Study design and period
An institution-based cross-sectional study was conducted from March 1 to 30, 2019.
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 are one governmental specialized Hospital, eight governmental health centers, one private Hospital, and one private clinic, which delivers anti TB treatment and screening service. Currently, about 483 TB patients attend in these health facilities, of those 412 were adults and had household contact history.
The source population constitutes all adult patients who have anti-TB treatment follow up at health institutions in Gondar town and had household contact.
All adult patients with TB who had household contact, anti-TB treatment follow up at health facilities in Gondar town and found during the specified study period.
All adult patients with TB who had household contacts and anti-TB treatment follow up in Gondar town health facilities were included.
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 closes to the calculated sample. So, all the study populations were included in the study.
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 tool and procedures
A pre-tested and structured interviewer-administered questionnaire was used. First the questionnaire was prepared in the English language and it was translated to the local language (Amharic); then to ensure its consistency it was re-translated to English language by language expert. The questionnaire had five sections; Socio-demographic characteristics of the participants, practice, personal and behavioral factors of the participants, health care system-related factors, disease and treatment conditions associated with the practice. Participants medical documents were reviewed to collect information about the type of TB, date of diagnosis and HIV/AIDS infection status, and to confirm the verbal reports of contact schreening status. Participants were interviewed after briefly explained the study purpose and getting consent from each individual patient.
Data quality assurance:
To test the fitness of the questionnaire for the study settings, the questionnaire was pretested taking 5% of the sample (20 TB patients) in Addis Zemen Hospital and health center prior to the actual study. Two days training was given for data collectors and supervisors about the data collection tool and data collection procedures. The data were checked for its completeness and accuracy.
Data processing and analysis:
After data collection, a questionnaire was checked for completeness and consistency. The data were entered in to Epi-Info version 7 and then export to SPSS version 20 software for analysis. Descriptive statistics were carried out to illustrate the means, standard deviations, and frequencies. Tables and figures were used to display the findings. Binary logistic regression analysis was done to identify variables having a significant association with the dependent variable. Then control the effect of confounding, all independent variables with a p-value less than 0.2 in the bivariate analysis were again entered to multivariable logistic regression. Finally, variables with P-value less than 0.05 considered as significantly associated factors. Hosmer and Lemeshow goodness of fit test was used for model fitness.