) and more for females patients (89.8% vs 81.3%, p = 0.05). Conclusions/Significance The involvement of HEWs in sputum collection and treatment improved smear-positive case detection and treatment success rate, possibly because of an improved service access. This could be applied in settings with low health service coverage and a shortage of health workers. Trial Registration ClinicalTrials.gov NCT00803322

0 comments Cited 86 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Daniel G. Datiko:

ORCID: http://orcid.org/0000-0002-8556-3069

Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Dereje Habte: Role: Data curationRole: MethodologyRole: Writing – review & editing

Degu Jerene: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Project administrationRole: Writing – review & editing

Pedro Suarez: Role: ConceptualizationRole: Writing – review & editing

William Joe: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 28 October 2019

Publication date Collection: 2019

Volume: 14

Issue: 10

Electronic Location Identifier: e0224196

Affiliations

[1 ] Challenge TB and Management Sciences for Health, Addis Ababa, Ethiopia

[2 ] Management Sciences for Health, Infectious Diseases Cluster, Arlington, Virginia, United States of America

Institute of Economic Growth, INDIA

Author notes

Competing Interests: The authors have declared that no competing interest exist.

* E-mail: dgemechu@ 123456msh.org , danieljohn42@ 123456yahoo.com

Author information

Daniel G. Datiko http://orcid.org/0000-0002-8556-3069

Article

Publisher ID: PONE-D-18-36778

DOI: 10.1371/journal.pone.0224196

PMC ID: 6816561

PubMed ID: 31658300

SO-VID: df6258a6-8d13-4cd1-a1a7-9e545856db17

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 25 December 2018

Date accepted : 8 October 2019

Page count

Figures: 1, Tables: 5, Pages: 16

Funding

Funded by: Challenge TB

Award ID: AID-OAA-A-14-00029

This KAP assessment was made possible by the generous support of the American people through the United States Agency for International Development, through the Challenge TB Project under agreement number AID-OAA-A-14-00029.

Custom metadata

Data Availability Data are available upon request--it is required that official or reasonable request should come to the authors or their institutions to share, as the data has sensitive personal property related questions. The authors have uploaded many supporting documents including data collection tools and site selection procedures. The contact address for data requests is Challenge TB/MSH Ethiopia, Box 1157 code 1250, Addis Ababa, Ethiopia; Phone +251-116-630-145 or +251-116-630-164 or through the corresponding author - dgemechu@ 123456msh.org .

Knowledge, attitudes, and practices related to TB among the general population of Ethiopia: Findings from a national cross-sectional survey

Read this article at

Abstract

Introduction

Materials and methods

Results

Discussion

Conclusions

Related collections

PLOS Global Public Health

Most cited references 48

Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review

Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study

Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia: A Community Randomized Trial

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Page count

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 125

Cited by 33

Most referenced authors 409