|Year : 2015 | Volume
| Issue : 1 | Page : 19-24
Knowledge of tuberculosis and human immune virus among tuberculosis suspects attending health facilities in Addis Ababa
Nebiyu Negussu Ayele1, Amare Deribew Taddege2, Kebede Deribe kassaye2, Mulugeta Chaka3, Ahmed Badei1
1 Department of Disease Prevention, Ethiopian Somali Regional Health Bureau, Jimma, Ethiopia
2 Department of Epidemiology and Biostatistics, Jimma University, Jimma, Ethiopia
3 Department of Health Education and Behavioral Science, Jimma University, Jimma, Ethiopia
|Date of Web Publication||4-Jun-2015|
Mr. Nebiyu Negussu Ayele
Department of Disease Prevention, Somali Regional Health Bureau, Jijiga
Source of Support: None, Conflict of Interest: None
Background: Tuberculosis is a major public health problem throughout the world in general and in Ethiopia in particular. In this study, we assess the knowledge of TB suspects about TB and HIV in health facilities of Addis Ababa. Materials and Methods: In the period of February to March, 2009, a cross-sectional survey was done in 27 health centers of Addis Ababa among TB suspects who had cough, and fever for ≥2 weeks. A total of 545 adult pulmonary TB or extrapulmonary TB (TB lymphadenitis) suspects (>15 years) were studied. Information about TB and HIV were collected using pretested questionnaire. Data was collected by trained health professionals and analyzed using SPSS 20.0 statistical software. Result: Most (94.4%) of the TB suspects heard about TB before. A few (12.8%) knew TB can involve other organs other than the lung. Ventilating living room was perceived by 34.6% as a means of reducing TB infection. Suspects who work in the public sector had three times increased odds of being knowledgeable than daily workers (AOR = 3.00, 95% CI: 1.53-5.88, P = 0.001). On the other hand, illiterates had lower odds of being knowledgeable about TB than above 12 graders (AOR = 0.1, 95% CI: 0.03-0.38, P = 0.001). Even if all suspects heard about HIV, still sharing meal (10.7%) and mosquito bite (7.9%) perceived as modes of transmission for HIV infection. Suspects who are 25-34 years old (AOR = 3, 08, 95% CI: 1.4-6.78, P = 0.001) and 35-49 years old (AOR = 2.16, 95% CI: 1.04-4.48, P = 0.033) were more likely to have good knowledge about HIV compared with >50 years old. Conclusion: Overall, suspects heard about TB and HIV before. However, there was less knowledge regarding other forms of TB. Misconception still persists on the area of HIV/AIDS. Hence a comprehensive approach needs to be followed to improve knowledge about TB and misconception about HIV/AIDS.
Keywords: HIV/AIDS, tuberculosis, TB lymphadenitis
|How to cite this article:|
Ayele NN, Taddege AD, kassaye KD, Chaka M, Badei A. Knowledge of tuberculosis and human immune virus among tuberculosis suspects attending health facilities in Addis Ababa. J Health Res Rev 2015;2:19-24
|How to cite this URL:|
Ayele NN, Taddege AD, kassaye KD, Chaka M, Badei A. Knowledge of tuberculosis and human immune virus among tuberculosis suspects attending health facilities in Addis Ababa. J Health Res Rev [serial online] 2015 [cited 2020 Jan 24];2:19-24. Available from: http://www.jhrr.org/text.asp?2015/2/1/19/158124
| Introduction|| |
Tuberculosis (TB) remains a major global health problem. 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).  According to the World Health Organization (WHO) global TB Report 2013, there were 8.6 million new TB cases in 2012 and 1.3 million TB deaths. An estimated 1.1 million (13%) of the 8.6 million people who developed TB in 2012 were HIV positive. About 75% of these cases were in the African region. 
The 22 High Burden Countries (HBCs) that have been given highest priority at the global level since 2000 accounted for 81% of all estimated cases worldwide. These countries have been the focus of intensified efforts in Directly Observed Treatment, Short course (DOTS) expansion. 
Ethiopia is one of the 22 HBCs. According to the WHO global TB report 2013, there were an estimated 230,000 (183-321 per 100,000) incident cases of TB including HIV positives. In the same year the prevalence of TB was estimated to be 210,000 (180-272, per 100,000). There were an estimated 16,000 deaths (13-23 per 100,000) due to TB, excluding HIV-related deaths. 
Among 41 high TB/HIV burden countries in the year 2011 there were about 38000 HIV-positive new TB cases in Ethiopia. Among 65,140 TB patients who were screened for HIV infection, 5,442 were found to be positive for HIV infection. 
Delay in TB diagnosis may lead to progression of disease leading to increased mortality and enhanced TB transmission in the community. Reports have indicated that patients become more contagious as the delay progresses.  Treatment delay, which mainly results from delayed diagnosis, is one of the major challenges of TB control programs in developing countries. ,, It is particularly important in a high HIV prevalence setting like Ethiopia, , where persons with HIV infection are at high risk of developing TB.
Studies in different countries report that knowledge about TB is affected by socioeconomic variables, ,, Low awareness, ,, income,  illiteracy,  gender, ,, and marital status.  Here we report results of knowledge on tuberculosis and HIV among TB suspects in public health facilities in Addis Ababa. This information will help to understand the level of knowledge of tuberculosis suspects and factor affecting it.
| Materials and methods|| |
Setting and period
The study was carried out from February to March, 2009, in -27 public health centers (primary health care units) in Addis Ababa, the capital city of the Federal Democratic Republic of Ethiopia. The population of the city was estimated at 2.9 million.  There were 27 government health centers in the city and all of them participated in the study.
A facility based cross-sectional study was conducted in 27 health centers in Addis Ababa.
Study population and sampling
Study participants were 545 adult pulmonary TB or extrapulmonary TB (TB lymphadenitis) suspects (>15 years) identified in the study health centers. Considering resources, the sample size was estimated using a single proportion sample size formulae by considering the following parameters: Prevalence of TB among adult pulmonary TB suspects of 29%,  95% CI, and 4% of margin of error and 10% for the nonresponse rate.
The total sample size was distributed equally among 27 health centers. From each health centers 20 patients were consecutively recruited, except in 5 health centers where 21 patients recruited. If he or she refused to be involved in the study, the next eligible attendee was approached.
TB suspects were identified using a pre-tested questionnaire. TB suspects were defined as individuals who had cough of >2 weeks OR two or more of the following symptoms: Weight loss, fever, excessive night sweats, and painless swelling of cervical or auxiliary lymph nodes of more than 2 weeks.  Diagnosis of TB and HIV was based on the national guideline and the detail procedure is published elsewhere. 
Information concerning the sociodemographic and knowledge of patients on TB and HIV was collected by trained general practitioners or nurses using a pretested and previously used questionnaire.  The questionnaire was originally developed in English and translated to Amharic (local language). To ensure consistency, the questionnaire was retranslated to English by another person who was blind to the original questionnaire. The overall knowledge of TB and HIV were assessed by scoring system. A score of one was given to correct responses, zero being used for incorrect/do not know responses. The mean value was used to categorize study participants into two categories. Score less than the mean value was considered as low knowledge, whereas score greater than the mean value was considered as good knowledge.  Accordingly, study participants who scored above the mean value (11.52) of the 23 questions for knowledge of TB were categorized as knowledgeable. Similarly, the mean value (11.85) of 17 questions about knowledge of HIV was used to categorize the study participants into two categories.
Data were entered into SPSS Version 20.0 statistical software. Univariate analysis was done to describe the sociodemographic characteristics, knowledge of TB, and knowledge of HIV. Outcome variables (knowledge about TB, and knowledge toward HIV) were dichotomized. Sociodemographic characteristics of the study participants were major independent variables. Whereas knowledge of TB and HIV were dependants. The data analyses was based on logistic regression.
First univariate analysis was conducted to see possible association and to estimate the crude OR, the different independent variables were fitted univariately to assess their independent effect in terms of the crude odds ratio and its 95% confidence interval (CI). Next, a stepwise multivariate logistic regression model was fitted containing all the independent variables that showed a significant effect in the univariate analysis at the 5% significance level, leading to adjusted odds ratio and their 95% confidence intervals.
Ethical clearance was obtained from the ethical committee of Jimma University and Addis Ababa health bureau. Written consent was obtained from each participants and confidentiality was assured for all the information provided. Identification of a participant was only through numerical codes.
| Results|| |
Sociodemographic characteristics of the study participants
A total of 506 suspects involved in the analysis, the rest 39 (7.2%) were excluded due to incomplete result on major outcome variables. The mean age was 35 years, minimum 15 maximum 82 (SD = 13.9). Majority (70.9%), of the study participants were Orthodox Christian by religion and the predominant job was daily laborer (40.3%). [Table 1] shows the sociodemographic characteristics of the study participants.
|Table 1: Demographic and social characteristics of TB suspects in Addis Ababa, Ethiopia, June, 2009 (n=506) |
Click here to view
Knowledge of study participants about TB
Majority (94.4%) of the suspects heard about TB before coming to the health facility. Most (83.6%) knew TB can affect lung; however, only (12.8%) knew TB can involve other organs other than the lung. Pertaining to the mode of transmission, most (74.5%) knew TB is transmitted by air droplets and only (14.6%) knew that it could be transmitted by drinking raw milk. Long-lasting cough was perceived by majority (77.5%) of suspects as a symptom of TB. On the other hand, only (34.6%) knew ventilating living room can reduce the risk of TB infection.
Crude and adjusted effects of selected covariates obtained from logistic regression are summarized in [Table 2] for the overall knowledge about TB. Suspects who work at a public sector had three times higher odds of being knowledgeable than daily workers (AOR = 3.00, 95% CI: 1.53-5.88, P = 0.001). Illiterates had lesser odd of being knowledgeable about TB than those who attend above 12 grades (AOR = 0.1, 95% CI: 0.03-0.38, P = 0.001) [Table 2].
|Table 2: Association of TB suspects sociodemographic characteristics with knowledge about TB in Addis Ababa, Ethiopia, June, 2009 (n=506) |
Click here to view
Knowledge of study participants about HIV/AIDS
All (100%) of the study participants herd about HIV, and most (95.8%) suspects believe HIV is contagious. Sharing meal (10.7%) and mosquito bite (7.9%) were perceived as HIV transmission routes. Moreover, unprotected sex and breast feeding from known HIV-infected mother mentioned by (77.3%) and (26.9%) of the suspects, respectively.
Abstaining from sexual intercourse (70%) and using condom (49.4%) mentioned as a prevention of HIV infection. Around (31.2%) of suspects believe antiretroviral therapy (ART) can cure HIV/AIDS patients.
Those who are in the age category 25-34 were three times higher odd of being more knowledgeable than age >50 (AOR = 3, 08, 95% CI: 1.4-6.78, P = 0.001). Similarly, age 35-49 years are 2.16 times more likely to have a good knowledge than >50 (AOR = 2.16, 95% CI: 1.04-4.48, P = 0.033). Suspects who are married had lesser odds of being knowledgeable than divorced (AOR = 0.55, 95% CI: 0.31-0.98, P = 0.98). On the other hand, merchant suspects have a good knowledge than daily workers (AOR = 1.89, 95% CI: 1.03-3.46, P = 0.98) [Table 3].
|Table 3: Association of TB suspects sociodemographic characteristics with knowledge about HIV in Addis Ababa, Ethiopia, June, 2009 (n=506) |
Click here to view
| Discussion|| |
In this study, several important findings were observed. Majority (94.4%) of the suspects ever heard about TB before; however, only 12.8% recognize TB can involve other organs other than the lung. Few of the suspects, 14.6%, aware TB is transmitted by drinking of raw milk, whereas 74.5% know TB transmitted by air droplets of infected person. Long-lasting cough perceived by 77.5% as a sign and symptom of TB. Ventilating a living room as a means of reducing the risk of TB infection indicated by 34.6% of suspect's. On the other hand, all suspects heard about acquired immunodeficiency syndrome (AIDS) before. Half of the suspects mention use of condom serves as a means of HIV prevention. Very few, 7.9% suspects believe mosquito bite can transmit HIV infection. Education and occupational status were associated with knowledge of TB, and only age was a predictor of comprehensive knowledge about HIV/AIDS.
The finding about ever heard TB before in our study is consistent with previous reports in Afar (A) (95.6%) other parts of Ethiopia, , Vietnam,  Tanzania,  and Kenya.  In this study, only few 14.6% know TB is transmitted by drinking of raw milk; however, majority 74.5% recognize TB transmitted by air droplets of infected person. Besides 34.6% distinguish ventilating a living room can reduce the risk of TB infection, 77.5% aware long-lasting cough as a symptom of TB, which is comparable to previous reports from this country, ,, and Tanzania,  nevertheless, lower than the findings of study conducted in Afar. 
Suspects who work at a public sectors had three times higher odds of being knowledgeable than daily workers (AOR = 3.00, 95% CI: 1.53-5.88, P = 0.001). Likewise, illiterates had lesser odds of being knowledgeable about TB than those who attend grade 12 and above (AOR = 0.1, 95% CI: 0.03-0.38, P = 0.001), which is consistent with the study done in India, West Bengal. 
On the other side, all suspects heard about HIV/AIDS before, which is in agreement with the 2011 Ethiopian demography and health survey report (EDHS). Our finding 49.4% believes use of condom can reduce HIV infection is lower than India 68%,  and EDHS report in Addis Ababa (82.4% females and 94.1% males).  This difference shows great change in knowledge of condom as a means of HIV prevention over time due to intensification of health education.
As a part of the effort to assess HIV/AIDS knowledge, we obtain common misconceptions about the transmission. Around 7.9% suspects in our study believe mosquito bite can transmit HIV infection, which is lower than, EDHS report 34.1% females and 29.3% males. 
The result age category 25-34 were three times had higher odd of being more knowledgeable than age >50 (AOR = 3, 08, 95% CI: 1.4-6.78, P = 0.001) similarly age 35-49 years are 2.16 times more likely to have a good knowledge than >50 (AOR = 2.16, 95% CI: 1.04-4.48, P = 0.033), this might be due to high exposure of adults to different social medias, however these findings were incongruity with 2011 EDHS report. 
Inclusion of all the health centers in Addis Ababa, use of primary data, and adequate sample size are some of the strength of this study. However, not measure previous history of TB status, which might have implication for the finding.
| Conclusion|| |
Greater parts of suspects ever heard about TB and HIV before. However, less awareness on other forms of TB, boiling raw milk and ventilating room as a means of TB prevention. Educational status and occupational status were predictors of knowledge about TB. Accepting condom as HIV prevention is low and misconception on HIV/AIDS mode of transmission and ART rationale were high. Hence a comprehensive approach on the behavioral domains needs to be followed to improve knowledge about TB and misconception about HIV/AIDS.
| Acknowledgments|| |
The authors acknowledge the study participants and health institutions for their unreserved support to give the necessary information.
| References|| |
World Health Organization. Global Tuberculosis Report:WHO; 2013.
World Health Organization. Global Tuberculosis Control. Geneva, Switzerland: WHO; 2012.
Madebo T, Lindtjorn B. Delay in treatment of pulmonary tuberculosis: An analysis of symptom duration among Ethiopian patients. Med Gen Med 1999;E6.
Demissie M, Lindtjorn B, Berhane Y. Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health 2002;2:23.
Wondimu T, Michael KW, Kassahun W, Getachew S. Delay in initiating tuberculosis treatment and factors associated among pulmonary tuberculosis patients in East Wollega, Western Ethiopia. Ethiop J Health Dev 2007;21:148-56.
Sreeramareddy CT, Panduru KV, Menten J, Van den Ende J. Time delays in diagnosis of pulmonary tuberculosis: A systematic review of literature. BMC Infect Dis 2009;9:91.
Kassu A, Mengistu G, Ayele B, Diro E, Mekonnen F, Ketema D, et al
. Coinfection and clinical manifestations of tuberculosis in human immunodeficiency virus-infected and -uninfected adults at a teaching hospital, northwest Ethiopia. J Microbiol Immunol Infect 2007;40:116-22.
Demissie M, Lindtjørn B, Tegbaru B. Human Immunodeficiency virus (HIV) infection in tuberculosis patients in Addis Ababa. Ethiop J Health Dev 2000;14:277-82.
Hoa NP, Diwan VK, Co NV, Thorson AE. Knowledge about tuberculosis and its treatment among new pulmonary TB patients in the north and central regions of Vietnam. Int J Tuberc Lung Dis 2004;8:603-8.
Ouédraogo M, Kouanda S, Boncoungou K, Dembélé M, Zoubga ZA, Ouédraogo SM, et al
. Treatment seeking behavior of smear-positive tuberculosis patients diagnosed in Burkina Faso. Int J Tuberc Lung Dis 2006;10:184-7.
Somma D, Thomas BE, Karim F, Kemp J, Arias N, Auer C, et al
. Gender and socio-cultural determinants of TB-related stigma in Bangladesh, India, Malawi and Colombia. Int J Tuberc Lung Dis 2008;12:856-66.
Mesfin MM, Newell JN, Walley JD, Gessessew A, Madeley RJ. Delayed consultation among pulmonary tuberculosis patients: A cross sectional study of 10 DOTS districts of Ethiopia. BMC Public Health 2009;9:53.
Ayuo PO, Diero LO, Owino-Ong'or WD, Mwangi AW. Causes of delay in diagnosis of pulmonary tuberculosis in patients attending a referral hospital in Western Kenya. East Afr Med J 2008;85:263-8.
Needham DM, Foster SD, Tomlinson G, Godfrey-Faussett P. Socio-economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia. Trop Med Int Health 2001;6:256-9.
Chang CT, Esterman A. Diagnostic delay among pulmonary tuberculosis patients in Sarawak, Malaysia: A cross-sectional study. Rural Remote Health 2007;7:667.
Yimer S, Holm-Hansen C, Yimaldu T, Bjune G. Health care seeking among pulmonary tuberculosis suspects and patients in rural Ethiopia: A community-based study. BMC Public Health 2009;9:454.
Huong NT, Vree M, Duong BD, Khanh VT, Loan VT, Co NV, et al
. Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: A cross-sectional study. BMC Public Health 2007;7:110.
Central Statistical Authority. Ethiopia Summary and Statistical Report of the 2007 Population and Housing Census Results. 2008.
Bruchfeld J, Aderaye G, Palme IB, Bjorvatn B, Britton S, Feleke Y, et al
. Evaluation of outpatients with suspected pulmonary tuberculosis in a high HIV prevalence setting in Ethiopia: Clinical, diagnostic and epidemiological characteristics. Scand J Infect Dis 2002;34:331-7.
Federal Ministry of Health Ethiopia. TB, Leprosy and TB/HIV Prevention and Control Program Manual. 4 th
ed. Addis Ababa, Ethiopia: Federal Ministry of Health Ethiopia; 2007.
Deribew A, Negussu N, Kassahun W, Apers L, Colebunders R. Uptake of provider initiated counseling and testing among tuberculosis suspects, Ethiopia. Int J Tuberc Lung Dis 2010;14:1442-6.
Legesse M, Aeni G, Mamo G, Medhin G, Shawel D, Bujne G, et al
. Knowledge and perception of pulmonary tuberculosis in pastoral communities in the middle and Lower Awash Valley of Afar region, Ethiopia. BMC Public Health 2010;10:187.
Vecchiato NL. Sociocultural Aspects of Tuberculosis Control in Ethiopia. Med Anthropol Quarter 1997;11:183-201.
Mesfin MM, Tasew TW, Tareke IG, Mulugeta GW, Richard MJ. Community knowledge, attitudes and practices on pulmonary tuberculosis and their choice of treatment supervisor in Tigray, northern Ethiopia. Ethiop J Health Dev 2005;19:21-7.
Hoa NP, Chuc NT, Thorson A. Knowledge, attitudes, and practices about tuberculosis and choice of communication channels in rural community in Vietnam. Health Policy 2009;90:8-12.
Mangesho PE, Shayo E, Makunde WH, Keto GB, Mandara CI, Kamugisha ML, et al
. Community knowledge, attitudes and practices towards tuberculosis and its treatment in Mpwapwa district, Central Tanzania. Tanzan Health Res Bull 2007;9:38-43.
Liefooghe R, Baliddawa JB, Kipruto EM, Vermeire C, De Munynck AO. From their own perspective. A Kenyan community's perception of tuberculosis. Trop Med Int Health 1997;2:809-21.
Abebe G, Deribew A, Apers L, Woldemichael K, Shiffa J, Tesfaye M, et al
. Knowledge, health seeking behavior and perceived stigma towards tuberculosis among tuberculosis suspects in a rural community in southwest Ethiopia. PloS One 2010;5:e13339.
Mfinanga SG, Mørkve O, Kazwala RR, Cleaveland S, Sharp JM, Shirima G, et al
. Tribal differences in perception of tuberculosis: A possible role in tuberculosis control in Arusha, Tanzania. Int J Tuberc Lung Dis 2003;7:933-41.
Legesse M, Ameni G, Mamo G, Medhin G, Shawel D, Bjune G, et al
. Knowledge and perception of pulmonary tuberculosis in pastoral communities in the middle and Lower Awash Valley of Afar region, Ethiopia. BMC Public Health 2010;10:187.
Das P, Basu M, Dutta S, Das D. Perception of tuberculosis among general patients of tertiary care hospitals of Bengal. Lung India 2012;29:319-24.
Central Statistical Agency. Ethiopian Demographic and Health Survey (2011). Addis Ababa, Ethiopia: ICF International; 2012.
[Table 1], [Table 2], [Table 3]