Assessment of Clients ’ Knowledge , Attitude , Practice and Associated Factors on Tuberculosis at Yejube Health Center , Northwest Ethiopia

The objective of this study is to asses clients knowledge, attitude, practice and associated factors towards tuberculosis in Yejube health center Northwest Ethiopia. Institution based cross-sectional study was conducted at Yejube health center among 392 individuals from March to June 2017. Data were analyzed mannually. Descriptive statistics was used to determine level of practice and its predictors. Out of the total 83.2% of respondents said that they heard about TB. Around 70.4% had awareness that TB can be transmitted through air droplet and knew cough (36.4%) was the most commonly stated symptom of TB while modern drugs used in health institution (80.7%) was the preferred choice of treatment. Similarly, 81.8% said that they would seek treatment at health facility if they had symptoms related to TB and 32.1% experience fear if themselves had TB. Individuals with educational level unable to read and write had poor level of practice on TB prevention compared to college and above. Individuals having poor attitude towards TB are also greater than those of having poor practice to having good attitude and individuals having poor knowledge towards TB has higher than having poor practice to having good knowledge. Most patients had little information about the cause of TB, transmission, prevention and associated factors. Level of practice is affected by poor attitude, poor knowledge. Therefore, it needs a strategy directed to bring a significant change in their attitude and knowledge towards patient with TB.


INTRODUCTION
Tuberculosis (TB) is a communicable disease caused by the bacteria, Mycobacterium Tuberculosis (MTB) in humans and may affect several organs within the body.However, the primary site for active TB infection is the lungs.TB is spread through droplet nuclei that become aerosolized when an infected person coughs, speaks, sings or talks.Although latent infection is possible, the bacteria are therefore the active disease that is referred to as TB (White Zahra, 2011;WHO, 2016).
Active, drug-sensitive TB disease is treated with a standard six-month course of four antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer.Without such supervision and support, treatment adherence can be difficult and the disease can spread.The vast majority of TB cases can be cured when medicines are provided and taken properly.And also, avoiding the risk factor play a major role in preventing TB.These factors include overcrowding, malnutrition, personal hygiene, smoking, retroviral infection, drug users and so on (Chaisson and Martinson, 2008;Hoa et al., 2009;WHO, 2007).Conducting this research provides will help to know the level of knowledge, attitude, practice and associated factors of tuberculosis.This study will also help managers and concerned bodies to take necessary measures.In addition this study will be used as abase line for further research and researchers in the field.

METHODOLOGY
Sample size determination: Institutional based crosssectional study was conducted from March to June, 2017.Sample size was calculated by using single population proportion formula by considering the following assumptions; Confidence level of 95%, tolerable error = 5% and the estimated prevalence we took 36.5% by taking a population proportion (P) value from similar cross sectional study conducted in Eastern Amhara Regional State 2013 (Kolappan et al., 2008): Adding 10% non-response rate, the final sample is 392.
Data collection and analysis: Data was collected using interviewer administered structured questionnaires.To assure weather the questionnaires were appropriate, valid and consistent we conducted pretest.Before starting data analysis, the data was coded, edited and organized.Then data is analyzed manually using tally method.

Knowledge towards tuberculosis symptoms, transmission and prevention:
The overall knowledge level about TB was 307(78.3%)good.From 392 respondants, 379 (96.7%) have heard about TB, while 13 (3.3%) of them have not.Out of 379 respondents that have heard of TB, about 33.2% of them received information from health workers, whereas 21.2% through media then followed by combination of different sources (45.6%).Majority (71.7%) of those who have heard of tuberculosis mentioned, about possible modes of transmission were through air, while 5.6% said that it is transmitted through contact with someone who had TB.With respect to clients knowledge about sign and symptom of TB, cough (76.5%) was the most commonly mentioned symptom of TB.Other symptoms mentioned by the respondants include cough and fever (5.6%), cough, weight loss and night sweating (5%).Knowledge of TB prevention, arround 60.2% of the respondents knew that it is prevented by covering of one's mouth while sneezing or coughing (Table 1).

Attitude towards tuberculosis:
In studying the attitude of respondants, the overall attitude level about TB was 164 good (41.8%) and out of the total 316(80.6%) of them thougt they would contract TB; through contact with TB patients 115 (29.3%), through contact with close friend 61(15.6%),through tobacco smoking 83 (21.2%), in work place 12 (3.1%)and the rest are About 305 of the participants had felt compassion and desire to help the patient, while 41 of them feel compassion but stay away from them, 33 of them afraid not to be infected, 8 of the participants have no particular feeling and 5 of the respondants said that as they would discriminate TB patients.They were asked on how a person who has TB usually treated in their community and about 318 might help them, 62 of them friendly but try to avoid them, 9 of them discriminate and 3 of the participants didn't know (Table 2).

Practice towards Tuberculosis prevention:
The overall level of practice on the prevention of TB was good 239 (61%) in this study.About 379 (96.7%) of respondants had window and the rest 13(3.3%) did not have.From those having window, 340 (89.7%) opened window and the rest did not.295 of participants opened windows in public transportation while the rest did not.Majority of respondants 375 (95.7%) said that they would consult health worker about their illness if they got TB, while others would like to talk to parents and partners.About 339 (86.5%) of them seek medical care immediately and 14 of the participants wait until they become seriously ill as shown in Table 3.

Associated factors:
From the participants monthly family income, most respondants (155) said that as they got 500-1000 per month.Only 76 (19.4%) of the respondants said that as there was health institution which give services for TB cases around their locality.Most of the respondants 203 (51.8%) had family members 7-10 (Table 4).

DISCUSSION
The aim of this study was to asses clients knowledge, attitude, practice and associated factors towards TB at Yejube health center.The results of this health institution based cross-sectional study showed that, most of the clients at Yejube health center have information about TB and their source of information was health workers.The finding is similar to the results of studies from Gambella Region (41.9%) (Munoz-Sellart et al., 2010) and East Amhara (66.6%) (Kolappan et al., 2008), but higher than the results of studies conducted in Nigeria where majority of the respondants heared about tuberculosis from radio (60%) (Esmael et al., 2013) and higher than the results obtained from India where majority of clients informed for tuberculosis from neighbours (50.5).This indicates that health workers are the main actors of information dissemination in our country about community problems.
Based on the present finding, majority of respondants knew the mood transmission of tuberculosis is inhaled droplet which is similar finding in East Amhara (79.9%) (Kolappan et al., 2008).
Majority of respondants identified cough as major symptom of TB and the result of this study is consistent with finding of studies conducted in East Amhara (86.5%).However,it is higher than in Gambella (22%) where majority of the respondants said hemoptysis as the major symptom of tuberculosis (Munoz-Sellart et al., 2010).The reason for the difference was sociocultural factors such as smoking and difference of basic knowledge about tuberculosis.Moreover, in this study the majority of respondants defined TB as curable disease with modern therapy.This was in agreement with study conducted in Nigeria (96.3%) (15) and East Amhara (65.9%) (Esmael et al., 2013).Most of the respondants in this study considered tuberculosis is curable which is similar finding in Nigeria (96.3%) (Kolappan et al., 2008) and different finding from a result of study conducted in Gambela Region where TB is considered killer even after treatment (58%) (Munoz-Sellart et al., 2010).
The overall level of knowledge of clients were good (75.8%) and poor (24.2%) which is quite higher than study conducted in Gambella Region which is 46.4% good and 53.5% poor.This is because there is cultural and infrastructural difference.In this study majority of the repondants thought they will contract TB through contact with TB patients and the study revealed majority of respondants felt fear and desparete if they had TB, which is similar finding in East Amhara (58.3%) and different finding from result of study conducted in India where TB was considered as hereditary disease (45.2%).Further more, how TB patient treated usually in the community is compassion and help which is different finding with research conducted in India.Majority of the respondants said that as many of the community help TB patients which is quite different from the result from a study conducted in India where majority were discriminated (72.6%) (Bati et al., 2013).This difference is due to regional varation.Majority of respondants in this study were aware of free of charge of TB treatment which is similar finding in East Amhara (43.1%) (Esmael et al., 2013) and Nigeria (90.5%) (Kolappan et al., 2008).
The overall level of attitude is good (44.1%) and poor (55.9%) which is higher than study conducted in Gambella Region with good ( 40.8%) and poor (59.2%).The reason for the difference is due to sociocultural, infrastructural and basic knowledge about tuberculosis.Based on the present finding, majority of the respondents had window, but 94.5% of them opened it.Furthermore, this finding indicate that, 24.7% of the participants did not open the window in the public transportation.These need health education about the use of opening their window on reducing the chance of contracting TB.More interesting fact was that, majority of study participants in this study reported that they would go to health facility if they thought they had symptoms of TB which is different finding with research conducted in East Amhara which they prefer self treatment (45.3%) (Kolappan et al., 2008) as their first choice.This might be due to lack of accesiblity for healthcare service and lack of awareness about the severity of disease.
In this study resparatory track infections are the main risk factors for tuberculosis development which is different result from a result of study conducted in Gambela Region where alcoholism (42.7%) is considered the main risk factor.This variation could be due life style and socio-cultural differences.Coinfection and poor immunization status are associated factors for tuberculosis burden in our study area which is different finding from a study in East Amhara where cost and transportation (69.9%, 54.5% respectively) are the main factors triggering the disease burden.This is due to infrastructural differences between the study areas.

CONCLUSION
Finally we conclude that even though the majority of our study participants had basic awareness about TB which is not translated in to knowledege that assist them to have good attitude and practice.In addition to this, they had little information about the cause of TB, transmission, prevention and associated factors.Therefore, health education directed towards bringing a significant change in their knowledge and attitude towards patient with TB must be stepped-up within the TB control programme.It would be better to establish an appropriate control measure such as establishing proper information, education and a communication pathway that indicate the level of severity of the disease, tuberculosis.In addition, creating proper awareness about its transmission, prevention, associated factors and availability of public service are very essential.

Table 1 :
Knowledge of clients about TB symptoms, transmission and

Table 3 :
Practice of clients towards tuberculosis prevention

Table 4 :
Associated Factors on clients' Knowledge, Attitude,