RIFT VALLEY UNIVERSITY

DEPARTMENT OF HEALTH HO

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE

TOWARDS TUBERCLOSIS AMONG PRISONERS IN PRISON, JATO
NEKEMTE EAST WOLLEGA ETHIOPIA, 2022

A RESEARCH SUBMITTED TO RIFT VALLEY UNIVERSITY, OF

HEALTH HOFOR PARTIAL FULFILMENT OF BACHELOR OF
SCIENCES IN NURSING

DECEMBER, 2022

NEKEMTE, ETHIOPIA
 RIFT VALLEY UNIVERSITY

DEPARTMENT OF HEALTH HO

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE

TOWARDS TUBERCLOSIS AMONG PRISONERS IN PRISON, JATO
NEKEMTE EAST WOLLEGA ETHIOPIA, 2022

GROUP NAME ID NO

1. BONTU DESALEGN………………………017
2. BONTU YADETA …………………………016
3. CHALA JEBENA…………………………..018
4. DIRIBA OLANA …………………………...025
5. EBA YADESA………………………………026

DECEMBER, 2022

NEKEMTE, ETHIOPIA

ii
Approval Sheet

We the undersigned, declare that this research paper is our original work and that all
sources of the materials in the research paper have been duly acknowledged. The matter
embodied in this research Paper has not been submitted earlier for a ward of any to the
best of our knowledge and belief.

GROUP NAME ID NO SIGNATURE: DATE

1. BONTU DESALEGN 017 ----------------- -----------------

2. BONTU YADETA 016 ----------------- -----------------

3. CHALA JEBENA 018 ----------------- -----------------

4. DIRIBA OLANA 025 ----------------- -----------------

5. EBA YADESA 026 ----------------- -----------------

iii
Approval
ASSESSMENT OF PREVALENCE OF PRE LACTEAL FEEDING AND
AFFECTED FACTOR AMONG MOTHER OF CHILDREN LESS THAN
TWO YEARS OF AGE, AT NEKEMTE TOWN, EAST WOLLEGA,
OROMIA, ETHIOPIA, 2022.
Advisor

Name date Signiture

___________________ ________________ ___________________

Examiner

___________________ ________________ ___________________

Examiner

___________________ ________________ ___________________

iv
ACKNOWLEGMENT

First of all we would like to give thanks to almighty GOD, for helping us in all challenges and to
do this research proposal. Above and for most we would like to express our deepest gratitude to
our friend’s for their valuable comments and marvelous constructive suggestion since the
preparation of proposal to the final of the research work.

Secondly we would like to acknowledge; Rift Valley University, of Health Science, School of
Nursing and Midwifery, Department of Nursing and Internet room workers for giving us this
golden opportunity. At last but not least we don’t want to pass without acknowledging all our
family members and friends for giving valuable support on this research.

Finally, we would like to extend me thanks to prison administration office to provide us

necessary baseline information that was used to develop this research.

v
Abstract
Background: TB is known to be the disease of under-privileged social conditions such as
poverty, malnutrition, and overcrowding. Prison is also a setting that constitutes all these
conditions under one roof. It concentrates individuals with background of poverty usually in
overcrowded and unhygienic environment, and with limited access to health service. Prison is
therefore becoming the place for concentrating, disseminating, making worse and even exporting
TB, including MDR-TB in the prison and general population at large.
Objective: To assess the knowledge, attitude and practice towards TB among prison population
of Prisoners, Western Ethiopia.

Methods and Materials: Institutional descriptive cross sectional study method was used to
assess knowledge, attitude and practice among prisoners of prison Jato town from December 10
–January 15, 2022. The Data was analyzed by using manual and tallying. Systematic random
sampling was employed to select study unit. The ethical approval and clearance letter of
permission was obtained from Rift valley University research coordinating office and an official
permission was obtained from prison administration. During data collection informed consent
was obtained from all respondents prior to interviewing selected prisoners.

Result: The study conducted of 352 prisoners in prison revealed that majority, 82% of the study
subjects heard about Tuberculosis. More than half, 280(79.5%) of the study participants claimed
that they fear when they acquire TB rather than seeking immediately medical services. Two
hundred and sixty eight (76%) of the respondents thought that TB is higher in the community
than in the prison population, which is highly different from the standard range put by WHO
which assured TB is 10-100 fold higher in prison than in the general community.

Key Words: Attitude, Knowledge, practice, prison, Tuberculosis,

vi
TABLE OF CONTENTS
ACKNOWLEGMENT................................................................................................................................ii
Abstract......................................................................................................................................................iii
TABLE OF CONTENTS............................................................................................................................iv
LIST OF TABLES.....................................................................................................................................vii
Lists of Figures...........................................................................................................................................vii
ABBREVIATIONS..................................................................................................................................viii
ABBREVIATIONS AND ACRONYM......................................................................................................ix
CHAPTER 1...........................................................................................................................................- 1 -
1. INTRODUCTION..............................................................................................................................- 1 -
1.1 Background...................................................................................................................................- 1 -
1.2 Statement of the problem...............................................................................................................- 1 -
1.3 Significance of the study...............................................................................................................- 2 -
2. LITERATURE REVIEW....................................................................................................................- 4 -
2.1 Basic facts about tuberculosis........................................................................................................- 4 -
2.1.1 Etiology..................................................................................................................................- 4 -
2.1.2 Mode of transmission of tuberculosis.....................................................................................- 4 -
2.1.3 Clinical manifestation of tuberculosis.....................................................................................- 4 -
2.1.4 Diagnosis of tuberculosis........................................................................................................- 5 -
2.1.5 Treatment and management of tuberculosis............................................................................- 5 -
2.2 Global burden of tuberculosis....................................................................................................- 6 -
2.3 Tuberculosis in Ethiopia................................................................................................................- 7 -
2.3.1 Tuberculosis epidemiology in Ethiopia..................................................................................- 7 -
2.3.2 Tuberculosis control in Ethiopia.............................................................................................- 8 -
2.4 Tuberculosis in prison...............................................................................................................- 9 -
2.4.1 Prevalence of tuberculosis in prisons....................................................................................- 10 -
2.4.2 Factors associated with tuberculosis in prisons.....................................................................- 10 -
2.4.3 Drug resistant tuberculosis in prisons...................................................................................- 12 -
2.4.4 Molecular epidemiology of tuberculosis in prison................................................................- 13 -
CHAPTER 3.........................................................................................................................................- 14 -
3. OBJECTIVES...................................................................................................................................- 14 -
3.1 General objective.........................................................................................................................- 14 -
3.2 Specific objectives.......................................................................................................................- 14 -

vii
CHAPTER 4:........................................................................................................................................- 15 -
4. METHODOLOGY............................................................................................................................- 15 -
4.1 The study area and period............................................................................................................- 15 -
4.2 Study Design...............................................................................................................................- 15 -
4.3 Source population........................................................................................................................- 15 -
4.5 Study Population.........................................................................................................................- 15 -
4.6 Eligibility Criteria........................................................................................................................- 15 -
4.6.1 Inclusion criteria.......................................................................................................................- 15 -
4.6.2 Exclusion criteria..................................................................................................................- 15 -
4.7 Sample size calculation...............................................................................................................- 15 -
4.8 Sampling procedure.....................................................................................................................- 16 -
4.9 Data collection tools and procedures...........................................................................................- 16 -
4.10 Study Variables.........................................................................................................................- 16 -
4.10.1 Dependent Variable............................................................................................................- 16 -
4.10.2 Independent Variables........................................................................................................- 16 -
4.11 Data Quality Assurance.............................................................................................................- 17 -
4.12 Data analysis procedures...........................................................................................................- 17 -
4.13 Operational Definition...............................................................................................................- 17 -
CHAPTER FIVE...................................................................................................................................- 18 -
5: RESULT...........................................................................................................................................- 18 -
5.1 Socio demographic characteristics of the respondents.................................................................- 18 -
5.2: Knowledge of prisoners in Jato Town,........................................................................................- 19 -
5.3: Attitude of the prisoners in prison towards Tuberculosis...........................................................- 23 -
5.4: - Practice of the prisoners in prison towards Tuberculosis.........................................................- 24 -
CHAPTER SIX.....................................................................................................................................- 26 -
6. DISCUSSION...................................................................................................................................- 26 -
CHAPTER SEVEN....................................................................................................................................- 28 -
7. STRENGTH AND LIMITATION OF THE STUDY.....................................................................................- 28 -
7.1 Strength of the study...................................................................................................................- 28 -
7.2 Limitation of the study................................................................................................................- 28 -
CHAPTER EIGHT.....................................................................................................................................- 29 -
8. CONCLUSION AND RECOMMENDATION...........................................................................................- 29 -
8.1 Conclusion...................................................................................................................................- 29 -

viii
 8.2 Recommendation........................................................................................................................- 30 -
References.............................................................................................................................................- 31 -
ANNEX ONE:......................................................................................................................................- 36 -
Part II: knowledge about TB.................................................................................................................- 38 -

ix
LIST OF TABLES
Table 1: Socio demographic characteristics Jato prisoners, Jato, 2022…………….16

Table 2: Knowledge of the respondents towards Tuberculosis, Jato, 2022………………..18

Table 3: Attitude of the respondents towards Tuberculosis, Jato, 2022……………………21

Table 4: Practice of the prisoners in prison towards Tuberculosis, Jato, 2022……....23

x
Lists of Figures
Figure: The reaction of prisoners towards Tuberculosis, Jato, 2022………………….18

Figure1: prisoners condition on information about Tubeculosis, Jato, 2022………….23

xi
ABBREVIATIONS
AFB - Acid Fast Bacilli
AIDS - Acquired Immuno Deficiency Syndrome
ALIPB - Aklilu Lemma Institute of Patho-biology
BCG - Bacillus Calmette-Guérin
BMI - Body Mass Index
DOTS - Direct Observed Treatment, Short-course
EPTB - Extra-Pulmonary Tuberculosis
FMOH - Federal Ministry of Health
HIV - Human Immunodeficiency virus
HSDP - Health Sector Development Program
ICRC - International Committee for Red Cross
LJ - Lowenstein-Jensen
MDG - Millennium Development Goal
MDR - Multi-Drug Resistance
NTCP - National Tuberculosis Control Program
PTB - Pulmonary Tuberculosis
RHB - Regional Health Bureau
SSA - Sub-Saharan Africa
TB - Tuberculosis
WHO - World Health Organization

xii
 CHAPTER 1

1. INTRODUCTION

1.1 Background
TB is still a priority in the global public health agenda, despite efforts and interventions that lasts
several decades. It is the second most common cause of death due to an infectious disease.
Current trends suggest that TB will remain among the top leading causes of global disease
burden over the next decades (16).
In Africa, the increasing of TB morbidity and mortality is caused by multiple factors, such as
widespread poverty, poor political commitment to TB control, civil strife, inadequate donor
support and the HIV epidemic. Predominantly, HIV epidemic has made a momentous
contribution since 2013s (18; 19; 21). The rate of TB among HIV/AIDS patients is documented
ranging from 20-44%. TB is known as the primary cause for death among HIV infected patients.
So, HIV infection has profoundly leaded on the epidemiology of TB (21). The African continent
as a whole is out of a track in achieving MDG 6; to have halted and begun to reverse the
incidence of TB in 2015 (15).
Ethiopia ranks 7th among the 22 high burden countries and 15th among the MDR TB priority
countries in 2016. It is one of the top three in Africa, with regard to a number of TB patients.
According to the FMOH hospital statistics data, PTB was the third leading cause of hospital
admission (7.8%), and the first leading cause of in-patient deaths (10.1%) in 2011. Due to poorly
developed health information system and absence of a national prevalence study, the actual
magnitude of TB in the country has not been accurately determined.

1.2 Statement of the problem

TUBERCULOSIS (TB) remains one of the leading causes of mortality, morbidity and health-
related socioeconomic problems worldwide, especially in resource poor countries. Ethiopia ranks
seventh among the world’s top 22 countries severely affected by TB, with an estimated incidence
rate of 378 cases per 100000 population in 2017(1,2).
Although the DOTS strategy was implemented nearly two decades ago, its current geographic
coverage and case detection rate remain low, and are challenged by extended delays in diagnosis
and treatment.(1,2)

1
As part of the Millennium Development Goals (MDG) for TB control, one avenue for enhancing
community participation is raising knowledge and care-seeking practice through health
education. TB control could be significantly improved if more consideration was given to the
population’s knowledge and attitudes about TB and related health care-seeking behaviour, by
directing efforts towards making individuals more informed and aware of all aspects of TB, its
treatment, and basic rules for preventing the spread of the disease to close contact (community
and family members, prison staff, inmates, and others who have social or physical contact with
TB patients).
The prison health service is typically under privilege and under-funded,5,6 and the prisons suffer
from severe overcrowding, poor hygiene and inadequate ventilation representing an epicenter for
transmission of T to close contacts and surrounding communities. Often there is no medical
screening upon admission; TB-infected prisoners are housed in crowded cells.
According to a recent report, Ethiopia ranks second behind South Africa in terms of its estimated
total prison population, with an officially registered population in excess of 80 000 (and a rate of
98 per 100 000 general population). In the first study of its kind, a relatively high prevalence of
pulmonary tuberculosis (PTB) and associated factors among Ethiopian prisoners was
documented in the same study population. Thus, the integration of a prison TB control
programmer into the national TB programmer should be given priority. Adequate information is
needed about prisoners’ awareness and practice regarding TB. Few studies have been carried out
to assess the level of TB knowledge among the civilian population in Ethiopia, (9–13) and to our
knowledge no study has been carried out among the prison population.

1.3 Significance of the study

European and North American countries are giving a considerable recognition and implementing
control and prevention measures for TB in prisons (29; 46). WHO/EURO prison health project,
started in 2013, is one of the initiatives addressing and integrating health needs of prisoners. In
addition, a number of scientific articles and reports are available that give guidelines for
planning, implementing and monitoring prison TB programs at national and international level.

In Africa, only Malawi has published implementation of specific interventions for TB in prisons
(17). The lack of specific and integrated interventions in prisons can make the settings to be
amplification sites of TB, including MDR-TB, since a late case detection, inadequate treatment
of infectious cases, release and recidivism without screening protocol, overcrowding, and poor
2
ventilation are likely apparent characteristics of African prisons. However, information about
epidemiology TB in prisons is very limited.

In Ethiopia, very few studies were conducted on TB in prison. As to the TB control program in
prison, there was a plan for establishing laboratory service, conducting screening survey and
developing specific guidelines in 2018 (4), but the implication is not satisfactory yet.

Thus, this epidemiological study will be conducted, in order to assess the prisoners’ knowledge,
attitude and practice towards the disease in Western Ethiopia. We expect that the results will
facilitate decision making about how to screen TB, prevent further spread and provide
appropriate prevention and control measures. It will have a substantial contribution for
developing and implementing TB control program in prisons. This will give an opportunity to
detect and manage those undiagnosed TB cases, and reduce potential sources of transmission for
the prison and general population. Furthermore, it will persuade policy makers, program
managers, and scientific communities to take necessary steps and measures for the well-being of
prison and general population at large.
The aims of the present study will be therefore to assess the level of knowledge and practice
related to TB and to investigate predictive factors of knowledge status of prisoners in one prison
setting in western Ethiopia.

3
2. LITERATURE REVIEW

2.1 Basic facts about tuberculosis

2.1.1 Etiology
TB is a bacterial disease caused by Mycobacterium (M). The genus Mycobacterium is divided in
to two main groups: tuberculosis complex and environmental Mycobacterium or non
tuberculosis Mycobacterium (NTM).The tuberculosis complex comprises the closely relate
species tuberculosis, M.bovis, African, micro and canettii. These species are the causative agents
of TB in humans and animals. Tuberculosis is the major cause of human TB all over the world
(8; 9).

2.1.2 Mode of transmission of tuberculosis

Tuberculosis infection occurs through inhaling an aerosol droplet that is generated when patient
with PTB coughs, talks, sneezes, spits and sings. For M. bovis, it can be transmitted through
drinking of raw milk that may infect the tonsils presenting as scrofula (cervical lymphadenitis),
or the intestinal tract, causing abdominal TB (8; 10).
In case of PTB, once the organism enters the alveolar region, alveolar macrophages engulf and
control multiplication of bacillus in most of the exposed individuals. This primary infection leads
to an active disease in about 10% of individuals only. In the remaining 90% of cases, individuals
remain asymptomatic and non-infectious, i.e. latent infection stage. However, in some
circumstances where the immune response is weakened, reactivation of latent infection can result
(10; 11).

2.1.3 Clinical manifestation of tuberculosis

Once a person develops the disease, PTB, there will be several suggestive clinical features,
especially 2 weeks’ or above duration of cough, sputum production and weight loss are
important for the diagnosis of PTB. Others respiratory symptoms like chest pain, haemoptysis,
breathlessness and/or constitutional symptoms like fever, night sweats, tiredness, loss of appetite
can also occur (10).

4
2.1.4 Diagnosis of tuberculosis
The diagnosis of PTB in adult is mainly done by collecting a sputum sample. Due to the nature
of the waxy coat of Mycobacterium cell wall, it retains an aniline dye (e.g. carbol fuchsin) even
after decolorization with acid and alcohol; they are thus named Acid Fast Bacilli (AFB). This
characteristic enables us to detect them by microscopy.
Although this method has low sensitivity; it is widely applied and used globally, because it is
simple, rapid and cost-effective. In resource limited settings, culture is used for a definitive
diagnosis of TB. However, it is much more costly than microscopy, requiring a long incubation
period and facilities for media preparation as well as skilled staff. The other diagnostic method is
chest x-ray (CXR). It is less applicable in low resource countries (10; 12; 13).

2.1.5 Treatment and management of tuberculosis

The treatment of TB is targeting five objectives:–preventing death from active TB or its late
effects; preventing TB relapse or recurrent disease; preventing the development of drug
resistance and decreasing TB transmission to others. The drugs that are used for first line
treatment of TB are safe and effective if properly used. In Ethiopia, these include rifampicin,
ethambutol, isoniazid, pyrazinamide and streptomycin. The administration of chemotherapy has
two phases. First, the intensive (initial) phase that consists of 3 or more drugs (rifampicin,
ethambutol, isoniazid, and pyrazinamide) for first the 8 weeks for new cases and 12 weeks for re-
treatment cases.
In this phase, drugs must be collected daily and swallowed under direct observation of a health
worker. Secondly, the continuation phase has at least 2 drugs (ethambutol, and isoniazid) that
will be taken for 4-6 months. In this phase, drugs must be collected every month and self-
administered by the patient, except for some conditions (10;14). The strategy of TB treatment is
called Directly Observed Treatment, Short-course (DOTS). It was adopted for the control of TB
and formulated global targets for the year 2000, namely to detect 70% of infectious new cases
and to cure 85% of the detected infectious cases at the World Health assembly in 1991. WHO
TB global report indicated that DOTS was being implemented in 184 countries that accounted
for 99% of all estimated TB cases and 93% of the world’s population in 2016 (15).

5
2.2 Global burden of tuberculosis
TB is still a priority in the global public health agenda, despite efforts and interventions that lasts
several decades. It is the second most common cause of death due to an infectious disease.
Current trends suggest that TB will remain among the top leading causes of global disease
burden over the next decades (16).
It was estimated that 9.2 million new cases of TB (139 per 100,000 population), including 4.1
million (62 per 100,000 population) new smear-positive cases occurred globally during 2016.
About 95% the new cases and 98% deaths due to TB occur annually in the developing world.
Asia and Africa account for 55% and 32% of cases globally, respectively. The SSA countries
have the highest rates, with an average rate of about 300 per 100,000 populations. Of the 9.2
million TB cases, 7.7% were estimated tobe co-infected with HIV. The African region accounts
for the majority of co-infected cases worldwide, about 85% in 2016 (15;17;18).
The burden of TB is predominately accounted by men; reported as the disease of men. For
instance, countries (2004) reported 1.4 million smear-positive cases in men, but only 775,000 in
women. This epidemiological difference is suggested to be due to gender differences in access to
TB services, exposure to infection and susceptibility to develop an active disease. For many
years, TB cases occurred predominantly among young adults, where approximately 6-8 million
cases in the economically most productive age groups (15-49 years old). However, in Western
Europe and North America countries, which have low incidence rate, TB cases tend to be in the
old indigenous population, whereas patients who are immigrants from high-incidence countries
tend to be young adults (18;19).

In the 20th century, morbidity and mortality due to TB steadily dropped in the developed world.
This was aided by better public health measures, improving living standards and widespread use
of BCG vaccine as well as the development of antibiotics in the 1950s. This downward trend
ended and the number of new cases started to increase in the mid 1980s. The major causes were
risk of reactivation of latent TB by increased life expectancy, poor compliance with anti-TB
treatment, and increased risk of exposure through HIV, urbanization, migration and destitution.
But, using massive expenditure of funds and human resources, the epidemic has been well
controlled and reversed in Western Europe and United States.
In most Western Europe and North America countries, TB is often attributable to immigrants
from high-incidence countries; they remain at increased risk of active TB (17; 18; 20; 21). For

6
instance, a study in Norway showed that immigrant had 7 up to 90 times higher than the crude
incidence of TB in the country (22).
The global increase in TB burden has sizeable contribution from Eastern Europe countries
(mainly the former Soviet Union) since 2013 and SSA since mid 1980s. The resurgence of TB in
the Eastern Europe countries is due to dramatically worsened living conditions, poor nutrition,
and economic decline during break down of the former Soviet Union, substandard TB treatment,
inadequate TB control program, emergence of MDRTB, and increased prison population (19; 23;
24). The epidemic in this region is also strongly linked to the emerging of successful strains, W-
Beijing strains, that are highly virulent and drug resistant, and has higher degree of transmission
(25).

In Africa, the increasing of TB morbidity and mortality is caused by multiple factors, such as
widespread poverty, poor political commitment to TB control, civil strife, inadequate donor
support and the HIV epidemic. Predominantly, HIV epidemic has made a momentous
contribution since 1980s (18;19;21). The rate of TB among HIV/AIDS patients is documented
ranging from 20-44%. TB is known as the primary cause for death among HIV infected patients.
So, HIV infection has profoundly lead on the epidemiology of TB (21). The African continent as
a whole is out of a track in achieving MDG 6; to have halted and begun to reverse the incidence
of TB in 2015 (15).

2.3 Tuberculosis in Ethiopia

2.3.1 Tuberculosis epidemiology in Ethiopia

Ethiopia ranks 7th among the 22 high burden countries and 15th among the MDRTB priority
countries in 2006. It is one of the top three in Africa, with regard to a number of TB patients.
According to the FMOH hospital statistics data, PTB was the third leading cause of hospital
admission (7.8%), and the first leading cause of in-patient deaths (10.1%) in 2011.
Due to poorly developed health information system and absence of a national prevalence study,
the actual magnitude of TB in the country has not been accurately determined. However, WHO
has estimated the burden of TB as presented in Table 2 (4; 15; 26).

7
Table 1 WHO (2007) estimates of TB burden in Ethiopia

Rates
Incidence ratio of all forms of TB 341 per 100,000
Incidence ratio of smear-positive TB 152 per 100,000
Prevalence of TB infection 546 per 100,000
Mortality rate due to TB 73 per 100,000
HIV among TB patients 41.00%
Source - Tuberculosis, TB/HIV and leprosy prevention and control strategic plan, 2007-2010
According to 2015/06 health institutions report, 120,163 (97.7%) TB patients were new cases;
out of which, 36,674 (31%) were smear-positive cases. The seven year trend of TB case
notification record indicated that proportional increment of extra- PTB (EPTB) and smear-
negative TB, while there is a downward trend for smear positive TB . This trend is assumed to be
due to the ongoing HIV/AIDS epidemic and causes for a growing caseload. HIV accounted for
about 32% of the estimated 141,000 total TB cases in 2015, and the prevalence of HIV among
TB patients was estimated 41% in 2007. This double burden of TB and HIV is attributing to
increasing demand for care and worsen situation of the already overstretched health care delivery
system in the country. They deplete resources, worsen stress and aggravate attrition of health
workers at service delivery points (4).

2.3.2 Tuberculosis control in Ethiopia

In Ethiopia, TB has been identified as one of the major public health problem, since about five
decades. The effort to control TB began in the early 1960s with establishment of a national
central office, and TB centers and sanatoriums in three major urban Hospitals. However, these
centers and national central office were not able to reduce the disease burden. As a result, a
standardized and well-organized TB programme, incorporating DOTS, is implemented since
1992. Currently, DOTS covers over 90% of the woredas in the country. The program is
combined and implemented with the leprosy program; named National Tuberculosis and Leprosy
Control Program since 2014.
The program is guided by the national strategic plan that was developed for the period from 2007
to 2010. The plan elaborates prevention and control strategies of TB, TB/HIV and leprosy. Its
implementation is intended to reduce morbidity, mortality and disability due to TB, TB/HIV and
leprosy (4).

8
The NTCP is organized in a hierarchical fashion with varying responsibilities under FMOH.
Within an integrated health system, the program relies on supervisory staff at the national,
regional, zonal and woreda levels, which has basic knowledge and skill on TB, TB/HIV and
leprosy. At the national level, the TB and leprosy control team is responsible for developing
guidelines, soliciting and coordinating external resources, providing technical assistance to the
RHBs, and monitoring the programmed performance in accordance with the national guidelines.
At the regional level, a regional team is responsible for the planning, guidance and supervision of
TB, TB/HIV and leprosy control activities in the region. At the zonal level, a zonal expert is
responsible for the planning, guidance and supervision of TB, TB/HIV and leprosy prevention
and control activities in the zone. At the woreda level, a woreda expert keeps the TB,
TB/HIV and leprosy registers and provides guidance and supervision to the general health staff
that are responsible for implementation of the TB, TB/HIV and leprosy control activities (4).
The NTCP has numerous challenges in combating the epidemic, such as high HIV prevalence,
low case detection rate, extended delay for diagnosis and treatment, inefficient and sub-standard
laboratory service. The program is also suffering from lack of operational research that could
improve the service delivery (4).

2.4 Tuberculosis in prison

TB is known to be the disease of under-privileged social conditions such as poverty,
malnutrition, and overcrowding. Prison is also a setting that constitutes all these conditions under
one roof. It concentrates individuals with background of poverty usually in overcrowded and
unhygienic environment, and with limited access to health service. Prison is therefore becoming
the place for concentrating, disseminating, making worse and even exporting TB, including
MDR-TB in the prison and general population at large. Everywhere, prisoners usually come
from a poor and socially marginalized segment of the society. So they come to prison with poor
health and high vulnerability to infection.
Although prison could be the strategic place where untreated conditions are discovered and dealt
with, so that prisoners leave healthier than they were when they came in. This only happens
rarely; they are rather at greater risks of acquiring and transmitting infectious diseases like TB
(29-31).
In Africa, where poverty, HIV/AIDS, and chronic malnutrition are unacceptably prevalent, the
prison population probably has a high burden of TB. However, published information about TB
in African prisons is very limited. Thus, we made a literature review on TB in prison, in order to
9
identify gaps of knowledge and describe the epidemiology of TB in prisons, particularly for the
African setting. We used Pub Med/Medline and Google Scholar database, and searched using
key words, such as “Tuberculosis and prison”, “Tuberculosis, Africa, and Prison” and “Prison
and Health”.

2.4.1 Prevalence of tuberculosis in prisons

Globally, the prevalence of TB in prison is very high that may account for up to 25% of a given
country TB burden. WHO estimated a prevalence of TB in prisons is 10- 100 fold higher than a
prevalence in the general population (32). According to our review among published studies, it
ranged from 3 to 200-fold higher than in the general population, both in high and low income
countries (23; 31; 33-46).
In Africa, we found only seven published prison studies that reported the prevalence of TB in
prison. These studies estimated 4 up to 35 times higher than the prevalence in the general
population (33;35;38;40;41;44;47). For instance, the prevalence of TB in prison of Antananarivo
was 16 times higher than in the general population of Madagascar (44). In Zambia, the
prevalence of TB in prisoners is about 10-fold higher than in the general population (33).
In other continents, most notably in the Eastern Europe countries, we found a number of
published studies (23;30;31;36;37;42;43;48-51). A Georgian study was one of the first nation
based study that reported a high burden of TB in prisons. The prevalence of smear- or culture-
positive TB was 5995/100,000-almost 200 times more than the prevalence in the general
population (39) .
The studies indicate that the disparity of TB burden in the prison population is very
disproportionate; to be infected with Mycobacterium is becoming a part of prisoners’ sentence.

2.4.2 Factors associated with tuberculosis in prisons

2.4.2.1 Socio- demographic factors

Most prisoners predominantly come from the poorly educated and socioeconomic deprived
segment of the general population, so they are at greater risk of acquiring and developing TB
even before admission to prison. Studies have identified the following risk factors for TB among
prisoners: low educated (37); homelessness, belonging to racial and ethnic minority groups and
excess alcohol use (36); and low income and narcotic drug use (52). Accordingly, they may have
poor access to health care that could increase the risk and prolonged period of infectiousness.

10
Indeed, these factors have also an adverse effect on immunologic function that increases
susceptibility to infection and development of the active disease (53).
A large number of prison studies reported that the mean and median age of TB cases ranged
from 27 to 37 years. In other words, TB in prisons whether from high or low incidence countries,
is consistently reported among young adults (15-49). They are also a largest proportion of the
prison population (33).
Prison studies indicated a significant difference between male and female prisoners regarding
identifying TB suspect and diagnosis (33). In Zambia prisons, new cases of TB only detected
among male prisoners (33). Similarly, a prison study from Malawi showed that all PTB cases
were male (40). Thus, the epidemiological difference could be due to poorer access to diagnostic
facilities, higher exposure to infection and increased susceptibility rather than biological
difference (35).

2.4.2.2 Prison related factors

Overcrowding is one of the typical characteristic of prisons that attributes to a high burden of
TB. A case-control study in St. Petersburg prisons (Russia) reported that an overcrowded cell
(more than 2 people per bed) and spending less time outdoors were independent risk factors for
developing TB in the prison .The Georgian study also indicated that being accommodated in a
prison with large number of prisoners (>600) had a significant association with an increased risk
of active TB; there was three times greater risk for prisoners accommodated in large prisons
(>600 prisoners) compared to small prisons (< 300 prisoners). Large prisons are notorious for
having poor hygienic standards and lack of adequate ventilation (39).

The length of imprisonment is one of the commonly identified risk factor for TB.
But, the risk related to duration of staying, either short or long period staying, has given
contradictory results in different studies. For instance, having PTB was positively associated
with a short staying (1-2 years) in Ivory Coast (41), Cameroon (35) and Tanzania (47) prisons.
These studies suggested that prisoners could have TB before they were sentenced, or a high
transmission rate of TB and poor living conditions may led to a rapid progression to the disease
in those susceptible. Conversely, the Georgian study showed that the risk of getting TB for those
who stayed 2 years or more was two times greater than for those who were imprisoned for less
than one year (39). As a result of poor living conditions, physical and emotional stress, the
longer prison stay may attribute to lengthy exposure to infection as well as deterioration of
11
immunologic function. On the other hand, the length of staying was not a significant risk factor
for TB in a Zambia prisons study (33).
Re-imprisonment (35;43), and a history of previously being in a prison (54;55) were found to
increase the risk of TB. A study in Maricopa County (USA) reported that
24% of TB patients in the civilian society had a history of imprisonment in the county jail prior
to their TB diagnosis. The majority of them (83%), who later developed TB, had not received
any TB screening while in jail (55). Similarly, a study in Memphis (USA) found that 43% of
community residents with TB had been incarcerated in the same jail at some time before their
diagnosis. This jail was a source of TB outbreak for prisoners and community members that
lasted several years (56).
Overall, the studies explicitly stated that the prison related factors are attributing to a high TB
burden both inside as well as outside of prisons and thus need to be addressed in TB control
strategies.

2.4.3 Drug resistant tuberculosis in prisons

High levels of MDR-TB are reported from some prisons with up to 24% of all TB patients (32).
Since the early 1990s, many Eastern Europe countries reported outbreaks of TB in prisons,
where the TB strains transmitted in prisons were more likely to be drug-resistant or associated
with HIV co-infection (30). A number of studies, mainly from Russia showed the emergence of
MDR-TB from prison populations to be a major health risk to the population, with economic
implications for the TB control (23;25;61-64).

History of imprisonment was identified as a strong predictor for acquiring drug resistant TB,
including MDR-TB. Active transmission of drug resistant strains; especially Beijing family
genotype, inadequate TB control program, lack of TB drugs, and spread of HIV infection were
mentioned as contributing factors for the catastrophic emergence of
MDR-TB in the prison (23;36;61;65).
In Africa, only Zambia (33) and Botswana (38) studies reported on drug resistant TB in prisons.
The Zambian study found resistance to at least one anti-TB drug among 40 (23.8%) of isolates;
where 16 (9.5%) of them were MDR-TB. This rate was found to be on the upper limit of
resistance rates reported among African countries (33).
On the whole, prisons are found to be an ideal site for concentrating and exporting drug resistant
TB.
12
2.4.4 Molecular epidemiology of tuberculosis in prison
Introduction of molecular epidemiology studies contributed much to our understanding of
transmission dynamics and causative strains of TB in prison. It gives an apparent reason why we
should be aggressive in control and prevention of TB in prison. A number of studies revealed
that prison is a place where Mycobacterium strains easily concentrated and disseminated. Studies
have further identified prisons as possible sources of outbreaks in the general population (61;66-
69). For example, a nine year retrospective epidemiological analysis of TB cases from Arkansas
correctional facilities (USA) demonstrated a high proportion of clustered TB cases2, a
dominance of a single strain for more than 50% of cases, and patients from the community were
infected by a strain that caused the largest cluster in the prison system (66).

A study in Tennessee (USA) indicated a Mycobacterium strain that was responsible for an
outbreak in the jail two years before was accountable for an outbreak in the surrounding
community (67). Similarly, a study in a large Spanish city also reported the existence of common
Mycobacterium strains that spread between imprisoned and urban population.
HIV-positive injecting drug users (IDUs), with a record of previous or current imprisonment
were responsible for dissemination of these common strains to the urban civilian population (68).
Lengthy imprisonment and diagnostic delay for PTB were reported to cause active transmission
of TB in the prison (69).

In Africa, there was only one published report from Madagascar. It also indicated a higher
proportion of clustered cases among the prisoners than in the general population. It suggested a
higher transmission rate of TB in the prison than in a non prison population. It showed active
circulation of strains between the prison and the outside (44).
All the above studies suggest that the absence of comprehensive and integrated TB control
strategies in prisons could lead to an outbreak, both in the prison and surrounding community.
Therefore, controlling TB in prisons should be a public health priority.

13
 CHAPTER 3

3. OBJECTIVES

3.1 General objective

To assess the Knowledge, Attitude and preventive Practice of prisoners in Jato prison Nekemte
Hospital towards Tuberculosis, 2022G.C

3.2 Specific objectives

1. To assess the knowledge of the prisoners towards TB among Jato prisoners,2022G.C
2. To assess the attitudes towards TB among prisoners in Jato Prison,2022G.C
3. To assess preventive practice towards TB among Prisoners in Jato prison,2022G.C

14
CHAPTER 4:

4. METHODOLOGY

4.1 The study area and period

The study will be conducted in Jato prison of Nekemte Hospital, Oromia regional state, Western
Ethiopia from April 04-May 15, 2022 G.C

4.2 Study Design

The study will be institutional quantitative cross sectional approach.

4.3 Source population

The source population will be all the population of the Jato prison.

4.5 Study Population

The study population will be sampled population from the prison population of Jato Prison.

4.6 Eligibility Criteria

4.6.1 Inclusion criteria

Prisoners who are mentally fit, willing to participate, above or equal to 15 years old and had ≥ 2
weeks duration of cough will be included in the study. In addition, PTB patients, who are taking
anti-TB treatment during the study, will be included in the study.

4.6.2 Exclusion criteria

Prisoners, who had ≤ 2 weeks duration of cough, who will be unwilling to participate will be
excluded. In addition, those who are less than 2 weeks after imprisonment and who are seriously
ill during the interview will also be excluded from the study.

4.7 Sample size calculation

Sample size will be determined by using single population formula.

no= (Z a/2)2P (1-q) where no=Sample Size

d2z a/2=95% CI which is 1.96

15
 P=50% =0.5

d=Margin of error

N=Total population of the Jato prisoners=1967

q=1-p=0.5

no=(1.96)2 0.5(1-0.5) = (3.84)(0.25) =384

(0.05)20.0025

Since the total population of the study is less than 10,000, the population correction formula
should be applied as,

nf= [( no/1+(no/N))]=[(384/1+(384/1967))]=320

By adding 10% non response rate, (320+10%) +320= 352

Therefore, the sample size for the study will be 352.

4.8 Sampling procedure

The sampling technique will be systematical. First, we will separate male and female prisoners
which all are more than 2 weeks after imprisonment. Secondly, we will select the respondents
using simple random sampling.

4.9 Data collection tools and procedures

The data will be gathered systematically considering equality between male and female ratio.
The research teams will interview the respondents giving them ample time and considering their
full consent for the study to be a participant.

4.10 Study Variables

4.10.1 Dependent Variable

Dependent variables are the knowledge, the attitude and the practice of the prisoners towards TB.

4.10.2 Independent Variables

Independent variables are Age, Sex, Marital status, Education, Residential condition,
Occupation, exposure history to TB patient.

16
4.11 Data Quality Assurance
To assure the quality of the data, by making pretesting questionnaire, translating the final version
of the questionnaire into local language (Afaan Oromo) and avoiding duplication of data will be
ascertained before the conduction of the study.

4.12 Data analysis procedures

The data will be checked manually for completeness; then coded and tallied, analyzed manually
by using scientific calculator and the result will be presented by percentages and numbers, using
tables and charts/graphs.

4.13 Operational Definition

Tuberculosis: A person with history of cough of either productive or dry type more than two
weeks, night sweating, loss of appetite, loss of weight and history of exposure to persons having
the above stated symptoms or known TB case.

Knowledge of TB:-≥15 year prisoners who cited knowing over 75 % of TB knowledge

questions were classified as having a good knowledge while those who report less than 75 % of
TB knowledge questions were categorized as having poor knowledge.

Attitude of TB: -≥15 year prisoner’s ways of perceiving and thinking all the ways of
transmission, protection methods, treatment option, and their views towards the other person has
the disease.

Preventive Practice of TB: - Any activities the respondents deal to prevent TB, to be treated
after attacked by the disease.

17
 CHAPTER FIVE
5: RESULT

5.1 Socio demographic characteristics of the respondents

The response was obtained from all of the respondents with response rate of 100%.As shown in
the table below majority (44.3%) of the respondents were in the age group of 15-24 and they
were males in sex (96%).Many of them (55%) were not married or single and they have learnt
primary school (1-8) (34.7%). Fourty percent of the respondents were unemployed. Oromo
accounts for 88% of the respondent’s ethnicity. Majority of the respondents were from Urban
(54%) area and 71% of them have been stayed in the prisoners for >12 weeks

Table 1: Socio demographic characteristics Jato prisoners, Jato, 2022.

S. Variables Categories Frequency Percent

n
o N=352

1 Age 15-24 156 44.3

25-34 109 31

35-34 57 16.2

>45 30 8.5

2 Sex Male 338 96

Female 14 4

3 Marital status Married 133 38

Single 196 55

Divorced 17 5

widowed 6 2

4 Educational status Un able to read and 21 6

write

Able to read and write 13 3.7

without formal
education

18
 Primary(1-8) 122 34.7

Secondary (9-12) 121 34.4

College and above 75 21.2

5 Job Gov’t Employee 33 9.4

Farmer 76 21.6

private work 43 12.3

Student 46 13

Un employed 142 40.3

Other 12 3.4

6 Religion Orthodox 122 36.7

Protestant 150 42.6

Muslim 44 12.5

Catholic 24 6.8

Other 12 3.4

7 Ethnicity Oromo 310 88

Amhara 21 6

Gurage 12 3.4

Tigire 9 2.6

Other 0 0

8 Where do you live Urban 191 54

Rural 161 46

9 Stayed for 2wks-12 wks 102 29

>12 wks 250 71

5.2: Knowledge of prisoners in Jato Nekemte Town,

Majority of the respondents containing 82% had heard about TB. Almost equal 43% and 40% of
the respondents claimed that the causes of TB as Bacteria and spoiled soil respectively. More
than half, 240(68%) of the respondents know the risks of TB among which major group 231

19
(66%) claimed as that exposure to infected persons followed by 170(48%), 102(29%), 84(24%)
claimed as overcrowding, drinking unboiled milk and low immunity respectively.

No; Sales; 0.18; 18% Yes No

Yes; Sales;
0.82000000000000
1; 82%

Figure1: prisoners condition on information about Tubeculosis, Jato, 2022.

Seventy one percent of the respondents know that TB transmission as through the air when the
infected person coughs or sneezes. Only 15(4%) of the respondents said that TB is transmitted by
shaking hands of the infected person.

Regarding questions about the ways of prevention of Majority, 206(59%) of them claimed as
opening the windows at home followed by 102(29%), 90(26%) and 43(12%) claimed as covering
mouth or nose when coughing or sneezing, isolating TB patients and by vaccination respectively.
Thirty two percent of them didn’t know how to prevent themselves from TB. Seventy nine
percent of the respondents know that treatment for TB is six months.

20
Table 2: Knowledge of the respondents towards Tuberculosis, Jato, 2022

s.no Knowledge questions Categories Frequency percentage

1 Ever heard about TB Yes 290 82

No 62 18
2 Causes of TB Bad luck/curse 77 22
Bacteria (germs 178 43
Spoiled soil(soil with a bad odor) 142 40
Other (specify…………) 21 6
3 Ever Infected with TB Yes 62 18
No 290 72
4 Know the risks for TB Yes 240 68
No 112 32
5 What is the risks for TB Over crowding 170 48
Drinking unboiled milk 102 29
Exposure to infected person 231 66
Low immunity 84 24
Other 8 2
6 Transmission of TB Through handshake 15 4
Through the air when the infected 250 71
person coughs or sneezes
Through sharing food with 82 23
infected person
By clothes with infected person 55 16
Don’t know 33 10
Other (specify) ___________ 5 1
7 What are signs and Cough that lasts longer than 2 203 58
symptoms of TB weeks
Weight loss 46 13
Night sweating 78 22

21
 Others(specify) ______________ 12 3
I don’t know. 78 22
8 How can we prevent our Through good nutrition 17 5
self from being
Covering mouth and nose when 102 29
Infected by TB? coughing or sneezing
By isolating TB patients 90 26
Opening windows at home 206 59
By vaccination 43 12
Do not know 112 32
Others (specify……..) 4 1
9 What is the best treatment Home Remedies 124 35
for TB? (more than one
answer is possible) Praying /holy water 56 16
Don’t Know 87 25
Modern drug 234 66
10 According to you, can a Yes, completely 262 74
TB affected person
Yes, partially 74 21
be cured?(chose only one)
No 16 5
11 If yes, how long should Two weeks 26 8
the treatment be
Six weeks 267 79
Taken to cure TB?
One year 43 13
12 Do you know any danger Death 227 64.5
if a TB patient is
Infects others 149 42
not taking treatment.
(multiple answer is Losses weight 68 19
possible )
Develops sever health problems 114 32
I don't know 23 7
Others (specify) 44 12.5
13 Do you know any danger Death 70 20

22
 if a TB patient is Relapse 151 43
not taking the drug Inability to cure infection 78 22
properly or (Multiple
answer is possible) Drug resistance 48 14
Don’t know 28 8

5.3: Attitude of the prisoners in prison towards Tuberculosis

As the following table illustrated more than half 271(77%) of the respondents claimed the TB as
very serious followed by 72(20.5%), 9(2.5%) claimed that TB is somewhat serious and not very
serious respectively. Two hundred and eighty (79.5%) of them fear to acquire the disease. High
number 247 (70%) of the study subjects respond that the TB treatment in Ethiopia is free of
charge followed by 55(16%) , 22(6%) respond as it is reasonably priced and it is expensive. Two
hundred and sixty eight (76%) of the respondents thought that TB is higher in the community
than the prison population.

Table 3: Attitude of the respondents towards Tuberculosis, Jato, 2022

s.no Variables Categories Frequency Percentage

1 In your opinion, how serious Very serious 271 77
disease is TB? Somewhat serious 72 20.5
(chose only one) Not very serious 9 2.5
2 Do you afraid to get infected Yes 280 79.5
with TB? (chose only one) No 72 20.5
3 Which do you think? Is TB In prison 84 24
higher in prisons or in In community 268 76
community
4 How expensive do you think 1. It is free of charge 247 70
TB treatment is 2. It is reasonably priced 55 16
in Ethiopia? (chose only one) 3. It is somewhat/moderately 28 8
expensive
4. It is very expensive 22 6

23
5.4: - Practice of the prisoners in prison towards Tuberculosis
The following table illustrated that the respondents’ reaction when they found out that they have
Tuberculosis were fear, seek immediate medication, feel shame, got sadness or hopelessness
constitute 129(36.6%), 91 (25.9%), 75(21.3%) and 57(16.9%) respectively. The figure below
depicts the respondent’s reaction towards TB.

#REF!; 0

25.9%

16.9%

21.3%

36.6%

Figure 2: The reaction of prisoners towards Tuberculosis, Jato, 2022.

More than half 196(56%) of the respondents claimed that they went to health facility 3-4 weeks
after the symptoms of TB has appeared followed by 39% who went to the health facility as soon
as they realized the symptoms.

24
 Table 4: Practice of the prisoners in prison towards Tuberculosis, Jato, 2022
s.n Variables Categories Frequen perce
o cy ntage

1 What would you do if you Go to a health facility 216 61.4

thought you had symptoms
of TB? (choose only one) Go to pharmacy 52 14.8

Got to traditional healer 96 27.3

Others (specify) 12 3.4

2 What would be your reaction Fear 129 36.6

if you were found out that
you have TB? (chose only Shame 75 21.3
one)
Sadness or hopelessness 57 16.9

Seek immediate medication 91 25.9

3 If you had symptoms of TB, When treatment on my own does not work. 15 4
at what point would you go
to the health facility? (chose When symptoms that look like TB signs last for 3–4 196 56
only one) weeks.

As soon as I realize that my symptoms might be related to 137 39

TB.

I would not go to the doctor 4 1

4 If you would not go to the Not sure where to go me 231 66

health facility, what is the
reason? (Please check all Cost constraint 80 23
that apply)
Difficulties with transportation/distance to Clinic 16 4.5

Do not trust medical workers 4 1

Do not like attitude of medical workers 72 20

Prison personnel refuses to refer 59 17

Other (specify) __ 49 14

25
 CHAPTER SIX
6. DISCUSSION
This study has tried to assess the knowledge, attitude and practice of prisoners in Prison found in
Jato Nekemte East Wollega Oromia regional state towards TB from December 20-January 10,
2022.

From the study, Almost all 338 (96%) of the study participants were males found
majorily,156(44.3%) in 15-24 age range and 196 (55%) of them were single. Nearly half, 142
(40.3%) of them were unemployed. This shows that, the major working force and the significant
age in which one can do many things were in prison. This may be because of unemployment
which in this study was high. Majority, 82% of the study subjects heard about Tuberculosis
while the remaining 18% didn’t. Almost half, 178 (43%) of the respondents who heard TB
claimed that TB is caused by Bacteria. When compared the KAP study done in Iraq which
showed, 64.4% of the prisoners had good knowledge about TB, the study finding of prisoners
knowledge was relatively high (55). The study done on the assessment of level of TB knowledge
in study population on prisoners in eastern Ethiopia revealed that only 1.6% of the respondents
described the cause of TB as Bacterial (56), which is very low when compared to this study. This
shows that there is an improvement of the ways through which the prisoners identified the cause
of TB. For this study, the prison had prisoners who were certified after some training on different
health professionals, who also had the responsibility to provide health information on different
public health importance. This opportunity might be one of the reasons for the improvement in
knowledge of the causes of TB.

More than half, 240(68%) of the respondents know the risks of TB among which major group
231 (66%) claimed as that exposure to infected person is one of the major ways through which
the disease transmitted.

Two hundred and sixty eight (76%) of the respondents thought that TB is higher in the
community than the prison population. This result is very far from the standard put by WHO
which explained as that the estimated prevalence of TB in prisons is 10-100 folds higher than
prevalence in the general population (48). This is the indicator that should be taken in to
consideration. Because, this much disparity showed that the health education on the disease is
not being given appropriately. This, in another way gave us hint that the prison population
should be screened for the disease.
26
The study revealed that, 247(70%) of the study participants knew that anti TB drugs are free of
charges including in the prison. This result is relatively higher than the result found on study
done on KAP of prisoners in southern Ethiopia which was about half percent (50). The same
study done on the same country revealed that 50% of the study participants in the study didn’t
know the risks of the TB, which is higher than this study results which was only 32%. More than
half of them, 68% knew that TB is risky. This showed that the presence of the improvement on
knowledge concerning the disease under the study.

27
 CHAPTER SEVEN

7. STRENGTH AND LIMITATION OF THE STUDY

7.1 Strength of the study

 The response rate was 100%.
 Important variables were used to identify the knowledge, attitude and practice of
the prisoners towards TB.
 The data were filled by the research team with great care.
 The study was conducted in prison set up which may give clue on the prisoners
KAP status, which we can say one of the few studies done in our country.

7.2 Limitation of the study

o The data was collected only from prisoners which is difficult to generalize the result for
all prisoners.
o Because the interview needs recalling some past events, the probability of recall bias
couldn’t be ruled out.
o Due to time constraint and skill gap on software analysis of different types, the possible
gaps on the study quality is not denied.

28
 CHAPTER EIGHT

8. CONCLUSION AND RECOMMENDATION

8.1 Conclusion
The study generally revealed that, the knowledge of the prisoners towards TB was high.
However, there is a gap between their knowledge and their practice and perception they had for
the disease.

The study showed that, there is a great gap between the WHO standard which dictated as TB is
prevalent 10-100 folds in prison population than general community, and the study subjects’
attitude on in which group of population TB is prevalent.

29
8.2 Recommendation
According to our study, even though the knowledge of the prisoners towards TB was relatively
high, they have poor practice on preventing the disease. If the situation continues without
intervention, it will affect major portion of the population. Therefore, we want to forward the
following recommendations

 The government should give attention about how prisoners build their awareness in
preventing TB,
 The prison administrative bodies should facilitate on the possibilities by which the
regular health education is given in the prison setup.

30
References
 Central Statistical Agency and ORC Macro. Ethiopia Demographic and Health Survey
2015. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency
of Ethiopia and ORC Macro.; 2016.
 Ministry of Health. Health Sector Development Programme (HSDP-III) 2005-2010.
Addis Ababa, Ethiopia: Planning and Programming Department; 2015.
 Central Statistical Agency. Population and Housing Census(first draft). Addis Ababa:
Central Statistical Agency of Ethiopia; 2018.
 Ministry of Health. Tuberculosis, TB/HIV and Leprosy prevention and control strategic
plan 2017-2019/20. Addis Ababa, Ethiopia: Disease Prevention and Control Department;
2017.
 International Center for Prison Studies. Prison Brief for Ethiopia. http://www kcl ac
uk/depsta/law/research/icps/worldbrief/wpb_country php?country=19 2018 January 2
[cited 2019 Mar 7].
 Ministry of Health. Health and Health Related Indicators. Addis Ababa, Ethiopia:
Planning and Programming Department; 2017.
 Ministry of Health. AIDS in Ethiopia, 6th Report. Addis Ababa, Ethiopia: National
HIV/AIDS Prevention and Control Office; 2016.
 Smith I. Mycobacterium tuberculosis pathogenesis and molecular determinants of
virulence. Clin Microbiol Rev 2003 Jul;16(3):463-96.
 Brooks G F, Butel J S, Morse S A. Mycobacteria . Medical microbiology. Appleton and
Lange; 2011. p. 275-84.
 WHO. TB/HIV: a clinical manual, second edition. China: WHO; 2014. Report No.:
WHO/HTM/TB/2014.329.
 Tufariello JM, Chan J, Flynn JL. Latent tuberculosis: mechanisms of host and bacillus
that contribute to persistent infection. Lancet Infect Dis 2013 Sep;3(9):578-90.
 WHO. Laboratory service in Tuberculosis control: Culture Part III. Geneva,
Switzerland: WHO; 2011. Report No.: WHO/TB/98.258.
 WHO. Laboratory service in Tuberculosis control: Microscopy Part II. Geneva,
Switzerland: WHO; 2015. Report No.: WHO/TB/98.258.
 Ministry of Health. Tuberculosis, Leprosy and TB/HIV Prevention and Control
Programme Manual, 4th edition. Addis Ababa, Ethiopia: MOH; 2018.

31
 WHO. Global tuberculosis control - surveillance, planning, financing. 2018. Report No.:
WHO/HTM/TB/2008.393.
 Murray CJ, Salomon JA. Modeling the impact of global tuberculosis control strategies.
Proc Natl Acad Sci U S A 1998 Nov 10;95(23):13881-6.
 Raviglione MC. The TB epidemic from 2012 to 2014. Tuberculosis (Edinb ) 2013;83(1-
3):4-14.
 Johnson JL, Ellner JJ. Adult tuberculosis overview: African versus Western perspectives.
Curr Opin Pulm Med 2011 May;6(3):180-6.
 Dye C. Global epidemiology of tuberculosis. Lancet 2006 Mar 18;367(9514):938-40.
 Bjune G. Tuberculosis in the 21st century: an emerging pandemic? Norsk Epidemiologi
2015;15(2):133-9.
 Fatkenheuer G, Taelman H, Lepage P, Schwenk A, Wenzel R. The return of
tuberculosis. Diagn Microbiol Infect Dis 2013 Jun34(2):139-46.
 Farah MG, Meyer HE, Selmer R, Heldal E, Bjune G. Long-term risk of tuberculosis
among immigrants in Norway. Int J Epidemiol 2015 Oct34(5):1005-11.
 Yerokhin VV, Punga VV, Rybka LN. Tuberculosis in Russia and the problem of multiple
drug resistance. Ann N Y Acad Sci 2011 Dec;953:133-7.
 Bobrik A, Danishevski K, Eroshina K, McKee M. Prison health in Russia: the larger
picture. J Public Health Policy 2015 Apr;26(1):30-59.
 Toungoussova OS, Bjune G, Caugant DA. Epidemic of tuberculosis in the former Soviet
Union: social and biological reasons. Tuberculosis (Edinb ) 2016 Jan;86(1):1-10.
 Demissie M,Omer OA, Lindtjorn B, Hombergh. Tuberculosis in EthiopiaIn, In:Berhane
Y, Hailemariam D and Kloos (Eds): The Epidemiology and Ecology of Health and
Disease in Ethiopia. Addis Ababa: Shama Books; 2016.
 Demissie M, Zenebere B, Berhane Y, Lindtjorn B. A rapid survey to determine the
prevalence of smear-positive tuberculosis in Addis Ababa. Int J Tuberc Lung Dis 2012
Jul;6(7):580-4.
 Shargie EB, Yassin MA, Lindtjorn B. Prevalence of smear-positive pulmonary
tuberculosis in a rural district of Ethiopia. Int J Tuberc Lung Dis 2016 Jan;10(1):87-92
 WHO/EURO. Status paper on prisons and Tuberculosis .Copenhagen , Denmark; 2017.
Report No.: EUR/07/5063912.

32
 WHO/EURO. Health in prisons : A WHO guide to the essentials in prison health.
Copenhagen , Denmark; 2017. Report No.: EUR/07/5063925.
 Stern V. Problems in prisons worldwide, with a particular focus on Russia. Ann N Y
Acad Sci 2011 Dec;953:113-9.
 WHO, ICRC. Tuberculosis control in prison: A manual for program managers. 2000.
Report No.: WHO/CDS/TB/2011.281.
 Habeenzu C, Mitarai S, Lubasi D, Mudenda V, Kantenga T, Mwansa J, et al.
Tuberculosis and multidrug resistance in Zambian prisons, 2012-2013. Int J Tuberc Lung
Dis 2017 Nov;11(11):1216-20.
 Jittimanee SX, Ngamtrairai N, White MC, Jittimanee S. A prevalence survey for
smearpositive tuberculosis in Thai prisons. Int J Tuberc Lung Dis 2007 May;11(5):556-
61.
 Noeske J, Kuaban C, Amougou G, Piubello A, Pouillot R. Pulmonary tuberculosis in the
Central Prison of Douala, Cameroon. East Afr Med J 2016 Jan;83(1):25-30.
 MacNeil JR, Lobato MN, Moore M. An unanswered health disparity: tuberculosis among
correctional inmates, 2012 through 2013. Am J Public Health 2005 Oct;95(10):1800-5.
 Sanchez A, Gerhardt G, Natal S, Capone D, Espinola A, Costa W, et al. Prevalence of
pulmonary tuberculosis and comparative evaluation of screening strategies in a Brazilian
prison. Int J Tuberc Lung Dis 2015 Jun;9(6):633-9.
 CDC. Rapid assessment of tuberculosis in a large prison system--Botswana, 2012.
MMWR Morb Mortal Wkly Rep 2013 Mar 28;52(12):250-2.
 Aerts A, Habouzit M, Mschiladze L, Malakmadze N, Sadradze N, Menteshashvili O, et
al. Pulmonary tuberculosis in prisons of the ex-USSR state Georgia: results of a
nationwide prevalence survey among sentenced inmates. Int J Tuberc Lung Dis 2011
Dec;4(12):1104-10.
 Nyangulu DS, Harries AD, Kang'ombe C, Yadidi AE, Chokani K, Cullinan T, et al.
Tuberculosis in a prison population in Malawi. Lancet 2017 Nov 1;350(9087):1284-7.
 Koffi N, Ngom AK, ka-Danguy E, Seka A, Akoto A, Fadiga D. Smear positive
pulmonary tuberculosis in a prison setting: experience in the penal camp of Bouake,
Ivory Coast. Int J Tuberc Lung Dis 2017 Jun;1(3):250-3.

33
 Bergmire-Sweat D, Barnett BJ, Harris SL, Taylor JP, Mazurek GH, Reddy V.
Tuberculosis outbreak in a Texas prison, 1994. Epidemiol Infect 2015 Dec;117(3):485-
92
 Martin S, V, varez-Guisasola F, Cayla JA, Alvarez JL. Predictive factors of
Mycobacterium tuberculosis infection and pulmonary tuberculosis in prisoners. Int J
Epidemiol 2014 Jun;24(3):630-6.
 Rasolofo-Razanamparany V, Menard D, Ratsitorahina M, Auregan G, Gicquel B,
Chanteau S. Transmission of tuberculosis in the prison of Antananarivo (Madagascar).
Res Microbiol. 2011 Nov;151(9):785-95
 Rao NA. Prevalence of pulmonary tuberculosis in Karachi central prison. J Pak Med
Assoc 2014 Aug;54(8):413-5.
 Aerts A, Hauer B, Wanlin M, Veen J. Tuberculosis and tuberculosis control in European
prisons. Int J Tuberc Lung Dis 2016 Nov;10(11):1215-23.
 Rutta E, Mutasingwa D, Ngallaba S, Mwansasu A. Tuberculosis in a prison population in
Mwanza, Tanzania (2011-2013). Int J Tuberc Lung Dis 2011 Aug;5(8):703-6.
 Drobniewski F. Tuberculosis in prisons--forgotten plague. Lancet 2014 Oct
7;346(8980):948-9.
 Chaves F, Dronda F, Cave MD, onso-Sanz M, Gonzalez-Lopez A, Eisenach KD, et al. A
longitudinal study of transmission of tuberculosis in a large prison population. Am J
Respir Crit Care Med 2017 Feb;155(2):719-25.
 Sretrirutchai S, Silapapojakul K, Palittapongarnpim P, Phongdara A, Vuddhakul V.
Tuberculosis in Thai prisons: magnitude, transmission and drug susceptibility. Int J
Tuberc Lung Dis 2012 Mar;6(3):208-14.
 Hammett TM, Harmon MP, Rhodes W. The burden of infectious disease among inmates
of and releasees from US correctional facilities, 1997. Am J Public Health 2012
Nov;92(11):1789-94.
 Lobacheva T, Asikainen T, Giesecke J. Risk factors for developing tuberculosis in
remand prisons in St. Petersburg, Russia - a case-control study. Eur J Epidemiol
2017;22(2):121-7.
 Rieder H L. Epidemiologic Basis of Tuberculosis Control. first ed. 2019. Paris,
IUATLD.

34
 Coker R, McKee M, Atun R, Dimitrova B, Dodonova E, Kuznetsov S, et al. Risk factors
for pulmonary tuberculosis in Russia: case-control study. BMJ 2016 Jan
14;332(7533):85-7.
 MacNeil JR, McRill C, Steinhauser G, Weisbuch JB, Williams E, Wilson ML. Jails, a
neglected opportunity for tuberculosis prevention. Am J Prev Med 2015 Feb; 28(2):225-
8.
 Jones TF, Craig AS, Valway SE, Woodley CL, Schaffner W. Transmission of
tuberculosis in a jail. Ann Intern Med 2016 Oct19;131(8):557-63.
 Long J, Allwright S, Barry J, Reynolds SR, Thornton L, Bradley F, et al. Prevalence of
antibodies to hepatitis B, hepatitis C, and HIV and risk factors in entrants to Irish
prisons: a national cross sectional survey. BMJ. 2011 Nov 24;323(7323):1209-13.
 Simooya OO, Sanjobo NE, Kaetano L, Sijumbila G, Munkonze FH, Tailoka F, et al.
'Behind walls': a study of HIV risk behaviours and seroprevalence in prisons in Zambia.
AIDS. 2011 Sep 7;15(13):1741-4.
 Watson R, Stimpson A, Hostick T. Prison health care: a review of the literature. Int J
Nurs Stud. 2014 Feb;41(2):119-28.
 Adjei AA, Armah HB, Gbagbo F, Ampofo WK, Boamah I, du-Gyamfi C, et al.
Correlates of HIV, HBV, HCV and syphilis infections among prison inmates and officers
in Ghana: A national multicenter study. BMC Infect Dis 2018 Mar7;8:33.

35
ANNEX ONE:
RIFT VALLEY UNIVERSITY COLLEGE OF HEALTH SCIENCE DEPARTMENT OF
NURSING

DATA COLLECTION QUESTIONNAIRE ON ASSESSEMENT OF KNOWLEDGE,

ATTITUDE AND PRACTICE TOWARDS TUBERCULOSIS AMONG PRISONERSIN
PRISON, JATO TOWN, 2022

CONSENT FORM SHEET

I would like to fill few questions and your willingness in the study. This study is conducting a
research on assessment of knowledge, attitude and practice towards TB among prisoners in
prison. The main Objective of our study is to assess knowledge, attitude and practice towards
tuberculosis among prisoners in prison. There will not identifier in our report ,data is going to be
reported in aggregate. Participation in this study is fully voluntary and you will not be harmed if
you refuse. Your genuine response is of great help for our study. The interview will not take
more than 30 minutes.

Will you willing to participate 1. Yes 2. No

Name of data collector……………………………………

Date …………….Sign………………….

36
Part I:Socio demographic information.

s.no Questions Possible Responses

1. Age in years _____________Years

2. Sex 1. Female 2. Male

3. Marital status 1. Single 2. Married 3. Divorced 4. Widowed

4. Education 1. Not able to read and write

2. Able to read and write without formal
school year
3. Primary (1-8)
4. Secondary (9-10 or 12)
5. College (10+ or 12+)
6. University degree

5. Occupation before imprisonment 1. Civil servant(gov’t) 2. Farmers

3. Private worker 4. Student
5. Unemployed6. Others (specify________)

6. Religion 1. Orthodox 4.Protestant

2. Muslim 5.Others (specify )
3. Catholic

7. Ethnicity 1. Oromo 2. Amara 3. Gurage

4. Tigre 5.Others (specify )

8. Residence place (before 1. Rural 2. Urban

imprisonment)

9. Type of Prisoner 1. New entrant 2. Two weeks

3.Greater than two weeks

10. How long have you imprisoned in ---------------------

this prison?

37
Part II: knowledge about TB

11. Have you heard about TB? 1.Yes 2. No

12. Have you ever been had a TB 1.Yes 2.No

disease?

13. What do you think are causes of TB? 1. Bad luck/curse

(choose only one) 2. Bacteria (germs)
3. Spoiled soil(soil with a bad odor)
4.Other (specify…………)

14. Would you know risk factors of TB? 1.Yes 2.No

15. Which risk factors do TB you 1.Overcrowding

know ? (multiple answer is
possible) 2.Using uncoiled milk
3.Living with infected person in the same house
4.Imunocompromised
5.Other(specify…………..)

16. Do you know mode of transmissions 1. Through handshake

of TB?( more than one answer is
possible)
2. Through the air when the infected person
coughs or sneezes
3. Through sharing food with infected person
4. By clothes with infected person
5. Don’t know
6. Other (specify) _______________

17. What are the signs and symptoms of 1. Cough that lasts longer than 2 weeks
TB? (multiple answer is possible)
2. Night sweating
3. Weight loss
4. Do not know
5.Others(specify) ______________________

38
18. How can we prevent our self from 1. Avoid shaking hands
being infected by TB ? (Please check
all that are mentioned.) 2. Covering mouth and nose when coughing or
sneezing
3. Avoid sharing dishes
5. Opening windows at home
6. Through good nutrition
7. By isolating TB patients
8. Do not know 9.others(specify……..)

19. What is the best treatment for TB? 1. Home Remedies

(more than one answer is possible)
2. Praying /holy water
3. Don’t Know
4. Modern drug

20. According to you, can a TB affected 1. Yes, completely 2. Yes, partially 3. No

person be cured?(chose only one)

21. If yes, how long should the treatment __________ weeks/months or don't know
be taken to cure TB?

22. Do you know any danger if a TB 1. Death 2. Infects others 3. Losses weight
patient is not taking treatment.
(multiple answer is possible ) 4. Develops sever health problems 5. I don't know
6. Others (specify) _________________

23. Do you know any danger if a TB 1. Death 2. Relapse

patient is not taking the drug
properly or defaulted?(Multiple 3. Inability to cure infection 4. Drug resistance
answer is possible)
5. Don’t know

39
ANNEX TWO: AFAAN OROMOO VERSION QUESTIONNAIRE

GAAFFIILEE RIFTII VALLIYII YUUNIVERSITII KOLLEJJI FAYYAA DAMEE

BARNOOTA HO

Odeffanno Riftii Valliyi

Waliigalte Jecha Iccitii Eeguu

Waliigaltee kana akkuma jirutti dubbisi.

Duran dursee akkam jirtu isiniin jechaa, nuti yuuniversitii Riftii Valliyii kollejjii fayyaa irraa
eebbifamtoota bara kanaa kan taanee yeroo ammaa qorannoo dhimma waa’ee tajaajila eegumsa
fayyaa namoota mana sirreessaa Jatoo keessa jiran irratti hojjecha jirra. Kunis
beekumsa ,ilaalchaa fi shaakalli sirreeffamtonni dhukkuba TB irratti qaban ilaallata.

Isinis qorannoo kana keessatti akka dabalamtan kabajaan afferamtaniittu; qorannoon kunis
tajaajila fayyaa sirreeffamtootaa fooyyessuuf bakka ol’aanaa qaba. Qorannoon kun Yuuniversitii
Riftii Valliyii fudhatama argateera. Odeeffannoo fi deebii isin nuuf kennitan marti iccitiidhaan
kan eegamu, qaama sadaffatiif darbee kan hin kennamne ta’uu isaa fi dhimma qorannoo kanaa
qofaaf kan oolu ta’uu isaa isin hubachiisuu barbaanna. Hirmaannaan keessan fedhii fi mirga
keessan; Hirmaachuu dhiisuun keessan qorannoo kana irratti miidhaa hin qabu, garuu qooda
fudhachuun keessan qorannoo kana guutuu gochuuf bakka guddaa qaba. Gaaffii isin gaafannu
yoo baay’atee daqiiqaa 30’ caalaa hin fudhatu. Ragaa nuuf kennuu, dhowwachuu yookiin
jidduutti addaan kutuun mirga keessani. Ragaa dhugaa fi qulqulluutu karoora fayyaa fooyyessuuf
barbaadama.

Yoo gaaffiin kun itti fufe fedhii qabduu? 1. Eeyyee 2. Lakki (deebiin isaanii eeyyee yoo
ta’ee gaaffii armaan gadii itti fufi, Lakkii yoo ta’e galateeffadhuutii nama itti aanutti darbi).

-Yeroon gaaffii itti eegalee ………………….Yeroo itti xumuramee……………………..

-Deebii deebii kennitootaa lakkofsa filannoo jiranii irratti giingoo maruun ykn barressuun ykn
mallattoo “I” irratti agarsiisi.

40
Kutaa Tokko

Odeeffannoo Sirreeffamtoota mana sirreessaa Jaatoo

Lakk. Gaaffilee Deebii

1. Umurii …………………..waggaadhaan

2. Saala 1. Dhiira 2. Dhalaa

3. Haala fuudhaa fi heerumaa 1. Hin fuunee /hin heerumne 2. bultii hin dhaabbanne
3. Wal hiikneera 4. Dhirsi koo na jalaa du’eera
4. Sadarkaa barnootaa 1.Hin Dubbisuu , hinbarreessu
2.Osoo hin baratiin barreesuufi dubbisuu nan danda’a.
3. Sadarkaa tokkoffaa(1-8) 4. sadar.lammaffa(9-12)
5. kollejjii(10+ ykn 12+) 6. Yuuniversiti digrii
5. Hojii 1. Hojii mootummaa 2. Qotee bulaa
3.Hojii dhuunfaa 4. Barataa/ttuu
5. Hojii hin qabu 6.Kan biraa(Ibsi_______)
6. Amantii 1. Ortodoksii 2. Musliima 3. Kaatoolikii
4. pirootestantii 5. Kan biraa, ibsi…………….
7. Qomoo 1. Oromoo 2. Amaara 3. Guraagee 4. Tigiree
5. Kan biraa, ibsi……..……..

8. Iddoo kam jiraachaa turte? 1. Magaala 2. Baadiyyaa

9. Yeroo hangam mana ------------------

sirressa keessa turtee?

Kutaa II: Beekumsa waa’eeTB.

10. Waa’ee dhukkuba Daranyoo 1.Eeyyee 2.Lakki

sombaa dhageesse beekta ?

11. Gaaffi 12 irratti deebiin kee 1. Carraa gadhee 2. Bacteriyaa (jermii)

eeyye yoo ta’e sababiin isaa 3. Gadda 4. Qillensa qorraa 5. Biyyee ajaa’aa
maal sitti fakkaataa?

12. Dhukkubni si qabatee beeka? 1.Eeyyee 2.Lakki

13. Dhukkuba TB tiif kan nama 1.Eeyyee 2.Lakki

saaxilu ni beekta?

41
14. Dhukkuba TB kan namatti fidan 1.Bakka tokkotti baay’achuu
maal fa’ati?(deebi lamaa fi isaa 2.Aannan osoo hin danfisiin dhuguu
ol filachuu ni dandeessa) 3.Nama dhukkuba TB tiin qabame waliin jiraachuu
4.Immunitiin namaa gadi bu’uu
5.Kan biraa(ibsi……..)

15. Dhukkubni TB akkamittin 1. Harkaan wal qabachuutiin

daddarbaa? 2. Karaa qilleensaa yeroo namni qufa’u ykn
haxxiffatu
3.Nama dhukkuba TB qabu waliin nyaachuun
4. Nama dhukkuba TB qabu waliin uffata tokko
uffachuun
5. Hin beekuu
6. kan biraa(ibsaa ________).
16. Mallattoon dhukkuba TB 1. Utaalloo turban lamaa ol
maalii ? 2. Dafqa halkanii hedduu
3. Hir’ina ulfaatina qaamaa
4. Hin beeku
5. Kan biraa ( ibsaa ________)

17. Dhukkuba TB akkamitti ofirra 1. Harkaan wal qabachuu dhiisuu

dhorkinaa ? 2.Afaan ofii cuqqalnii qufa’uuykn haxxiffachu
3. Manatti foddaa banuu
4. Karaa nyaata gaarii
5. Talaalliitiin
6. Namoota dhukkuba TB qaban adda baasuutiin
7. Hin beeku
8.kan biraa (ibsaa…………)
18. Yaalii sirriin dhukkuba TB 1. Biqilootaan fayyadamuu
maalii? (tokko qofaa filadhu) 2. Manatti ofiin of yaalu
3. Biifuutiin
4. Hin beeku
5. Qoricha ammayyaa
19. Akka keetti,namni dhukkuba TB 1. Eeyyee, Sirritti ni fayya
tiin qabamee fayyuu ni danda’aa 2. Eeyyee, hamma tokko
(tokko qofaa filadhu). 3. Lakki
20. Eeyye yoo jette, qorichi TB Ji’oota……………..?
hangamiif fudhatamu qaba?

42
21. Namni dhukkuba TB tiin 1. Du’a
qabame yaalii hinarganne
2. kan biraatti dabarsa
argaganne argatu yoo ta’e 2. nama biraatti dabarsa
miidha i hin arganne yoo ta’e
3. Ulfaatina qaama hir’isa
maal ta’a? 4. Rakkoo fayyaa babal’isa
5. Hin beekuu
6. Kan biraa (ibsaa) ________
22. Miidha qoricha TB addaan 1. Du’a
kutuu ni beektaa ? (7tokko 2. Deebe ka’uu dhukkuba TB
qofaa filadhu) 3. Fayyuu dhiisuu
4. Qorichaa dandamachuu
5. Hin beeku

B. Ilaalchaa waa’ee TB

23. Akka ilaalcha keetti, Dhukkubni TB hangam 1. Baayyee cimaa

akka cimu ni beekta ? 2. Hamma tokko cimaa
3. Baayyee cimaa miti

24. Dhukkuba TB tiin yoo qabamtee ni sodaatta ? 1.Eeyyee 2.Lakki

25. Akka yaada keetti, dhukkubni TB mana 1. mana sirressaa

sirressa keessatti moo hawaasa keessatti irra 2. Hawaasa keessatti
caalaa baay’ataa ?

26. Itiyoopiyaa keessatti gatiin qoricha dhukkuba 1. Tolaan kennama

TB hammam ol ka’aa akka ta’ee ni beektaa ? 2. Qarshiitiin bitama
(tokko qofa filadhu) 3. Hamma tokko gatiin isaa ol
ka’aadha
4. Gatiin isaa baay’e e ol ka’aadha.

Shaakallii waa’ee TB

27. Yoo mallattoo dhukkuba TB qabaatte maal 1. Gara mana yaalan deema
gootaa (tokko ol filachu ni dandeessa). 2. Gara mana qorichan deema
3. Gara mala aadattin deema
4.Yaalii filannoo kootinan deema

43
 (biqiltoota, kkf…)
5. Kan biraa (ibsi _________)
28. Yoo mallattoo dhukkuba TB ofirratti argite 1.Mana yaalan deema
maal gootaa ?(tokko qofaa filadhu). 2.Mana qorichaan deema
3.Qoricha aadaan fudhadha.
4.Ofiikoon of yaala
5.Kan biraa(ibsi…..)
29. Yoo dhukkubaa TB tiin qabamuu kee barte 1. Nan sodaadha
maal goota (tokko ol filachu ni dandeessa) 2. Nan aja’ibsiifadha
3. Nan qaana’a
4. Nan gadda ykn nan gammada
5. Yaalii hatattamaan barbada
30. Yoo mallattoo dhukkuba TB qabaatte yeroo 1.Yoon ofii koo of yaalee fayyu
kam mana yaala deemtaa (tokko qofaa filadhu) dadhabe
2.Yeroo mallattooon TB fakkaatu
turban 3-4 tti galu
3.Yeroo mallattoon dhukkuba koo
mallatto TB natti fakkate
4. Gara dooktara deemu hin fedhu

31. Yoo mana yaala hin deemne ta’e, sababni ati 1. Eessa akka deeman hin beeku
hin deemneef maalidha ? (tokko qofa filadhu) 2. Birriin ittin demu hin qabu
3. Rakkoo geejibatu jira
4. Hojjettoota mana yaalaa bira
deemu hin fedhu
5. Ilaalcha hojjettota fayyaatu gaarii
miti
6. Sirreffamtoni mana sirreessa
fakkenya na fudhatu
7. Kan biraa (ibsi _________)

44