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Research Article | Open Access
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  • | Provisional

    Factors Influencing Tuberculosis Knowledge among TB Patients in Gakenke District, Rwanda

    Innocent Hakizimana 1 2     Erigene Rutayisire 1      

    1Public Health Department, Mount Kenya University Rwanda

    2Monitoring and Evaluation Department, Nemba District Hospital, Rwanda.

    Abstract

    Knowledge of tuberculosis has been shown to influence health seeking behaviour. The study aim was to assess knowledge of tuberculosis and identify the associated factors. This study was a cross sectional descriptive research design with quantitative approach. The target population was the TB patients visited health facilities in Gakenke District. A sample of 376 TB patients was randomly selected from three health centers. Interview-administrated structured questionnaire was used to collect data from 376 TB patients. Data was analyzed with SPSS-version 22. The study protocol was approved by Mount Kenya University Rwanda. The majority of respondents 71.0% were male, 51.6% were aged 45 years and above, 81.9% were married, and 65.2% had completed primary education. Few respondents identified a germ as the cause of TB (24.7%). This study revealed that 54.3% of TB patients had good knowledge about TB. The findings from multivariate analysis show that male were three times more likely to have good knowledge about TB compared to female (AOR=3.31, 95%CI: 1.98-5.53, p<0.001). Compared to TB patients aged 45 years and above, respondents aged 25-34 years old were more likely to have good knowledge about TB (AOR=38.71, 95%CI: 9.22-162.48, p<0.001). TB patients who live between 2-5 km from nearest health facility were more likely to have good knowledge about TB compared to those who live at more than 5 km (AOR=33.58, 95%CI: 14.95-74.40, p<0.001). The ministry of health and other stakeholders in health sector need to continue the interventions that aim to reduce TB infection.

    Received 16 Apr 2020; Accepted 25 Apr 2020; Published 08 May 2020;

    Academic Editor:Larance Ronsard, National Institute of Immunology, New Delhi-110067.

    Checked for plagiarism: Yes

    Review by:Single-blind

    Copyright©  2020 Innocent Hakizimana, et al.

    License
    Creative Commons 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.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Innocent Hakizimana, Erigene Rutayisire (2020) Factors Influencing Tuberculosis Knowledge among TB Patients in Gakenke District, Rwanda . Journal of Public Health International - 2(3):19-31.
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    DOI10.14302/issn.2641-4538.jphi-20-3324

    Background

    Tuberculosis (TB) is a major cause of illness even though drugs to cure this disease have been available for the past 60 years. Despite efforts which are invested in the monitoring and treatment of tuberculosis, it remains a major public health problem and 8.8 million cases have been estimated in which 1.7 million have died; 27% of these 8.8 million cases and 37% of all deaths were observed from Africa that houses 11% of the world‘s population. Tuberculosis kills someone approximately every 29 seconds, nearly 5,000 people every day, according to World Health Organization 1.

    Tuberculosis occurs in every part of the world. In the year 2010, the largest number of new tuberculosis cases occurred in Asia, accounting for 60% of new cases globally. However, Sub-Saharan Africa carried the greatest proportion of new cases per population with over 270 cases per 100 000 inhabitants in 2010 2.

    A study conducted in Ethiopia revealed that of the 476 pulmonary TB suspects, 395 (83.0%) had ever heard of TB; “evil eye” (50.4%) was the commonly mentioned cause of TB. Individuals who could read and write were more likely to be aware about TB ((crude OR = 2.98, (95%CI: 1.25, 7.08)) and more likely to know that TB is caused by a microorganism ((adjusted OR = 3.16, (95%CI: 1.77, 5.65)) than non-educated individuals. Males were more likely to know the cause of TB ((adjusted OR = 1.92, (95%CI: 1.22, 3.03)) than females. 51.3% of TB suspects perceived that other people would consider them inferior if they had TB. High stigma towards TB was reported by 199(51.2%). 220 (46.2%) did not seek help for their illness. Individuals who had previous anti-TB treatment were more likely to have appropriate health seeking behavior ((adjusted OR = 3.65, (95%CI: 1.89, 7.06)) than those who had not 3.

    The Incidence of tuberculosis (per 100,000 people) in Rwanda was reported at 106.00 in 2010 and was about 123 in 2008 and 115 in 2009. A report from Rwanda Biomedical center (RBC) showed that incidence rate of tuberculosis infections reduced from 63 people per 100,000 in 2014 to 50/100,000 in 2017 4. However, no report that indicated the factors associated with TB knowledge among TB patients in Rwanda.

    In Gakenke District, the number of TB cases has been increasing from 145 cases in 2015, 157 cases in 2016 up to 3200 cases in 2017 whereas countrywide the number of TB cases is 3365 cases in the same year 2017.

    Relatively few studies have investigated the factors influencing the TB knowledge among TB patients, especially in highly endemic countries. Knowledge of tuberculosis has been shown to influence health seeking behavior, specifically among people infected by TB and live in rural area are at a higher risk of transmitting tuberculosis than the general population. The study aim was to assess knowledge of tuberculosis and identify the associated that knowledge, in order to inform tailored interventions for advocacy, communication and social mobilization in rural communities of Rwanda.

    Material and Methods

    Study Design, Setting and Population

    This study was a cross sectional descriptive research design using quantitative approach. A cross-sectional study design was chosen because; the present study compared a single point in time variables. Quantitative method was selected because these methods allowed researcher assess more variables at the same time.

    This research targeted all TB patients that visited different health facilities in Gakenke District Northern Province, Rwanda from April to December 2019. Randomly, three health centers from Gakeneke District were selected.

    Gakenke District is one of five districts of the Northern Province of Rwanda, with 348,334 inhabitants (NISR, 2012). People survive mainly by agricultural, farming and commercial activities (selling of goods and services). Commonly, diseases like intestinal worms, diarrhea, malaria, HIV and AIDS, tuberculosis, as well as upper and lower respiratory tract infections are seen in the outpatient departments of health facilities of Gakenke District (Gakenke Annual Report, 2017).

    Sample Size and Sampling Technique

    The data was collected among TB patients that frequently utilize the different health facilities in the three sectors of Gakenke District. The sample size of 384 TB patients was dram by using Cochran formula. Cochran (1963:75) formula used to determine proportions in single cross-sectional surveys was used for sample size determination (Cochran, 1963).



    As there is no study in Rwanda showing the level of TB knowledge among TB patient, based on the above explanations the following assumptions were applied: p, level of knowledge 50%, d is the expected margin of error (5%), Z, the standard score corresponding to a 95% confidence interval (1.96).



    However, 376 TB patients completed the questionnaire. This shows that the response rate was 97.9%.

    Two-stage sampling method was used, in the following way:

    Selection of Sectors

    Three health centres were randomly selected among seven sectors of Gakenke District by a simple random sampling. The selected health centres are Rutake, Rutenderi and Karambo.

    Selection of clients: all adult clients frequenting the health center during the study period using a systematic sampling method. All new cases ranking second, fourth, and….ordered number in the exhaustive list of OPD service client register during open hours of the day.

    Data Collection Methods

    Data were collected by using a questionnaire adopted from previous study conducted in Uganda. Eligible participants were interviewed face-to-face using a structured questionnaire with both open and closed questions to collect information on socio-demographics, socio-economic, TB related knowledge including cause of TB, TB symptoms, and TB prevention measures. The researcher provided a verbal introduction about the purpose of study.

    Data Analysis Procedures

    Data was analyzed using SPSS version 22. Demographic and outcome data was summarized into frequencies, percentages and measures of central tendency. Responses to the 36 (including multiple response questions) questions about TB were scored (one point for correct and zero for incorrect) and categorized into 0–50, 51–75 and 76–100 percent corresponding to poor, moderate and high TB knowledge respectively as a composite outcome. The association between exposure variables and TB knowledge was explored by univariate analysis and Multivariate analysis. Tests were two-sided and considered significant if P<0.05. Potential determinants of TB knowledge with P < 0.05 at univariate level were included in a multivariable ordinal logistic regression model to estimate their adjusted odds ratios (aOR).

    Ethical Consideration

    Ethical clearance certificate was obtained from the Research and Ethical Clearance Board at Mount Kenya University Rwanda. A permission to collect data was obtained from Director of Health unit at Gakenke District. The researcher informed the participants that then participation was voluntarily and that they had to sign consent form for confidentiality of data. No names of participants were put down but only codes were used and all information about this subject was kept confidentially.

    Results

    Demographic Characteristics of Respondents

    The study is carried out in three health centres of Gakenke District (Rutake, Rutenderi and Karambo).

    The table 1 contains the demographic characteristics of the respondents which contain sex, age and education level. The findings shows that out of 376 TB patients who participated in the study, 71.0% were male, 51.6% were aged 45 years and above, 81.9% of respondents were married, and 15.2% of respondents had no formal education. The results further showed that 30.9% of respondents were farmers, 72.9% were Christian, 74.5% never smoke, and 61.2% had ever drink, 34.9% had more than 5 family members, 32.4% had less than 3 73.4% had the income. The majority of TB patients who participated in the study 326(86.7%) have tested for HIV, near a half of respondents 170(45.2%) live between 2-5 km from a nearest health facility.

    Table 1. Socio-Demographic Characteristics of respondents
    Variables Frequency Percentage
    Sex    
    Male 267 71
    Female 109 29
    Age group    
    15-24 17 4.5
    25-34 69 18.4
    35-44 96 25.5
    45 and more 194 51.6
    Marital Status    
    Single 68 18.1
    Married 308 81.9
    Education level    
    No formal education 57 15.2
    Primary 245 65.2
    Secondary 74 19.7
    Occupation    
    Farmer 116 30.9
    Housewife 81 21.5
    Self employed 86 22.9
    Public Servant 32 8.5
    Unemployed 61 16.2
    Religion    
    Christians 274 72.9
    Muslims 102 27.1
    Ever Smoke    
    Yes 96 25.5
    No 280 74.5
    Ever drink    
    Yes 230 61.2
    No 146 39.8
    Family members    
    < 3 122 32.4
    3-5 123 32.7
    More than 5 131 34.9
    Family income    
    < 20,000 4 1.1
    20,000-40,000 276 73.4
    40,000-60,000 39 10.4
    More than 60,000 57 15.1
    Ever tested for HIV    
    Yes 326 86.7
    No 50 13.3
    Distance to nearest Health facility    
    Less than 2 km 97 25.8
    Between 2-5 km 170 45.2
    More than 5 km 109 29

    Source: Primary data

    The Level of TB Knowledge among TB Patients

    The individual questions about the TB knowledge including the knowledge of groups at risk to be contaminated by TB, the fact of being informed on how TB is transmitted, knowledge on mechanisms to prevent and manage TB by different independent variables. (Table 2)

    Table 2. TB knowledge among TB patients in Gakenke District
    Knowledge scale Response Frequency Percentage
    TB cause Germs 93 24.7
      Smoking 112 29.8
      Alcohol 37 9.8
      Malnutrition 58 15.4
      Witchcraft 52 13.8
      Don’t know 24 6.4
    TB symptoms Coughing over 15 days 127 33.8
      Any cough 143 38
      Weight Loss 101 26.9
      Chest Pain 138 36.7
      Coughing up blood 163 43.4
      Shorten of breath 109 29
      Vomiting 101 26.9
      Fever > 14 days 119 31.6
      Fatigue 97 25.8
      Don’t Know 43 11.4
    TB Transmission Airborne 168 44.7
      Sharing Utensils 183 48.7
      Sharing Meals 259 68.9
      Shaking hands 156 41.5
      Touching public items 191 50.8
      Don’t know 174 46.3
    TB prevention Not sharing the same eats and drink with a person who has TB 178 47.3
      Not sharing a bedroom with a person who has TB 75 19.9
      Take a well-balanced diet 87 23.1
      Closing home windows 105 27,9
      Not to spit anyhow 145 38.6
      Don’t know 98 26.1
    Who can get TB Anybody 152 40.4
      Alcoholics 110 29
      Drug users 72 19.1
      Poor 28 7.4
      Prison History 14 3.7
    TB is curable Yes 214 56.9
      No 162 43.1
    How is TB cured With specific drugs 130 34.6
      Treatment in community 50 13.3
      Herbs 117 31.1
      Home rest alone 47 12.5
      Prayer 7 1.9
      Don’t know 25 6.6
    How long is TB treatment < 1 month 17 18.9
      1-3 months 52 13.8
      3-6 months 58 15.4
      6-8 months 128 34
      >8 months 22 5.9
      Don’t know 45 12

    The findings on TB knowledge among TB patients from Gakenke District shows that 93(24.7%) knew the real cause of TB (germs), 127(33.8%) knew that coughing over 15 days is one of TB symptom, 168 (44.7%) respondents knew that TB is transmitted through airborne, 178(47.3%) knew that not sharing the same eats and drink with a person who has TB is one way of TB prevention, the majority 162(56.9%) TB patients knew that TB is a curable disease, A total of 128 (34.0%) of TB patients knew that TB treatment can last between 6-8 months, 17(18.9%) knew that TB treatment can last less than one month while some of respondents 45(12.0%) don’t know the duration of TB treatment. (Figure 1)

    Figure 1. Level of TB knowledge among TB patients in Gakenke District
    Figure 1.

    To determine the level of knowledge, total scores were estimated from 36 questions ( considering multiple responses) related to TB. The mean score was 23, considering the mean score; respondents with a score of above mean score were considered as having good knowledge, respondents with a score between 18-22 were considered to have moderate knowledge, and respondents with a score less than 18 were considered to have poor knowledge. The findings presented in Figure 1 shows that the majority 204(54.3%) of respondents demonstrated a good knowledge about TB, 20.2% demonstrated a moderate knowledge while 25.5% of respondents had a poor knowledge.

    Factors Associated with TB Knowledge among TB Patients in Gakenke District

    Both bivariate and multivariate analyses were performed to estimate socio-demographic factors associated with TB knowledge. Socio-demographic factors associated with TB knowledge are presented in table 3. For analysis purpose, in both bivariate and multivariate analysis moderate and poor knowledge were combined.

    Table 3. Bivariate analysis of socio-demographic factors associated with TB knowledge
      Level of Knowledge P-value
    Variables Good knowledge Poor/Moderate knowledge n(%)  
    n(%)
    Sex     <0.001
    Male 163(79.9) 104(60.5)  
    Female 41(20.1) 68(39.5)  
    Age group     <0.001
    15-24 2(1.0) 15(8.7)  
    25-34 67(32.8) 2(1.2)  
    35-44 45(22.1) 51(29.7)  
    45 and more 90(44.1) 104(60.5)  
    Marital Status     <0.001
    Single 0(0) 68(39.5)  
    Married 204(100) 104(60.5)  
    Religion     <0.001
    Christians 203(99.5) 71(41.3)  
    Muslims 1(0.5) 101(58.7)  
    Ever Smoke     <0.001
    Yes 0 96(55.8)  
    No 204(100) 76(44.2)  
    Ever drink     <0.001
    Yes 42(20.6) 104(60.5)  
    No 162(79.4) 68(39.5)  
    Family members     0.872
    < 3 64(31.4) 58(33.7)  
    3-5 67(32.8) 56(32.6)  
    More than 5 73(35.8) 58(33.7)  
    Ever tested for HIV     0.969
    Yes 177(86.8) 149(86.6)  
    No 27(13.2) 23(13.4)  
    Distance to nearest Health facility     <0.001
    Less than 2 km 1(0.5) 96(55.8)  
    Between 2-5 km 162(79.4) 8(4.7)  
    More than 5 km 41(20.1) 68(39.5)  

    Findings on the socio-demographic factors associated with TB knowledge show that out of 204 respondents who demonstrated good knowledge about TB, 163(79.9%) were male, and out of 172 respondents with poor/moderate knowledge, 68(39.5%) were female. The findings show that gender was associated with TB knowledge (p<0.001). The majority of respondents with good knowledge were aged 45 years and above 90(44.1%), with this aged group 104(60.5%) demonstrated poor/moderate knowledge. Age group of respondents were significantly related to TB knowledge (p<0.001). The findings shows that all respondents (204) with good knowledge were married, 68(39.5%) of respondents with poor/knowledge were single; marital status was significantly related to TB knowledge (p<0.001). Religion, smoking, drinking, and distance to health facility were significantly associated with TB knowledge (p<0.001). Factors such as ever tested for HIV and number of family member were not significantly associated with TB knowledge.

    Economic Factors Associated with TB Knowledge among TB Patients in Gakenke District

    The relationship between factors such as education level, occupation and family income and TB knowledge were investigated. (Table 4)

    Table 4. Bivariate analysis of Socio-economic factors associated with TB knowledge among TB patients
    Variables Level of knowledge P-value
      Higher knowledge n(%) Poor/Moderate knowledge n(%)  
    Education level     <0.001
    No formal education 56(27.5) 1(0.6)  
    Primary 147(72.1) 98(57.0)  
    Secondary 1(0.5) 73(42.4)  
    Occupation     <0.001
    Farmer 108(52.9) 8(4.7)  
    Housewife 81(39.7) 0  
    Self employed 0 86(50.0)  
    Public Servant 1(0.5) 31(18.0)  
    Unemployed 14(6.9) 47(27.3)  
    Family income     0.872
    < 20,000 3(1.5) 1(0.6)  
    20,000-40,000 149(73.0) 127(73.8)  
    40,000-60,000 21(10.3) 18(10.5)  
    More than 60,000 31(15.2) 26(15.1)  

    Regarding socio-economic factors (education, occupation and income), the findings shows that 147 (72.1%) respondents with good knowledge had primary education level, 98(57.0%) of respondents with poor/knowledge had primary education; education level was significantly related to TB knowledge (p<0.001). The findings shows that 149(73.0) of respondents with good knowledge had the income of 20,000-40,000 Rfws, 127(73.8%) of respondents with poor knowledge had the income between 20,000-40,000 Rfws. But no significant relationship observed between family income and TB knowledge (P=0.872). A total of 108 (52.9%) respondents with good knowledge were farmers, 86(50%) of respondents with poor TB knowledge were self-employed. (Table 5)

    Table 5. Multivariate analysis of factors associated with TB knowledge
      Good knowledge P-value
    Variables AOR 95%CI  
    sex      
    Male 3.31 1.980-5.533 <0.001
    Female Ref.    
    Age group      
    15-24 0.154 0.034-0.692 0.015
    25-34 38.711 9.223-162.486 <0.001
    35-44 1.02 0.625-1.665 0.938
    45+ Ref.    
    Ever drink      
    Yes 0.148 0.091-0.239 <0.001
    No Ref.    
    Distance to nearest health facility      
    Less than 2 km 0.017 0.002-0.129 <0.001
    Between 2-5 km 33.585 14.959-74.403 <0.001
    More than 5 km Ref.    

    None of socio-economic factors were taken into multivariate analysis. Socio-demographic factors such as gender, age group, drinking, distance to health facility were included in multivariate analysis. The findings show that male were three times more likely to have good knowledge about TB compared to female (AOR=3.31, 95%CI: 1.98-5.53, p<0.001). Compared to TB patients aged 45 years and above, respondents aged 25-34 years old were more likely to have good knowledge about TB (AOR=38.71, 95%CI: 9.22-162.48, p<0.001). Respondents who ever drink alcohol were less likely to have good knowledge about TB (AOR=0.148, 95%CI: 0.091-0.239, p<0.001). TB patients who live between 2-5 km from nearest health facility were more likely to have good knowledge about TB compared to those who live at more than 5 km (AOR=33.58, 95%CI: 14. 95-74.40, p<0.001).

    Discussion

    Knowledge of tuberculosis has been shown to influence health seeking behavior. In this study we report sub-optimal knowledge about TB in the general population of Gakenke District. Researcher also identified that younger age, having primary education, ever drinking, marital status, and distance to health facility, religion and occupation; were associated with a good level of TB knowledge in the bivariate model. In multivariate analysis, being male, aged 25-34 years old, and living at distance of 2-5 km, were significantly associated with good TB knowledge.

    In contrast to the findings from this study where the researcher observed that 54.3% of TB patients had good TB knowledge, a study conducted in Uganda found that only 208(18.3%) respondents demonstrated good knowledge, the majority 358(31.4%) demonstrated moderate knowledge 5. Comparing individual variables on TB knowledge, this study found that 24.7%, in line with this finding a study conducted in Uganda found that few respondents identified a germ as the cause of TB (26.7%).

    A study conducted in Ethiopia found that 74.4% of respondents were found to have good knowledge 6, compared to this study which found 54.3% of respondents with good TB knowledge. The difference between TB knowledge reported in Ethiopia and in Rwanda may due to the study area and study participants, in Ethiopia the study was conducted in urban area and among health care professionals while this study was conducted in rural area (Gakenke) and among TB patients.

    In contrast to our findings, a study conducted in Brazil found 67% knew how tuberculosis is transmitted, 87% knew its key symptoms and 81% declared they would take preventive therapy if prescribed. Among KAP-interviewed index cases, 67% knew they could spread tuberculosis, 70% feared for the health of their families and 88% would like their family to be evaluated in the same services 7. In contrast to our findings a study conducted in Pakistan found overall lower knowledge on TB where cough was the most commonly stated symptom in both the urban (66.2%) and rural (63.4%) areas. Other symptoms cited were: coughing up blood (urban 56.5%, rural 50.0%), weight loss (urban 57.4%, rural 38.0%). Possible modes of transmission indicated by the respondents were sharing food utensils (urban 35.6%, rural 29.6%), eating in the same plate (urban 44.7%, rural 44.1%), shaking hands (urban 3.0%, rural 5.4%) and touching items in the public places (urban 0.0%, rural 1.7%) 8.

    Inconstancy between these previous studies and the present study regarding the factors associated with TB knowledge may due to the study design, study population and geographical location.

    Regarding the factors associated with TB knowledge, this study found that male are more likely (AOR=3.31, 95%CI: 1.98-5.53, p<0.001) to have good knowledge compared to female respondents, younger respondents were more likely to have good knowledge about TB (AOR=38.71, 95%CI: 9.22-162.48, p<0.001). Respondents who live between 2-5 km from nearest health facility were more likely (AOR=33.58, 95%CI: 14.95-74.40, p<0.001) to have good knowledge about TB.

    A study conducted in Uganda found that independent determinants of poor knowledge of TB in the multivariable analysis included (aOR, 95% CI) lack of formal education (0.56; 0.38 – 0.83, P = 0.004), unemployment (0.67; 0.49 – 0.90, P = 0.010) and never testing for HIV (0.69; 0.51 – 0.92, P<0.012). Whilst, older age (1.73; 1.30 – 2.29, P<0.001) and residing in Lira (2.02; 1.50 – 2.72, P<0.001) were independent determinants of higher knowledge of TB 5.

    A study conducted in Ethiopian revealed that training is the strongest determinant of knowledge, AOR 3.386 and 95% CI (1.377, 8.330). On the other hand, job location and age category, AOR 0.592 and 95% CI (0.286, 1.223) and 0.913 95% CI (0.649, 1.284), respectively, were not found to be associated with TBIC knowledge in the multivariate models 6.

    A study conducted in Brazil found that illiterate relatives (adjusted OR = 4.39; 95%CI 1.11 – 17.36), those who do not watch or watch little television (adjusted OR = 3.99; 95%CI 1.2 – 13.26), and also those who do not have the Internet access (adjusted OR = 5.01; 95% CI 1.29 – 19.38) were more likely to have low knowledge regarding tuberculosis 9. A study conducted in Philippine revealed that a wide lack of knowledge was found about the link between HIV/AIDS infection and TB among individuals with medium and low socio-economic status and non-college educational background. Other several studies found that Individuals who could read and write were more likely to know the cause of TB which is consistent with our findings with previous reports 10,11. Males were more likely to know the cause of TB compared with females. The poor knowledge among women and non-educated individuals concerning the cause of TB will result in inappropriate health care seeking behavior 12.

    Limitation of the Study

    The sample size was not exhaustive to be a holistic sample of the country as the participants were from only one district. However, the selected patients were closely reflecting the majority of outpatient department clients and were selected in different health centers. Therefore, the limited number of respondents did not compromising the validity of the findings as the results of the quantitative data were not meant to be projected to the broader population but, instead provide information that could be used to improve programming and planning of TB interventions in Rwanda.

    Conclusion and Recommendations

    This study reveals more than a half of TB patients from selected health facilities have good knowledge about TB. The factors that influence TB knowledge include gender, age group, marital status and education level. The results revealed that male responded were more likely to have good knowledge about TB when compared to female. Younger respondents were more likely to have good knowledge of TB compared to older respondents. Patients who live within 2-5 km from nearest health facilities were most likely to have good knowledge about the cause of TB, symptoms of TB, and TB prevention measures.

    Recently, despite Government effort in promoting diagnosis and treatment, the number of tuberculosis cases is still high in general population. Community sensitization about different measures and practices of prevention and transmission can contributes a lot in reducing and eradicating of tuberculosis. The ministry of health and other stakeholders in health sector need to continue the interventions that aim to reduce TB infection.

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