Study design and period
An institution-based cross-sectional study was conducted from March 1 to 30, 2019.
Study area
The study was conducted in Gondar Town, Northwest Ethiopia. Gondar town is one of the historical towns in Ethiopia. It is found about 737-km away from Addis Ababa. In the town, there is one governmental specialized hospital, eight governmental health centers, one private Hospital, and one private clinic, which delivers anti TB treatment and screening service currently for about 483 patients with TB of those 412 were adults and had household contacts.
Source population
The source population constitutes all adult patients with TB who had household contact and anti-TB treatment follow up at health institutions in Gondar Town.
Study population
All adult patients with TB who had household contact and anti-TB treatment follow up at health facilities found in Gondar town during the specified study period.
Inclusion criteria
All adult patients with TB who had household contacts and anti-TB treatment follow up in Gondar town health facilities were included.
Exclusion criteria
Adult patients with TB who had household contacts and were critically ill and unable to communicate, patients start treatment at the day of data collection.
Sample size determination and sampling procedure
The sample size was determined using a single population proportion formula, taking 33.7% magnitude of household contact screening practice of a study conducted in Amhara Region, Northwest Ethiopia (16) with the following assumptions: 95% CI and 5% margin of error and by adding 10% none response rate the total sample size was 379. The study populations were 412 close to the sample calculated so all the study populations were included in the study.
Operational definition
Household contact: A person who shared the same enclosed living space for one or more nights with the index case during the 3 months before the commencement of the current treatment episode(16, 20, 21).
Household contact TB screening adherence: if the patient brought at least one household contact for TB screening and otherwise not-adherent(16).
Patient with sufficient knowledge on TB: a patient who answered greater than or equal to 80% of the given TB related knowledge questions(16).
HIV AIDS co-infection: Presence of confirmed HIV/AIDS along with TB (22).
Waiting time: time taken to get service after the arrival of health facilities(13).
Patients who were satisfied by the services delivered at health facilities: Those respondents who scored points ≥ 75% of the given satisfaction related questions otherwise unsatisfied (23, 24).
Index Case: refers to TB patient who is initially diagnosed with infectious TB, and around him, contact investigation for a potentially exposed individual is indicated (21).
Data collection tools and procedures
A pre-tested and structured interviewer-administered questionnaire adapted from previous studies was used. The questionnaire was prepared in the English version and it translated from English to the local language (Amharic); then it re-translated again to the English by a language expert to ensure consistency. The questionnaire had five sections; Socio-demographic characteristics of the patients, practice, Personal and behavioral factors of the patient, Health care system-related factors, Disease and treating conditions associated with the practice. The logbook review was used to collect information about the type of TB, date of diagnosis and HIV/AIDS infection status and the instrument for logbook review was part of the main instrument (questionnaire) indicated by observing. After briefly presenting the study purpose and getting consent from each individual patient, data collectors interviewed the participants.
Data quality assurance:
The quality of the data was assured by pre-testing the questionnaire on 5% of the sample (20 TB patients) in Addis Zemen Hospital and health center prior to the actual study to test the fitness of the questionnaire for the study settings. Training about the data collection tool as well as data collection procedures was given to data collectors and supervisors for a total of two days prior to the data collection process. The collected data were checked daily for the completeness and accuracy by supervisors and principal investigator and detailed feedback was provided to the data collectors in the next morning.
Data processing and analysis:
After data collection, a questionnaire was checked for completeness and consistency then it was entered to Epi-Info version 7 and then export to the SPSS software version 20 for analysis. Descriptive statistics were carried out to illustrate the means, standard deviations, and frequencies of the demographic profile of the respondents, magnitude of the practice. Tables and figures were used to display the findings. Binary logistic regression analysis was made to identify variables having a significant association with the dependent variable. Then all independent variables with a p-value less than 0.2 in the bivariate analysis were again entered to multivariable logistic regressions to control the effect of confounding. Finally, significant factors were determined based on AOR included in 95% confidence level at P-value less than 0.05. Hosmer and Lemeshow goodness of fit test was used for model fitness.