PREVALENCE OF PULMONARY TUBERCULOSIS AMONG

SUSPECTED PATIENTS VISITING SHENEN GIBE HOSPITAL

OROMIA REGION, ETHIOPIA

BY:- AMARE GEBEYEHU

A RESEARCH PAPER TO BE SUBMITTED TO DEPARTMENT OF

MEDICAL LABORATORY SCIENCE, JIMMA UNIVERSITY, IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF BACHELOR OF SCIENCE (BSC) IN MEDICAL
LABORATORY SCIENCE AND PATHOLOGY

JUNE, 2015

JIMMA, ETHIOPIA,

1
 JIMMA UNIVERSITY
COLLEGE OF PUBLIC HEALTH AND MEDICAL
SCIENCE DEPARTMENT OF MEDICAL
LABORATORY SCIENCE AND PATHOLOGY

PREVALENCE OF SMEAR POSITIVE PULMONARY

TUBERCULOSIS AMONG SUSPECTED PATIENTS
VISITING SHENEN GIBE HOSPITAL, OROMIA REGION,
ETHIOPIA

BY: - AMARE GEBEYEHU

ADVISOR: -Dr. GEMEDA ABEBE

JUNE, 2015

JIMMA, ETHIOPIA,

2
ABSTRACT

Back ground: - Tuberculosis is one of the health problems in the world.This

affects one–third of the world population. TB is greatest killer worldwide due to
single infection next to HIV. And 95% cases and 98% deaths due to TB occur in
developing countries especially in Sub-Saharan Africa and East Asia.

Objective: - To determine the prevalence of smear positive pulmonary

tuberculosis among suspected patients attending at Shenen Gibe Hospital
during the study period.

Method: - A cross–sectional study design was conducted from11/08/07-

10/09/07E.C from all presumptive TB cases visiting Shenen Gibe Hospital.
Socio demographic and risk factor data was collected by using questionnaires.
Sputum sample was collected and processed by ZN stain technique then
examined by microscopically. presumptive TB cases.

Result: - From 165 presumptive TB cases; 84(50.91%) male and 81(49.10%)

females, 12(14.81%) were smear positive for AFB. Previous contact history with
TB patients, habit of cigarette smoking and number of rooms are significantly
associated with TB prevalence. Prevalence of TB was relatively higher among
female (14.81%), age group >45years (5.88%), illiterate groups (8.77%) and
family income <500 (12%)

Conclusion and Recommendation: - Based on this study prevalence of PTB is

higher among cigarette smoker, alcohol drinker, previous contact history with
TB patients, illiterate, and those whose family income is low. Therefore health
worker, health center administration and community administration should do
cooperatively to create awareness about the disease, the effect of associated
risk factor and means of prevention.

I
 ACKNOWLEDGEMENT

I would like to express my deepest gratitude to Jimma University, Medical

science college, Medical laboratory science school that for providing me the
opportunity to undertake this research, andto my advisor Dr. Gemeda Abebe
for his guidance constructive idea and advice. I would like to express my
thanks to all my heartfelt friends who help me to develop this research .

Finally I would to express my heartfelt appreciation to Shenen Gibe Hospital

laboratory staffs for their unreserved support during the data collection period.

II
 TABLE OF CONTENT

TITLE PAGES
Abstract ....................................................................................................I

Acknowledgement ....................................................................................II

Table of content ......................................................................................III

List of tables.............................................................................................V

Abbreviations and acronyms....................................................................VI

Operational definitions...........................................................................VII

Chapter one

1 .Introduction .........................................................................................1

1.1 Back ground Introduction................................................................1

1.2 Statement of the problem .................................................................3

1.3 Significance of the.............................................................................5

Chapter two

2 .Literature review...................................................................................6

Chapter three

3. Objective............................................................................................10

3.1 General Objective..............................................................................10

3.2 Specific Objectives..........................................................................10

Chapter four

4 .Methods and materials........................................................................11

4.1 study area and period...................................................................11

4.2 study design.................................................................................11

4.3 populations ...................................................................................11

4.3.1 Source population .................................................................11

4.3.2 Study population ....................................................................11

4.4 Sampling Technique .......................................................................12

4.5 sample size determination..............................................................12

III
4.6 Study variables...............................................................................12

4.6.1 Dependent variable .......................................................................12

4.6.2 Independent variables....................................................................12

4.7 Materials and reagent ......................................................................13

4.8 data collection process......................................................................13

4.9 data processing and analysis ...........................................................13

4.10 ethical considerations ....................................................................14

4.11 Quality assurance ..........................................................................14

Chapter five

RESULT..........................................................................................15

Chapter six

DISCUSSION ..................................................................................16

Chapterseven

CONCLUSION AND RECOMMENDATION

ANNEX ONE

ANNEX TWO

Reference………………………………………………………………….……24

ANNEX THREE

Laboratory procedure………………………………………………………….……28

ANNEX FOUR

Patient Examination Request Form…………………………………………….29

ANNEX FIVE

Questionnaire…………………………………………………………………..…….30

IV
 LIST OF TABLE
Table 1:- Distribution of smear positive PTB by age and sex among

Suspected patients visiting Shenen Gibe Hospital laboratory

from11/08/07-10/09/07 E.C.……………………………………………………………
18

Table 2:- Distribution of smear positive PTB by educational status

among suspected patients visiting Shenen Gibe Hospital Laboratory

from11/08/07-10/09/07E.C...............................……………………19

Table 3:-Distribution of smear positive PTB by contact history, No of windows,

No of rooms among suspected patients visiting Shenen Gibe Hospital

Laboratory from11/08/07-10/09/07E.C .......................20

Table 4:- Distribution of smear positive PTB by family size and family income

per month among suspected patients visiting

Laboratory from11/08/07-10/09/07E.C .......................21

Table 5:- Distribution of smear positive PTB by habit of cigarette smoking,

alcohol drinking, raw milk drinking among suspected patients

Visiting Shenen Gibe Hospital Laboratory from 11/08/07-10/09/07E.C

……………………………………………………………………….. …22

Table 6:-Distribution of smear positive PTB by occupational status among

Suspected patients visiting Shenen Gibe Hospital from

11/08/07-10/09/07 E.C................................................23

V
ABBREVIATION AND ACRONYM

AFB - Acid Fast Bacilli

AIDS - Acquired Immune Deficiency syndrome

DOTS - Direct Observation treatment short course

HIV - Human Immune deficiency Virus

MOH - Ministry of Health

MTB - Mycobacterium Tuberculosis

MDRTB - Multi-Drug Resistance Tuberculosis

PTB - Pulmonary Tuberculosis

TB - Tuberculosis

WHO - World Health Organization

Zn-Stain- Ziehl Nielsen stain

HC - Health Center

VI
DEFINITIONS
Illiterate: - one who cannot read and write

Infectious disease= called communicable disease or contagious disease any

Disease that can transmitted from one person to another

Physical contact or inhalation of droplet etc.

Literate= one who can read and write

New case: - patient who has never been treated for tuberculosis, who has

taken anti tuberculosis less than one month.

Prevalence: - a measure of total number of existing cases or event of to disease

at a specified point of time.

PTB Suspect: - Patients presenting with clinical features to PTB such chronic

cough, weight loss, fever, night sweating, chest pains, which

makes the health worker think the patient may have PTB and

requires to for sputum AFB examination

Relapse case: - a patient previously declared cured but with a new episode of

symptom of disease and bacteriological positive (sputum smear

or culture) of TB.

Risk factor: - condition which is its presence increase the probability that the

disease occurs in the time future.

Smear (sputum) negative: - Absence of at least three AFB or sputum

Microscopy

Sputum smear positive: - when there are at least two AFB positive results of

sputum examination.

VII
CHAPTER –ONE

INTRODUCTION

Tuberculosis is a common and in many cases fetal infectious disease caused by

various strain of mycobacterium, usually mycobacterium tuberculosis (M.TB).
Humans are the only reservoir for M.TB. (1)

M.TB is an intracellular pathogenic bacterium with complex lipid rich cell wall
which makes it resistant to most antimicrobial agent and need long term
treatment. (2) M.TB is a fairly non motile rod shape bacterium. The rods are 2-
4 µm in length and 0.2-0.5µm in width, and are an obligate aerobe. M.TB is not
classified as gram positive or gram negative, but acid fast. Under ZiehlNeelson
stain acid fast bacilli appear red or pink with blue background. The major
determinant of M.TB virulence is its cell wall which composed of peptdoglycan
and lipid complex. The lipid complex consists of mycolic acid, cord factor and
wax-D which account 60% cell wall. (3) And it is fastidious slow growing
bacteria which required up to 8 week to be defected in the laboratory culture.
(2)

Although MTB affect any parts of the body, typically it has high affinity to lung.
People acquire MTB infection by inhalation of air contaminated with MTB
bacteria. Patients with active PTB have high intensity to transmit the agent to
other person. (1, 2)

Since the infection dose of TB is very low, inhalation of just a single bacterium
can lead to new infection (4). Most of TB infection cases are asymptomatic and
few of cases progress to active PTB. As it affects any parts of the body TB has a
wide range of symptom. The followings are the classical symptom of PTB
infection: chronic cough, blood tinged sputum, fever, night sweat, weight loss
etc. (1,2)

1
There are several methods for the diagnosis of TB. This include chest X-ray,
microscopic (AFB), culture which is fundamental for diagnosis as well as
sensitivity testing and serological test. Among those microscopic (AFB) is
routine in developing countries such as Ethiopia because of its simplicity and
cost. (5)

TB is preventable and completely curable disease if correct management and

drugs or treatment has taken for the correct length of time. Unless it is
changed to MDR TB strain, the first line drugs are effective to cure TB. (2, 4)

2
1.2. Statement of the Problem

Tuberculosis is still a major public health problem in the world. According to

the global epidemiology of the disease, one third of the world population are
infected with M. Tuberculosis and one new infection occur per seconds in spite
of not all changed to active PTB. (1, 2, 5). During 20 th century TB killed
approximately 100 million people worldwide. (1, 5)

According to WHO report in 2010 there were an estimated 8.8 million incident
cases of TB and 1.45million death. Of those death 1.1 million were among HIV
negative people and 0.35 million were among HIV positive. (6)

Approximately one third of the 34 million people living with HIV/AIDS

worldwide are co-infected with latent TB. Studies shows that people livening
with HIV and infected with latent TB are 21-34 times more likely to develop
active PTB than people without HIV. (2, 4)

Of all countries that report their TB statistics to WHO, there are 22 countries
that are referred to as “high TB burden” countries and they have been
prioritized at the global level since 2000. Ethiopia is ranked at seventh (7 th)
among those 22 high TB burden countries. In 2010 the WHO estimated that
there were globally 290,000 cases of MDR-TB among those cases of TB
reported to them. According to WHOthere are 27 high burden countries for
MDR TB. These are countries where at least 4000 cases of MPR-TB each year
and at least 10% newly registered are MDR-TB and Ethiopia ranked at ninth
(9th). In 2009 there were estimated 9.7million children who were orphan as a
result of their parents dying by TB. (6)

The report conducted by WHO in 2006 to assess the distribution of TB cases

showed that Africa region (24%), south Asia region (35%) and western pacific
region (24%) together accounts 83% of all notified new and relapse cases of
TB. The global world report in 2008 indicates that a total of 202 countries and

3
territories reported TB as 9.2 million new cases of TB around 2.5 million smear
positive were close to Africa, South east Asia, and west of pacific. (7)

More people in developing countries contract TB because of compromised

immunity largely due to high rate of HIV infection and the development of
AIDS. The current rapid rise of TB cases in Ethiopia is also partially due to
epidemics of HIV/AID. The other problem for the management of TB, is the
development of MDR-TB and these is usually due to the result of patient
missing of dose drugs and incomplete course of treatment. Treatment of MDR -
TB cases must be done based on the sensitivity testing; it is impossible to treat
such patients without the drug sensitivity information. (8)

TB affects all age groups and both sexes, but there are groups more vulnerable
to develop the disease. Risk factor such as poverty, malnutrition, overcrowded
living condition, and defective immunity are highly associated for increment of
TB cases. The age group mainly affected of between 15 and 45 years. (9)

Ethiopia is the third most populous country on Africa with TB burden.

According to the MOH hospital statistics data, TB is the leading cause of
morbidity and the third cause of hospital admission in Ethiopia. Ethiopia
reported 141,909 cases of all type of TB in 2007. (10)

Early diagnosis of the disease and prompt treatment is essential for an effective
and efficient TB control program. Delay in diagnosis may worsen the disease,
increase the risk of death, and increase the chance to transmit the agent to
community etc. Studies in Africa shows that patients and health care delays
are the major problem in the control of TB. (11)

4
1.3. Significance of the Study

As it is clearly described in the statement of problem and literature review,

reports on the prevalence of PTB is high in developing countries like Ethiopia.
This study can provide information about the prevalence of PTB infection in
Jimma town and surrounding community. Also it may provide base line
information on the prevalence of PTB to the concerned governmental and
service institution and describe socio-demographic characteristic of the
infection. Furthermore this study initiates other researchers on the topic to
determine the magnitude of the problem and implement solution to reduce.

5
CHAPTER –TWO

LITERATURE REVIEW

Tuberculosis is continues to be an important health problem worldwide in both

morbidity and mortality. PTB is the commonest form of disease in about 80% of
patients, extra-pulmonary which affects organs other than lungs such as,
nerves system, lymph nodes, and joints etc account about 20% of all TB
patients. (12)

In 2007 there were an estimated 13.7 million chronic active cases of TB

worldwide while in 2010 there were an estimated 8.8million new cases and 1.5
million associated death mostly occurring in developing countries. The absolute
case of TB has been decreasing since 2006. (13).

A prevalence survey study for smear positive TB in Thailand, Thai prison in

2007 shows that of 71594 prisoners, 22132(30.9%) were identified as TB
suspects, and 254(1.2%) were confirmed by sputum smear for TB. In this study
males were most lively diagnosed with TB disease. (14)

A study conducted in central India in 2009, the prevalence of PTB shows that
of 2341 individual eligible for screening 297(7.9%) were positive for PTB. The
overall prevalence of culture and smear positive PTB was 387(95% CI: 273-502)
per 100,000 population. The prevalence of PTB increase with age and
significantly higher among males: 444/100,000 (95% cl: 415-693) as compared
to female: 233/100,000(95%cl: 101-346) P<0.001. (15) Similar community
based cross-sectional survey conducted in Central India, Jobalpur District in
2012 about the prevalence of PTB shows that out of 7533 individual who were
symptomatic and submit sputum sample, 221 (2.93%) were positive for PTB.
This study reveals that the prevalence of PTB was higher among male and rural
area. (16)

6
According to the study conducted in Brazilian prison in 2005 to determine the
prevalence of PTB and to assess the performance of several screening
strategies, the overall prevalence of TB cases was 4.6%. (17)

A prospective study conducted in France, Paris about the prevalence and

clinical predictor of PTB from August 2005 to January 2007, shows that of 134
patients isolated on admission to the ward for suspicious of PTB 26(19.4%)
were positive for PTB. According to the study, PTB was significantly associated
with young age, HIV infection, weight loss and upper lobe disease. (18)

According to the study conducted about PTB among women with cough in
Tanzania, Dar Es Salaam in 2009 shows that out of 616 TB suspects, 14(2.3%)
were smear positive .(19)

A study conducted in 2010 in pokhara, kaski, and Nepal showed that of the 62
HIV infected drug user PTB was diagnosed in 3(4.8%) of participant. All of them
were male in productive age group. Cough was the major clinical symptoms
(54.8%) in the study participant. (20)

A retrospective study conducted in Nigeria between 2006 -2008 showed that of

3679 participants who were attending in infections disease hospital (IDH) in
INKANO 541(14.7%) were positive for TB. In this study the age group 30-43
years had the highest prevalence. Nigeria has been ranked as the third TB
affected nation in the world. (21)

Similar retrospective study conducted in Ghana, Tamale teaching health

hospital from January 2004 to December 2010 to determine the prevalence of
TB, shows that out of a total of 4720 recorded new cases, 620 were smear
positive yielding positivity rate 13.0%. The positivity rate of year-on-year bases
was 15.7%(2004), 15.8%(20050, 13.4%(2006), 12.7%(2007), 20.6%(2008),
10.0%(2009) and 6.3%(2010). (22)

A cross-sectional survey conducted in 2009 in 18 prisons in Malawi to

determine the prevalence of PTB shows that of 7714 individuals who have

7
cough > 1 week duration and submit sputum 54 (0.7%) had smear positive
PTB. The prevalence of PTB was higher in larger urban prison (1.1%) than in
district prison (0.3%) with p<0.001. (23)

In Ethiopia in 2001 the TB and leprosy control program had registered 94,
957cases of PTB from the DOTS implementing areas, among which 33,028
were new smear positive PTB cases. For the entire country the case notification
rate of all forms were 173 per 100,000 population and new smear positive case
were 60per 100,000population. (24)

Of 16695 adult participants in 2006 in rural district of Ethiopia, 436(2.6%)

were symptomatic for TB and submitted sputum sample for AFB and 13(3%)
were positive for AFB. There were 34 smear positive cases identified through
the existing health care delivery on ant-TB medication at the time of survey.
The ratio of smear positive on treatment to those newly detected by the survey
was 2:1. (25)

A retrospective study conducted about the prevalence of PTB in Agaro Teaching

Health Center from 2005/6-2009/10 for five years shows that prevalence of
smear positive PTB was 10.9% on the other hand the percentage of smear
positive PTB shows gradual decrease from 19.8% in 2005/6 to 5.8% in
2009/10. (26)

Other study conducted in Northeast Ethiopia in 2012 showed that out of 400
participant 30(7.5%) (95% CI: 5.2-10.6%) were found to have PTB. Of these
19(63%) cases were co-infected with HIV. (27)

A study conducted in Eastern Ethiopia prison in 2011 shows that of 371

suspected participant identified by active screening 33(8.9%) were confirmed as
smear and culture positive for PTB. According to this study factors significantly
associated with PTB were young age (15-44), urban residence, having cough for
greater than 4 weeks, sharing cell with TB patients or prisoner with chronic
cough. (28)

8
A study conducted in North Gondar Zone prison in 2012 shows that among
250 participant prisoner 26(10.4%) were found to have PTB. From those
positive for PTB 9(34.6%) were positive for HIV and 12(46.2%) were having
under nutrition. (29)

The study conducted in Seka health center, Jimma, Oromia region, Ethiopia to
determine the prevalence of smear positive PTB in 2010 shows that of 165
requested for AFB, 18(10.62%) were smear positive. According to this study,
habit of drinking raw milk, contact history and occupational status had
significantly associated with prevalence of PTB. (30)

9
 CHAPTER- THREE

OBJECTIVE

3.1. General Objective

- To determine the prevalence of smear positive PTB among presumptive

TB cases attending Shenen Gibe Hospital during the study period.

3.2. Specific Objective

- To determine the magnitude of smear positive PTB

- To determine the socio-demographic characteristic o PTB infected

patients.

-To assess the association between PTB and socio-demographic variable.

-To document a baseline for further study.

10
CHAPTER- FOUR

METHOD AND MATERIALS

4.1. Study Area and Period

This study was conducted in Shenen Gibe Hospital within the time period
of11/08/07-10/09/07E.C. Jimma town which is around 2.5km away from JU
in Oromia Region. It is found at altitude and longitude of 8 039’N and 390 5’E
respectively and elevation between 1788-1825m above sea level.

4.2. Study Design

A cross- sectional study design was conducted on the PTB suspected patients
visiting Shenen Gibe Hospital during the study period.

4.3. Population

4.3.1. Source Population

The source of population for this study was all individual who visit Shenen
Gibe Hospital during the study period.

4.3.2. Study Population

The study population for this study was all suspected patients who were
requested for AFB examination at Shenen Gibe Hospital laboratory during the
study period.

4.4. Sampling Technique

Convenient sampling technique was used. All patients requested for AFB
examination at Shenen Gibe Hospital laboratory during the study period was
included.

4.5. Sample Size Determination

Sample size for this study was calculated by using the formula

11
n= (Z∞/2)2 p (1-p)

d2

p = Prevalence

n=Sample Size

Z∞/2=95% confidence interval

d= degree of margin errors a retrospective study in Agaro Teaching Health

Center from 2005/6 – 2009/10 shows that prevalence (p=10.9%)(26) and

n= (1.96)2 0.109(1-0.109) = 149.2 =150

(0.05)2
Due to10 % margin of error the sample size will be 165.

4.6. Study Variable

4.6.1. Dependent variable

Smear positive PTB

4.6.2. Independent variable

 Family income

 Smoking cigarette

 Drinking alcohol

 Consumption of raw milk

 Housing condition

 Age

 Sex

 Contact history with TB patients

 Occupational status

 Marital status

 HIV test

 Diabetic history

 BMI

12
4.7. Material and Reagent

Materials Reagents

 Sputum cup - 3% acid alcohol

 Glove - Methyl blue

 Gauze - Carbolfuchsin

 Applicator stick - oil immersion

 Pipette - clean water

 Microscopic slide

4.8. Data collection process Plan

Before the actual data collection, pretest was carried out to evaluate the
validity of the format and procedure of the study. Information concerning the
socio-demographic of suspected patients was collected by using structured
questionnaires. Sputum sample was collected by trained technician with great
care. Appropriate sputum sample collection procedure was explained to
patients and the quality of sample was checked before examination. According
to national TB and leprosy control program (NTLCP) manual and procedure
smear was prepared, stained and examined microscopically for AFB.

4.9. Data processing And Analysis

The data was processed manually and analyzed by using available computer
soft ware program (SPSS). Cross tabulation and simple descriptive statics was
used to show the positive rate with independent variable. Based on the result
appropriate interpretation and discussion was made by comparing results with
similar local and international studies. Finally conclusion has been drawn and
possible recommendation was forwarded.

13
4.10. Ethical consideration

A consent letter from Jimma University student research program was sent to
Shenen Gibe Hospital administration.Before starting data collection permission
was obtained from Hospital administration. The purpose of the study was
explained to patients and positive patients were treated in the clinic.

4.11. Quality Assurance

To ensure the reliability and validity of the study result, the following quality
assurance was implemented.

Pre-analytical phase

 Well experienced laboratory personnel were participated in this study

after orientation about the activity to be done.

 Patients were awared how to collect spot-morning –stop +sputum

 Reagents and equipments was checked for reliability and reproducibility

of the test.

Analytical

 Sop was implemented throughout the study time.

Post–analytical

 The result of the test was cheeked before giving to patient.

 The laboratory result was kept properly for rechecking.

 Clear and neat result report has been sent to physician.

CHAPTER –FIVE

14
RESULT

During the study period a total of 165 TB suspected patients were attended
atShenen Gibe Hospital. The overall prevalence of smear positive PTB among
suspected patients in the study area was 10.91(18/165). Among 165 suspected
patients, 84(50.90%) were males and 81(49.10%) were females. This study
indicates that the disease is more prevalent in female patients with the
positivity rate of 14.81%.Age distribution of this study shows that the
prevalence of smear positive PTB is higher in age group of 15-30years
(13.33%(8/60). Sex had no statstical association with the occurrence of PTB
(p>0.05)

Table 1:-Distribution of smear positive PTB by age, sex among suspected

Patients visiting Shenen Gibe Hospital from 11/08/07-10/09/07E.C.

AFB examination Total Association

Sex Positive Negative

No % No % No %

Male 6 7.14 78 92.77 84 50.90 X2=2.736

Female 12 14.81 69 85 81 49.09 Df=2

Total 18 10.90 147 89.09 165 100 P=0.255

Age in year X2=1.534

<15 1 25 3 75 4 2.42 Df=1

15-30 8 13.33 52 86.66 60 36.36 P=0.215

31-45 7 10.60 59 89.39 66 40

>45 2 5.88 32 94.12 34 20.61

Total 18 10.90 147 89.09 165 100

15
During the study period prevalence of PTB was 7.14% (6/84) and % (12/81)
among suspected male and female patients respectively. Occurrence rate of
PTB among age group >45year was 8.33% (4/48) and low prevalence of PTB
below 15 years of age. There was no statistical association between sex and age
in year with the occurrence of PTB (p>0.05)

Marital status and educational status had no stastical association with the
occurrence of PTB (p>0.05). More of suspected patients were married 61.81%
(102/165) and majority of suspected patients had no formal schooling..

Table 2:- Distribution of smear positive PTB by educational status among

suspected patients visiting Shenen Gibe Hospital laboratory from11/08/07-
10/09/07E.C

AFB examination Total Association

Marital status Positive Negative

No % No % No %

Single 6 15.79 32 84.21 38 23.03 X2=0.00

Married 8 7.84 94 92.15 102 61.81 Df=1

Divorced 2 16.66 10 83.33 12 7.27 P=1.00

Widowed 2 15.38 11 84.61 13 7.87

Total 18 10.90 147 89.09 165 100

Educational Status X2=1.793

Illiterate 5 8.77 52 91.12 75 34.54 Df=1

Read and write 5 8.33 55 91.66 60 36.36 P=0.181

Grade 1-8 2 20 8 80 10 6.06

Grade 9-12 3 13.63 19 86.36 22 13.33

Higher education 3 18.75 13 81.25 16 9.69

16
 Total 18 10.90 147 89.09 165 165

Prevalence of smear positive PTB among illiterate and widowed of suspected

patients was 8.77% (5/75) and 15.38% (2/11) respectively. Most of suspected
patients had no formal schooling .Marital status and educational status had no
statically association with the occurrence of PTB (p>0.05)

There was statically association between contact history with TB patients and
occurrence of PTB (p<0.05). Number of rooms was statically associated with the
occurrence of PTB ,and number of windows had no statistical association with
the occurrence of PTB (p>0.05). Majority of suspected patients had 1 rooms
46.66% (77/165) and 1 windows 33.33% (55/165).

Table 3:- Distribution of smear positive PTB by contact history No of rooms, No

of windows among suspected patients visiting Shenen Gibe Hospital laboratory
from11/08/07-10/09/07E.C.

AFB examination

Contact history Positive Negative Total

No % No % No % Association

Yes 5 23.81 16 76.19 21 12.72 X2=3.99

No 13 9.15 129 90.84 142 86.06 Df=1

Total 18 10.90 174 89.09 165 100 P=0.046

No of Rooms X2=3.754

1 12 15.58 65 84.41 77 46.66 Df=1

2 6 7.89 70 92.10 76 46.06 P=0.049

3 0 0 9 100 9 5.45

Total 18 10.90 147 89.09 165 100

No of window X2=1.594

17
1 8 14.54 47 85.45 55 33.33 Df=1

2 5 10.63 47 90.38 52 31.51 0.207

3 5 11.36 39 88.63 44 26.66

4 0 0 13 100 13 7.87

5&above 0 0 1 100 1 0.6

Based on the study previous contact history with TB patients, and number of
Rooms are statically associated with occurrence of PTB. (p<0.05). No of
windows had no statically associated with the occurrence of PTB. (p>0.05).
Prevalence of smear positive PTB among suspected patient who had one
window was 14.54% (8/55)

In this study family size and family income per month had no statistical
association with the occurrence of PTB (p> 0.05). About 73.93%(122/165) of
TB suspected patients come from family size of 1-5 individual per house hold
with positivity rate 12.29% (15/122) and 33.33% (55/165) have family income
of 1000-1500 birr per month with positivity rate 9.09% (5/55 ).

Table 4:- distribution of smear positive PTB by family size and family income
per month among suspected patients visiting Shenen Gibe Hospital laboratory
from 11/08/07-10/09/07E.C.

AFB examination

Family size Positive Negative Total

Association

No % No % No %

1-5 15 12.29 107 87.70 122 73.93 X2=1.303

6-10 3 7.33 38 92.68 41 24.84 Df=2

10+ 0 0 2 100 2 1.21

18
Total 18 10.90 147 89.09 165 100 P=0.521

Family income per month X2=0.130

<500 6 12 44 88 50 30.30 Df=1

500-1000 5 9.09 50 90.90 55 33.33 P=0.719

1001-1500 5 16.66 25 83.33 30 18.18

1500+ 2 6.66 28 93.33 30 18.18

Total 18 10.90 147 89.09 165 100

Number of people in house hold (family size) and family income per month in
birr had no statically associated with the occurrence of PTB (p>0.05).
Prevalence of smear positive PTB among suspected patients who had family
size 1-5 and family income per month < 500 birr was 12.29% (15/122) and
12% (6/50) respectively.

Based on this study cigarette smoking is statistically associated with the

occurrence of PTB (p<0.05) but raw milk and alcohol drinking had no
statistical association with the PTB (p>0.05). Prevalence of smear positive PTB
among suspected patients who had no habit of cigarette smoking and alcohol
drinking was 8.90% (13/146) and 10.85% (14/129) respectively.

Table 5:- Distribution of smear positive PTB by cigarette smoking habit,

drinking alcohol behavior and drinking of raw milk behavior among suspected
patients visiting Shenen Gibe Hospital laboratory from 11/08/07-
10/09/07E.C.

AFB examination

Habit of smoking Positive Negative Total

cigarette
Association

No % No % No %

Yes 5 26.32 14 78.68 19 11.5 X2=5.842

19
 No 13 8.90 133 91.09 146 88.48 Df=1

Total 18 10.90 147 89.09 165 100 P=0.016

Habit of drink alcohol X2=0.009

Yes 4 11.11 32 88.88 36 21.81 Df=1

No 14 10.85 115 89.14 129 78.18 P=0.923

Total 18 10.90 147 89.09 165 100

Habit of drinking raw X2=0.015

milk
Df=1
Yes 11 10.68 92 89.32 103 62.42
P=0.903
No 7 11.29 55 88.71 62 37.57

Total 18 10.90 147 89.09 165 100

Based on the study habit of cigarette smoking is statistically associated with

the occurrence of PTB (p<0.05) but alcohol and habit of raw milk drinking were
not statistically associated with occurrence of PTB (p>0.05), prevalence of
smear positive PTB among suspected patients who had no habit of drinking
alcohol was low (10.85%) (3/129).

As this study indicates, occupational status had no statistical association with

the occurrence of PTB (p>0.05). About 37.78% (41/129) of suspected patients
were farmer with positivity rate 8.97% (7/78).

Table 6:- Distribution of smear positive PTB by occupational status among

suspected paints visiting Shenen Gibe Hospital11/08/07-10/09/07E.C.

AFB examination

Occupational Positive Negative Total

Status Association

20
 No % No % No %

Farmer 7 8.97 71 91.02 78 47.27 X2=0.023

Government employer 5 16.66 25 83.33 30 18.18 Df=1

Student 4 16.66 20 83.33 24 14.14 P=0.881

House wife 2 6.89 27 93.10 29 17.54

Other 0 0 4 100 4 2.42

Total 18 10.90 147 89.09 165 100

The occurrence rate of PTB among suspected house wifes and farmer patients
was 6.89% (2/29) and 8.97% (7/78) respectively. There was no statically
association between occupational status and occurrence of PTB (p>0.05)

Table:-7 distributions of smear positive PTB by diabetic history, BMI and HIV
tests among suspected patients visiting Shenen Gibe Hospital 11/08/07-
10/09/07E.E.

AFB examination

Diabetic history Positive Negative Total

No % No % No % Association

Yes 1 8.33 11 91.66 12 7.27 X2=0.088

No 17 11.11 136 88.88 153 92.72 Df=1

Total 18 10.90 147 89.09 165 100 P=0.766

BMI X2=7.857

Normal 14 9.09 140 90.90 154 93.33 Df=1

Abnormal 4 36.36 7 63.63 11 6.66 P=0.005

Total 18 10.90 147 89.09 165 100

HIV test X2=0.322

Yes 14 11.76 105 88.23 119 72.12 Df=1

No 4 9.52 42 91.3 46 27.88

21
 P=0.571

Total 18 10.90 147 89.09 165 100

Based on the study BMI is statically associated with occurrence of PTB (p<0.05). But diabetic
history and HIV test were not statistically associated with occurrence of PTB (P>0.05).

22
CHAPTER –SIX
DISCUSSION
In this study the overall prevalence of sputum smear positive PTB was 10.91%
(18/165). A retrospective study in Nigeria from 2006-2008 which is 14.7% (21)
and in Ghana Tamate from 2004-2008 which is 13.0% (22), but in Eastern
Ethiopia prison in 2011 which is 8.9% (28) and in North Gonder prison in 2012
which his 10.4% (29). Other similar studies conducted in central India in 2012
which was 2.93% (16), in Brazilian prison in 2005 which was 4.6% (17) and in
Tanzania in 2009 which is 2.3% (19). This discrepancy may be due to the effect
of socio-economic variation, socio-demographic difference, test methodology
and time length which the study conducted.

When we see the age and sex distribution of this study, 84(50.91%) of
suspected patients were males with 6 of them were positive for AFB which is
lower than females 81(49.10%) with 12 of them were positive for AFB. And
66(40%) of suspected patients were in age group 31-45 year with 7 of them
were smear positive and 34 (20.61%) were in age group >45years with 2 of
them were smear positive. The result is in line with other studies conducted in
India in 2009 (16), a retrospective study in France Paris from 2005-2007 (18)
and in Nigeria from 2006-2008 (21).

According to this study out of 165 suspected patients 57(34.54%) had no

formal schooling and 5 of them were smear positive for AFB. This is higher
prevalence relative to literate and this may be due to knowledge variation to TB
disease. Previous contact history with TB patients was significantly associated
with the occurrence of PTB. (p<0.05). This is due to the fact that MTB bacteria
transmit through air and stay as latent infection. This result agree with other
study conducted in eastern Ethiopia prison in 2011 and in Seka Health Center
in 2010 (1,2,28,30).

Even though the result of this study revealed that family size and family
income per month were not statically associated with occurrence fo PTB, the

23
prevalence was higher among those whose family size >1-5 and whose family
income< 500 birr per month. This is why because poverty, malnutrition,
overcrowded living condition etc. considered as a significant associated risk
factor for increment of TB cases in developing countries (7, 9).

The result of this study shows that there was a statistical association between
cigarette smoking with the occurrence of PTB (p<0.05). This is due to the effect
of cigarette smoking on the respiratory organ especially on the lung and
immune system as a whole. This leads to fast development of active PTB.
Prevalence of smear positive PTB among suspected patients who had habit of
drinking raw milk is higher relatively and it is consistent with study conducted
in Seka Health Center in 2010 (8,30).

This study clearly indicates that the prevalence of TB diseases show

progressive decrement and it reveals that the disease is in programming
intervention and disease management. The strength of this study was for all
suspected patients use structured questionnaire for patient information and
instructed them about the correct sample collection process, however the study
had some limitation shortage of time to complete all sample size, absence of
concentration and culture technique to increase sensitivity, absence of
biological safety cabinet all may increase the prevalence.

24
 CHAPTER SEVEN
CONCLUSION AND RECOMMENDATION
7.1. Conclusion

In conclusion the prevalence of smear positive PTB was 10.91% among TB

suspected patients in Shenen Gibe Hospital. This result may increase if other
sensitive method was implemented. The majority of people affected were within
age group 15-30years and had no formal schooling. This related with immune
status and awareness to the TB disease. Cigarette smoking, N o of rooms and
previous contact history with TB patients were the predicting factor for PTB.
Even though the prevalence of the study seems to be decreasing, TB remains
the major public health problem and there is a need to maintain and further
TB control measures on a sustained and long term basis.

 7.2. Recommendation

To tackle the effect of TB disease the respective health authorities, health

workers and governmental bodies should

-Give health education about the character of the disease, mode of

transmission and method of prevention in a continuous manner.

 Create awareness about the effect of associated risk factor such as

cigarette smoking, alcohol drinking

 Initiate further studies to identify clearly the risk factors for PTB and
burden of the disease as well.

25
 ANNEX –TWO

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program, 3rdedi 2005,P 10-14

10 Guidline for prevention of transmission of TB in health care facilities,

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11. WHO, an expanded DOTS farm work for effective tuberculosis

control,2002, p-3

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12. WHO, sixteen global reports on tuberculosis, 2011, www, slide

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15. Jyothi Bhat, VikasGrao, PunnathathwGopalanciopi, ----prevalence

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Prevalence of PTB baseline survey in Central India; PLoS ONE,

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17.SanchezA,Gerhardt G, Natal S,et al Prevalence of PTB and

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18.Lagrage-Xelot M, Porcher R, Gallien S., Wargnir A., Pavie J., deCastro

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19.Esther N., Godfey M., Eluid W., and Odd. MO; Pulmonary

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public health 2009, 3; 9(1): 273.19646288.

20. SC verma, GP Dhungana, Hs Joshi, HB. Kunwar, RkJha,

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Akpokhrel, prevalence of PTB among HIV infected drug user in

Pokhara; Kaski, Nepal, Tuberculosis, lung disease and HIV/AIDS,

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22. S.S.K. Acquah, L, Quaye, J.B. Ziem, E.D. Kuugbee,

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23.Sobaniponi FM, Horries AD, Gausif F, Banda HT: Prevalence of smear

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25.Shargie E.B, Yasin . M.A, Lindtjorn, B; Prevalence of smear positive

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Ethiopia J health sci, March 2012, 22(1): 71-76.

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Immunological profile of HIV co-infection patients in North west

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5-331.

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28. Abebe D.S, Djune G., Ameni. G., Bitta. D., Abebe F.; Prevalence of

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29. Beyene M., Fanaye A., Moges T. et.al Prevalence of smear positive PTB

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73.

ANNEX – THREE

29
 LABORATORY PROCEDURE
6. Smear the appropriate sputum on microscopic slide

7. Allow the smear to air dry

8. Cover the smear with carbolfuchsin (primary stain) and heat the stain
until vapor come out and wait for 5’, do not over heat.

9. Wash off the stain with clean water.

10. Cover the smear with 3% acid alcohol (decolorizer) until the smear
the is sufficiently decolorized for 1 minute

11. Wash off the smear with clean water again.

12. Cover the smear with ethyl blue (counter stain) for 2’

13. Wash of the stain with clean water.

14. Wipe off the back of the slide with tissue paper and allow air dry.

10. Use a drop of oil immersion and examine

ANNEX –FOUR

30
 Patient’s Examination Requested Form

Card No ------------------------------------- Date----------------

Pt Name ------------------------------------ Age ----------------- sex -----------

Reason for examination or request --------------------------------------------

Signature of physicians Name -----------------------

Sign ------------------------

Lab serial No; ----------------------------------

Date specified Appearance Positive Negative

Visual Appearance of Sputum May be

15.Bloody

16.Purulent

17.Muco-purulent

18.Saliva

Signature of lab personnel Name -------------------

Sign --------------------

Date --------------------

31
 ANNEX –FIVE

QUESTIONNAIRE

JIMMA UNIVERSITY

College of public health and medical science department of medical

laboratory science and pathology, questionnaire for study of prevalence of
PTB among patients atShenen Gibe Hospital.

Instruction: - fill the blank space with appropriate words and mark (x)

accordingly.

ID- No __________________ Age __________ Sex __________

1.Marital status

A,SingleB married C. Divorced D widowed

2 Educational status

A Illiterate B Read and write C 1-8 grade D 9-12 grade

E Higher education

3 Occupational status

A Farmer B Student C House wife D Government employee E, Other (specify)

4 Family income how much is your family income per month in birr?

A 500 B 501-1000 C 1001-1500 D 1500+

5. Life style

5.1 Family size A 1-5 B 6-10 C 10+

5.2 No of room A.1 B.2 C.3 D.4 E.5& above

6. No of window A.1 B.2 C.3 D.4 E.5& above

32
7. Have you ever been contact history with people who have PTB

A. YesB. No

7.1 If yes how long? A, for a day B, a week C, a month D, above

8. Have you ever drink alcohol? A, Yes B, No

8.1 If Yes how long? A, every day B, per week C, per month

9. Have you ever smoke cigarette? A, Yes B, No

9.1. If Yes how long? A, Every day B, per week C, per month

10. Have you ever drink raw milk? A, Yes B, No

10.1If Yes how long? A, Every day B, per week C, per month

11. Were you tested for HIV? A. yes B. No

12. Are you diabetic? A. yes B. No

13. BMI____________? A. normal B. bnormal

33