Questionnaire for assessment of Knowledge, Attitude, and Practice of communities towards tuberculosis in Shinille Town, Somali Regional State, Eastern Ethiopia from February to May, 2013.

Date: ___ / ___ / ___

PART ONE: General and socio-demographic characteristics of the respondents

  1. code of the respondent ______
  2. Gender: A. MaleB. Female
  3. Age (year): ______
  4. To which ithic group do you belong?
  1. SomaliB. AmharaC. OromoD. TigreE. Other______
  1. What is your religion?
  1. OrthodoxB. MuslimC. ProtestantD. CatholicE. Other ______
  1. What is your current marital status?
  1. MarriedB. Unmarried.C. DivorcedD. Widowed
  1. What is your current educational status?
  1. IllitrateD. University level
  2. Less than gradeE. Other ______
  3. Grade 8-grade
  1. What is your current occupation?
  1. EmployedC. HousewifeE. Unskilled workerG. Student
  2. Un-employedD. FarmerF. Daily wagesH. Other ____
  1. What is your average household income per month?
  1. No defined incomeB. Irregular incomeC. Regular income of

PART TWO: Questionnaire about TB knowledge and awareness

  1. Have you ever heard about the disease called TB?A. YesB. No
  2. If yes, from whom/where?
  1. Newspapers and magazines E. Family, friends, neighbours and colleagues
  2. Media (radio, TV, etc.)F. Religious leaders
  3. Brochures, Posters and Printed materialG. Teachers
  4. Health workersH. Other (please explain):____
  1. What do you think is the cause of TB
  1. Bacteria/GermsC. Shortage of foodE. Hot climate G. Smoking/chewing
  2. Cold airD. DustF. Sunlight H. Other (specify)__
  1. What are some of the common signs and symptoms of TB?
  1. Cough for 3 or more weeksE. Fever and sweat at night
  2. Sputum with bloodF. Chest pain
  3. Weight lossG. Don’t know
  4. Loss of appetiteH. Other (specify):_____
  1. Do you think that the disease can be transmitted from the patient to other person?
  1. Yes B. No C. Don’t know
  1. If yes, how can a person get TB?

A.Through the air when a person with TB sneezes or coughs

B.Through touching items in public places (doorknobs, handles in transportation, etc,)

C.Through sharing cups E. Through handshakes F. Don’t know

D.Through eating from the same plate G. Other (specify)___

  1. Do you think that the transmission of TB is preventable?
  1. Yes B. No C. Don’t know
  1. If yes, how can a person prevent getting TB?
  1. Covering mouth and nose when coughing or sneezing
  2. Avoid shaking handsF. Through good nutrition
  3. Early treatmentG. Use separate room for the patient
  4. Avoid sharing cups with a patientH. Don’t know
  5. Closing windows at homeI. Other specify ______
  1. Can TB be cured?
  1. Yes B. No C. Don’t know
  1. How can someone with TB be cured?
  1. Modern drugs given by health institutions health personals
  2. Herbal remediesD. PrayingF. Selftreatment
  3. Home rest without medicineE. Don’t knowG. Other ______

PART THREE: Assessment of TB attitudes and health care-seeking behavior of Communities.

  1. In your opinion, how serious a disease is TB?
  1. Very seriousD. Not very serious
  2. Somewhat seriousE. Don’t know
  1. How serious a problem do you think TB is in your area?
  1. Very seriousD. Not very serious
  2. Somewhat seriousE. Don’t know
  1. Do you think you can get TB?
  1. Yes B. No C. Don’t know
  1. What would be your reaction if you were found out that you have TB?
  1. FearC. ShameE. Other ______
  2. SurpriseD. Sadness or hopelessnes
  1. Who would you talk to about your illness if you had TB?
  1. Doctor or other medical workerC. ParentE. No one
  2. SpouseD. Close friendF. Other ____
  1. What would you do if you thought you had symptoms of TB?
  1. Persue other self-treatment options (herbs, etc.)
  2. Go to health facilityD. Go to traditional healers
  3. Go to pharmacyF. Other ______
  1. If you had symptoms of TB, at what point would you seek medical help?
  1. When treatment on my own does not work
  2. When symptoms that look like TB signs last for 3-4 weeks
  3. As soon as I realize that my symptoms might be related to TB
  4. I would go to health facility or contact health personals.
  5. I don’t know
  1. If you would not go to the health facility, what is the reason?
  1. Not sure where to go
  2. Cost
  3. Cannot leave work (overlapping work hours with medical facility working hours)
  4. Do not want to find out that something is really wrong
  5. Difficulties with transportation/distance to clinic
  6. Do not trust medical workers
  7. Do not like attitude of medical workers
  8. Other (please explain):______

PART FOUR: Assessment of TB stigma of Community.

  1. Do you know people who have/had TB?
  1. Yes B. No C. Don’t know
  1. How do you feel towards people with TB disease?
  1. “I feel compassion and desire to help.”
  2. “I feel compassion but I tend to stay away from these people.”
  3. “It is their problem and I cannot get TB.”
  4. “I fear them because they may infect me.”
  5. “I have no particular feeling.”
  6. Other (please explain):______
  1. In your community, how is a person who has TB usually regarded/treated?
  1. Most people reject him or her
  2. Most people are friendly, but they generally try to avoid him or her
  3. The community mostly supports and helps him or her
  4. Other (please explain):______
  1. In your opinion, are some people more likely to become infected with TB than others?
  1. Yes B. No C. Don’t know
  1. If yes, who is more likely to be infected?
  1. Men C. both men and womenE. very old peopleG.otherspecify
  2. WomenD. children under 5 yearsF. don’t know

Thank you very much for participating in my survey!!

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