Quality Of Care And Associated Factors Among Patients With Multi-Drug Resistant Tuberculosis Receving Treatment In Alert Hospital Addis Ababa,Ethiopia, 2020

Quality Of Care And Associated Factors Among Patients With Multi-Drug Resistant Tuberculosis Receving Treatment In Alert Hospital Addis Ababa,Ethiopia, 2020 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quality Of Care And Associated Factors Among Patients With Multi-Drug Resistant Tuberculosis Receving Treatment In Alert Hospital Addis Ababa,Ethiopia, 2020 Kemal Ahmed Hasen, Abigiya Zewde Biru, Dube Jara Boneya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8367521/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Multi-drug resistant tuberculosis (MDR-TB) remains a critical public health challenge worldwide and in Ethiopia, where treatment success largely depends on the quality of care. Assessing the quality of MDR-TB services and identifying associated factors is vital for improving treatment outcomes and controlling transmission. Objective To assess the quality of MDR-TB care and associated factors among patients receiving treatment at ALERT Hospital, Addis Ababa, Ethiopia, in 2020. Methods An institution-based cross-sectional study was conducted among 294 MDR-TB patients selected using systematic random sampling. Data were collected through structured questionnaires and patient records. Descriptive statistics were used to summarize socio-demographic characteristics, knowledge, and care-related variables. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with quality of care at a 95% confidence level. Results Of 294 respondents (96% response rate), the majority were female (72.8%) and aged 51–68 years (29.9%). Knowledge about MDR-TB was generally low; only 20.1% knew its meaning, and 19.4% recognized it as a curable disease. Most respondents (64.8%) reported not being informed about drug side effects, 68.0% were not told about sputum test requirements, and 73.1% were unaware of treatment duration. Shortages of drugs and laboratory reagents were reported by 80.4%, and MDR-TB treatment cards were often partially (49.8%) or not filled (34.7%). Adherence to directly observed treatment (DOT) was poor, with transportation (51.8%) and stigma (26.9%) cited as major barriers. In multivariable analysis, male patients were more likely to receive quality care [AOR = 2.06; 95% CI: 1.29–3.29], while screening at inpatient units was significantly associated with reduced likelihood of receiving quality care [AOR = 0.53; 95% CI: 0.33–0.84]. Conclusion The study revealed suboptimal quality of MDR-TB care characterized by poor patient knowledge, inadequate provider–patient communication, frequent drug shortages, and incomplete patient records. Improving patient education, strengthening provider communication, ensuring uninterrupted drug and reagent supply, and adopting patient-centered approaches are essential to enhance MDR-TB care and treatment outcomes. Figures Figure 1 Figure 2 1. INTRODUCTION 1.1Background A kind of tuberculosis infection known as multi-drug-resistant tuberculosis (MDR-TB) is brought on by bacteria that are resistant to at least two of the most potent first-line anti-TB treatments, isoniazid and rifampin. Extensively drug-resistant tuberculosis (XDR-TB) is a kind of tuberculosis that is resistant to line drugs [ 1 ]. Every year, millions of people suffer from tuberculosis (TB), which remains a major global health concern. Every year, tuberculosis (TB) affects the health of over 10.4 million people globally, leading to about 1.8 million TB-related fatalities, with resource-constrained nations accounting for 95% of these deaths [1]. When compared to new TB cases, the frequency of MDR-TB is significant in Sub-Saharan nations, particularly among previously treated TB individuals [ 2 ]. Every year, there are about 500,000 instances of multidrug resistant tuberculosis (MDR-TB) [3], 3% of these cases are treated, and MDR-TB causes over 100,000 fatalities. Furthermore, extensively drug-resistant (XDR) MDR-TB infections accounted for up to 10% of cases [4]. MDR-TB is characterized by resistance to both isoniazid and rifampicin; MDR-TB with added resistance to any fluoroquinolone and at least one of the three second-line injectable medications—amikacin, capreomycin, and kanamycin—is known as XDR [ 5 ]. Ethiopia was listed as one of the thirty countries with the highest TB burden (TB, TB/HIV, and MDR-TB) in a recent World Health Organization (WHO) study of high TB-related burden countries. TB is still one of Ethiopia's top causes of death. The 2017 WHO study said that the prevalence of MDR-TB in Ethiopia was 2.7% among newly diagnosed cases and 14% among those that had already received treatment, while the prevalence of TB/HIV co-infection was estimated to be 8% of the afflicted population [6]. Furthermore, a number of Ethiopian investigations revealed that the prevalence of MDR-TB was 31.4% in Jimma [7], 28% in Addis Ababa [8], 46.3% in Addis Ababa [9], and 5% in Northwest Ethiopia [ 10 ]. Rapid MDR-TB transmission is a serious global public health issue, particularly for nations with limited resources, and it poses a significant obstacle to TB control initiatives. Furthermore, the sub-Saharan region, including Ethiopia, has been unable to effectively control MDR-TB due to a number of linked variables, including high TB prevalence, inadequate treatment, and restricted access to healthcare [11]. Lastly, the quick spread of XDR-TB has lately surfaced as an additional difficulty for TB control initiatives [ 12 ]. 1.2. Statement of the problem The advent of extremely drug-resistant TB further hampers efforts to address the issue, particularly in developing nations like Ethiopia. MDR-TB is a man-made disease caused by inadequate anti-TB treatment. One of Ethiopia's biggest problems is diagnosing and treating MDR-TB. One of the most common infectious diseases nowadays is MDR-TB. MDR TB affects about one-third of the world's population, with developing nations accounting for the majority of these infections [1]. Ethiopia was placed 15th out of 27 high-burden MDR-TB countries in the 2014 World Health Organization (WHO) TB report, with an estimated MDR rate of 1.6% (0.9%–2.8%) for new cases and 12 (5.6%–21%) for retreatment cases [5]. The majority of MDR-TB cases are the consequence of human error, which can be caused by a single or a combination of factors related to drug supply management, inappropriate guidelines, poor adherence, poor infection control practices, poor storage conditions, incorrect dosage or combination, poor organization, lack of information, lack of treatment monitoring, and inadequate DOTS strategy implementation. The management of MDR-TB will be an integrated part of the NTP, organized by all health professionals, cognizant of the community's MDR-TB transmission, and executed through the current health care delivery system. Treatment adherence increases the likelihood of a successful cure for MDR TB. It is anticipated that in order to successfully treat tuberculosis, the patient will need to take anti-tuberculosis medications for several months. Multidrug resistant tuberculosis (MDR) cases, high mortality rates, and high treatment costs are all consequences of non-adherence to tuberculosis treatment. These raise the burden of tuberculosis on the country, its allies, and local communities. Numerous studies have been conducted to determine what elements affect non-adherence in different contexts. Cultural customs, lifestyle, and economic status are just a few of the variables that might vary based on certain population contexts and their characteristics. Assessment of MDR-TB is particularly important for the research area because, in addition to the gaps in TB and MDR-TB detection and treatment in developing nations, Addis Ababa is a densely populated location with a large influx of people from neighboring regions as well as within the region. Because the city is one of the channels for illicit and subpar anti-TB contraband drugs, it is also susceptible to counterfeit anti-TB medications. Therefore, the purpose of this study is to evaluate the prevalence and potential risk factors for MDR-TB, which is crucial for treating and preventing both TB and MDR-TB. 2. Literature review The literature review considers both conceptual and empirical studies in order to obtain existing information on the proposed research. The main aspects in this chapter are treatment of multidrug resistant tuberculosis, its prevalence, treatment regimen and factors resulting in quality of health care. The aim of literature review is to prepare a summary on existing literature and to contribute towards study in this area. The general idea from the past literature suggests that there is shortcoming in the quality of TB care provided to patients infected with multidrug resistant tuberculosis. Data demonstrate frequent delays in the diagnosis of MDR/RR-TB and globally less than one quarter of the estimated MDR/RR-TB patients are detected and reported to national surveillance systems (WHO, 2016). Empirical management of TB without drug susceptibility testing (DST), inappropriate drug regimens, and insufficient attention to concurrent social support for patients to facilitate treatment completion are major drivers of DR-TB. There have been no systematic reviews on the quality of care provided to patients infected with DR-TB, and critical gaps in service delivery among studies involving patients with DR-TB have been reported. Satyanarayanaet al. (2015) found one study that “examined quality of care for DR-TB, which identified that only 39% of healthcare providers reported conducting DST for eligible TB cases” Moreover, using simulated patients, Das et al. (2015) found that that even among qualified, trained doctors in India, a DST was rarely ordered for a simulated patient with classic TB symptoms and a clear history of previous, incomplete therapy. Quality TB care is patient-centric care that is consistent with international standards, delivered in an accessible, timely, safe, effective, efficient and equitable manner. Questionnaire shall be designed in order to understand disease, quality of care and quality of life among multidrug resistant tuberculosis patients and will be administered at health centers in Addis Ababa. Drug-resistant strains of Mycobacterium tuberculosis (MTB) arise from spontaneous chromosomal mutations at a predictable low frequency, but a study done by Gandhetal. revealed that selection pressure that is caused by inappropriate utilize of anti-TB drugs results in the emerging of resistant MTB. Similarly, a study done in Ethiopia identified long treatment, poor treatment follow up & interruption of treatment were identified as risk factors for significant increases in MDR-TB. Other studies done in Ethiopia and China also revealed that HIV infection, cigarette smoking, and alcohol drinking, overpopulated, and weak DOTS (Directly Observed Treatment Short-course) program were the major risk factors for spread of MDR-TB infection. 2.1. Prevalence of Multidrug Resistant Tuberculosis One of the top ten causes of death globally, tuberculosis continues to be a significant source of illness. An estimated 10.0 million (range: 9.0–11.1 million) people worldwide have tuberculosis (TB) in 2018; this figure has been comparatively steady in recent years. With an average of about 130 new cases per 100,000 people annually, the burden of disease varies greatly between nations, ranging from less than five to more than 500. In 2018, there were an estimated 1.2 million (range: 1.1–1.3 million) TB fatalities among HIV-negative individuals (a 27% decrease from 1.7 million in 2000), and an additional 251,000 deaths (range: 223,000–281,000) among HIV-positive individuals (a 60% decrease from 620,000 in 2000). All age groups are affected by tuberculosis (TB), although men (≥ 15 years old) bear the brunt of the disease, accounting for 57% of all cases in 2018. In contrast, women made up 32% and children under the age of 15 made up 11%. People living with HIV (PLHIV) accounted for 8.6% of all TB cases (WHO, 2019). Geographically, the WHO areas of South-East Asia (44%), Africa (24%), and the Western Pacific (18%) accounted for the majority of TB cases in 2018. The Eastern Mediterranean (8%), the Americas (3%), and Europe (3%) had lower numbers. India (27%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria (4%), Bangladesh (4%), and South Africa (3%) were the eight nations that made up two thirds of the global total. 87% of cases worldwide were found in these and 22 other nations on the WHO's list of 30 high TB burden countries (WHO, 2019). According to a study done in Tigrai Regain Axum Town, the prevalence of MDR-TB was 37/200 (18.5%). However, the prevalence of MDR-TB/RMP resistance was 7 (3.5%) when RMP mono-resistance (RMP-MR) was taken into account as a proxy indicator for MDR-TB. In descending order, the percentages of MDR-TB cases in each zone were as follows: Western (31%), Southern (22.6%), Eastern (20%), Northwest (19.4%), Central (13.9%), Southeast (13.3%), and Mekelle Zone (0%)Factors Linked to the Occurrence of MDR-TBAge was statistically linked to MDR-TB after controlling for possible confounding variables (AOR: 1.06, 95%CI 1.00–1.11). However, there was no correlation found between the incidence of MDR-TB and sex, site of residence, educational status, having a windowed home, family size, income, alcohol consumption, cigarette smoking, or incarceration. Patients and their loved ones should be given a detailed explanation of the study conducted in the Philippines regarding the rationale for extended treatment and the consequences of treatment interruptions. Before beginning treatment, it is also essential to inform patients about anticipated side effects. Patients may be deterred from seeing traditional healers by patient education that dispels prevalent misconceptions regarding tuberculosis, preventing a delayed diagnosis and course of treatment (26). Compared to control patients, case patients had significantly higher rates of alcohol misuse documented in their medical records. Numerous studies have shown a link between alcohol abuse or alcohol use disorders and loss to follow-up during MDRTB treatment (13–15, 27); one small randomized clinical trial showed better TB outcomes for patients in groups randomly assigned to receive behavioral counseling or naltrexone integrated into TB care (28). This conclusion, along with similar findings from other studies, necessitates further research to evaluate the impact of managing alcohol use as part of TB clinical treatment and screening for alcohol dependency using standard assessment techniques. 2.2. Quality of care of MDR-TB patients "Fitness for use" is the definition of quality. Organizational excellence is the outcome of an organization's application of the quality principle. The four fundamental tenets of quality management at a healthcare facility are: doing the right thing the first time and every time, continual improvement, listening to patient concerns, and teamwork among all healthcare personnel. The idea and set of guiding principles that serve as the cornerstone for the organization's ongoing improvement is quality of care. All procedures aimed at meeting the demands of MDR-TB patients are referred to as quality of care. Drug-resistant tuberculosis (DR-TB) is one of the major infections contributing to the worldwide health problem caused by antibiotic resistance. [1] . Poor quality care is widespread in the field, despite the fact that inadequate access to diagnosis and treatment for DR-TB remains a major challenge—only 160,684 of the 558,000 people predicted to become ill with DR-TB each year were identified, and only 139,114 (25%) of them began treatment [2]. In the field of DR-TB treatment, this is evident not only in the 65% treatment success rate worldwide but also in other subtle ways [3]. Safety, equity, and efficacy are all quality dimensions; patient centeredness is a phrase that has recently entered the TB field's lexicon [4], if not its real practices. [5] Where DR-TB has to be improved immediately. However, for a variety of reasons, including the fact that measures of successful therapy are mostly focused on bacteriologic outcomes, little is known regarding quality in the routine management of DR-TB [6].Serious issues with the diagnosis and treatment of DR-TB are highlighted by three recent "cascade" reviews [7], [8], and [9]. However, there is little literature that reports systematic evaluations of the quality of DR-TB treatment. In actuality, the treatment of DR-TB in settings with limited resources has just been recognized as an essential and practical approach during the past 20 years [10] . Previous efforts to control tuberculosis concentrated on preventing drug-susceptible TB patients from developing resistance while undergoing treatment [11], ignoring the fact that the majority of drug-resistant tuberculosis (DR-TB) is transmitted through primary transmission [12], and placing the blame squarely on those who have TB. There is still a propensity to blame those who have the illness for their potentially fatal situation [13] , and this may be one of the reasons DR-TB quality of care has received so little research. The limited studies that have been conducted on MDR-TB and quality demonstrate that people who contract DR-TB have a terrible experience; one study participant summed it up by saying, "I cry every day" [14]. Studies on the quality of life of people with DR-TB become crucial in the lack of official quality of care evaluations [15]. People with DR-TB had poor quality of life assessments, particularly in the physical and psychological areas, according to a recent mixed-methods study conducted in India [16] . Similar poor quality experiences for individuals with DR-TB have been documented in other qualitative investigations [17], [18], [19], and [20]. These experiences include low engagement in care, paternalistic attitudes of TB physicians, and staffing shortages or absences that significantly jeopardize DR-TB services. Many factors influence how people with DR-TB perceive the quality of their care [21]. Some of these, such as pill burden, frequent use of injectable medicines, adverse events, and a long course of therapy, can be linked to the treatment regimens themselves [22] . DR-TB treatment is quite difficult. The regimens administered to patients with DR-TB are complicated, with a global "success rate" of about 65% [23]. Five to seven different medications are administered over a period of nine to twenty-four months in the most popular regimens [24]. The most problematic of these agents is the daily injection that, until recently, was the mainstay of most DR-TB regimens, despite the fact that there is little scientific evidence to support the use of this class of medications and that up to one in three recipients experience permanent hearing loss [25] . Only one of these medications (amikacin) should be used when there are no other treatment options and only if there is proven susceptibility to it and formal hearing assessments can be performed, according to a recent update to the WHO's guidelines regarding the routine use of injectable agents [26]. Despite this, a lot of programs are still using these drugs and do not intend to phase them out of treatment plans anytime soon, partly due to their low cost. While the harm caused by injectable pharmaceuticals has received a lot of attention, oral medications used to treat DR-TB can provide poor quality experiences for those who have the illness. 2.3. Health Related Quality of life of MDR-TB patients The result of providing patients with MDR-TB with high-quality care is their health-related quality of life (HRQoL). According to Leidy et al. (1999) and Dion et al. (2004), HRQoL is "the extent to which a disease and its treatment(s) affect a patient's subjective perception of physical, mental, and social wellbeing on a daily basis." In addition to their physical health, patients with chronic illnesses place a great priority on their emotional and social well-being (Sherbourne et al., 1999). The idea of evaluating health status beyond traditional indicators, such mortality and morbidity, has expanded the importance of monitoring HRQoL (WHO, 2013). The impact of illnesses and related morbidities on daily activities and functions is measured by HRQoL. Because of this, HRQoL evaluation has emerged as a critical health outcome and a topic of interest for researchers, policy makers, and medical professionals. To determine the best course of action for enhancing the health and quality of life of TB patients, an HRQoL evaluation is essential (Chamla, 2004). "There is a dearth of literature about anti-TB drug-induced mortality, morbidity, and loss in quality of life, particularly in low-resource settings," according to a 2015 WHO progress report on MDR-TB treatment (WHO, 2011). The current study assesses the etiology, prevalence, transmission, and standard of care of patients with multidrug-resistant tuberculosis in Addis Ababa, Ethiopia's health facilities. Therefore, this study will assist close the gap in reported outcomes among MDR-TB patients and give much-needed information about the quality of care, the impact of MDR-TB therapy, and the health-related quality of life of MDR-TB patients. 2.4 Conceptual framework Figure 1Conceptual framework 2.5significance of the study Assessment of the incidence and prevalence of MDR-TB is an important program indicator, as it adds knowledge to the existing TB Challenge Programme. It is essential to reach practical recommendations to improve the quality of services and enhance outcomes for MDR-TB patients, thereby reducing mortality and morbidity. The findings of this study can serve as evidence for governmental and non-governmental organizations working in the area of MDR-TB, particularly in TB activities at national, regional, and district levels, by providing basic information on factors influencing DOTS. These results will alert planners and program managers to design appropriate intervention strategies that contribute to the reduction of MDR-TB and improve the health status of vulnerable populations. Furthermore, this study provides baseline data that can be used by program implementers and researchers for future planning and investigations. 3. OBJECTIVES 3.1. General objective To assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia 3.2. Specific objectives To determine the level of quality of MDR TB care among multi-drug resistance in health facilities in Addis Ababa, Ethiopia To identify factors associated with quality of MDR TB care among multi-drug resistance tuberculosis patients in health facilities in Addis Ababa, Ethiopia. 4. Material and methods 4.1 Study area and Study period The study was conducted in Addis Ababa City Administration, Ethiopia, from March 1 to May 30, 2020, at a government hospital. Addis Ababa, the capital city of Ethiopia, covers an area of approximately 526.99 km² and, according to the 2017 census, has a total population of 4,687,593. The city is administratively divided into 10 sub-cities and 99 woredas. Among these, KolfeKeranio, Yeka, and Nifas Silk-Lafto are the most densely populated sub-cities. Addis Ababa is ethnically diverse, representing the majority of Ethiopia’s ethnic groups due to its status as the national capital. Religiously, Ethiopian Orthodox Christianity is the dominant faith, accounting for 74.7% of the population, followed by Islam (16.2%), Protestant Christianity (7.77%), and Catholicism (0.48%). According to the Ministry of Health 2017 report, the city hosts six hospitals, 92 health centers, and 750 private clinics under federal administration, along with 30 additional hospitals managed by other authorities (excluding police and armed forces facilities). Certain hospitals and health centers provide MDR-TB DOTS and serve as designated testing sites. Among these, ALERT Hospital is one of the established MDR-TB treatment centers. The ALERT MDR-TB Center was founded in March 2011 (Gregorian calendar) under the ALERT Center, which is a federal hospital and training institution supported by the USAID Challenge TB Project. The unit has expanded its services to include the management of patients with pre-extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB). The MDR-TB unit is staffed by one internist, three general practitioners, one pharmacy professional, seven nurses, one phlebotomist, two cleaners, one social worker, one IT service provider, and one runner. As of March 2017 (Ethiopian calendar), a total of 416 patients had ever been enrolled in the ALERT MDR-TB program. Of these, 109 patients were on active follow-up, 144 had completed treatment, 88 were cured, 24 were lost to follow-up, 41 had died, 4 experienced treatment failure, 6 were transferred out, and 14 were transferred in. The overall treatment success rate was estimated at 75.6%. 4.2 study design Cross-sectional study was conducted using quantitative data collection. 4.3 Study population The source population consisted of infectious cases of multidrug-resistant pulmonary tuberculosis in the Addis Ababa region. The study population included all smear-positive multidrug-resistant pulmonary tuberculosis cases who visited the outpatient departments of the study centers between March and August 2020. The study subjects were recruited from two groups of patients: smear-positive multidrug-resistant tuberculosis patients with no previous exposure to MDR-TB, and smear-positive MDR-TB patients with more than one month of exposure to MDR-TB. Smear-positive TB patients with no previous exposure to tuberculosis drugs were classified as new cases (not exposed to MDR-TB), while those with previous exposure to MDR-TB treatment for at least one month were classified as the re-treatment group. The re-treatment group comprised defaulters, treatment failures, relapses, and/or chronic cases. 4.4 Inclusion All smear positive cases with no previous treatment for multidrug resistance tuberculosis or with previous treatment for tuberculosis for at least one month were included. Smear positive cases who declined to participate in the study, 4.5 Exclusion criteria Patients Who received anti-TB treatment but for less than onemonth, all smear negative cases, patients with extra-pulmonary tuberculosis and patient who doesn’t hear or deaf patient were excluded from the study. 4.6Source and type of data The study utilized both primary and secondary data sources. Primary data were collected from healthcare professionals involved in the treatment of MDR-TB, patients diagnosed with MDR-TB, their relatives, and community members residing in Addis Ababa. Data collection was carried out through one-to-one discussions with respondents. Secondary data were obtained through an extensive review of published and unpublished literature, workshop proceedings, relevant national policies, development strategies, and academic journals aligned with the study objectives. 4.7Sampling technique and sample size 4.7.1. Sample size Determination The required sample size was determined using the single population proportion formula: Proportion (p): proportion of multi-drug resistance TB used in Tigrai region, Axum town 18%, 2019 Level of confidence = 95% Level of significance = 5% Margin of error (d) = 5% n-The minimum sample size required p- Estimated proportion of MDR TB d- Margin of error Z (α/2) 2 = Standard normal value at (1 –α/2) Sample size (n) = (1.96) 2 * 0.18(1–0.18)/ (0.05) 2 Sample size = 226.8 By considering non-response rate of 10% 206.4*10%=22 Finally, the total sample size (n) was 227 + 22 = 249. The required sample size for the second objective was determined using the double population proportion formula with Epi Info version 7.2.2.6 StatCalc software, as presented below. Factors that showed significant association with the corresponding odds ratio in previous studies were selected to calculate the sample size. As summarized in Table 1 . Table 1 sample size determination for specific objective two Factors CI Power (1-β) Ratio The proportion of outcome among exposed The proportion of outcome among unexposed OR Sample size N N + Non-response rate (10%) Poor Quality care 95 80 1 25 49.2 2.9 140 154 Adverse event 95 80 1 80 94.1 4 90 99 Treatment success 95 80 1 65 77.5 1.9 412 454 For the second objective , the required sample size was calculated using the double population proportion formula with the StatCalc program of Epi Info version 7. Factors associated with the quality of MDR-TB care among multidrug-resistant tuberculosis patients were used, with a 95% confidence interval, 80% power, and a 1:1 ratio of the two populations. Adjusted odds ratios from previous studies were applied, and a 10% non-response rate was included. Based on a treatment success rate of 65% (AOR = 1.9) and adding 10% for non-response, the required sample size was 454. Finally, the largest sample size of 454 was used, as it was sufficient to cover the sample size needed for all study objectives. Finally the largest sample size will be used 454 because of it can encompass the sample size needed for all objectives. 4.7.2. Sampling technique The research shall employ simple random sampling technique among stakeholders at various healthcarefacilities in Alert Hospital Addis Ababa. The target sample for the study include healthcare providers, patients infected with MDR-TB, relatives of MDR-TB patients, community members living in Addis Ababa and its periphery. 4.8. Study Variables 4.8.1 Dependent variable Quality of MDR-TB care and service 4.8.2Independent variables Age Gender Education Healthcare facility Socioeconomic background Type of disease (MDR-TB) Effectiveness of treatment Efficiency of treatment Treatment accessible to the patient Safety of the treatment Treatment available to the patient on time Compliance Tolerance Equitable treatment to all patients Consistently high quality of anti-TB medications Method of treatment (Processes) consistent with international standards (including lab & diagnosis) 4.9. Data Collection Tools Data were collected using structured, interviewer-administered questionnaires. The questionnaires were initially developed in English and then translated into local languages (Amharic and Afaan Oromo). Three sets of questionnaires were prepared: one for MDR-TB patients, another for community members and relatives of patients, and a third for healthcare professionals. All questionnaires were pre-tested for reliability and validity, with Cronbach’s alpha greater than 0.70 considered acceptable. The questionnaires included both closed-ended and open-ended questions to capture quantitative data. They were divided into two sections: the first section collected socio-demographic characteristics of respondents, while the second section included detailed questions related to clinical outcomes, quality of care, health-related quality of life, perceptions, attitudes, and beliefs among MDR-TB patients, their relatives, and the community. Responses for Likert-scale questions were measured on a five-point scale ranging from strongly disagree (1) to strongly agree (5) to assess degrees of attitudes and opinions. In addition, semi-structured interviews were conducted with selected key informants to obtain more in-depth information. During these interviews, researchers probed further by asking related questions for clarification and elaboration. 4.10. Data collection procedures Data were collected using structured questionnaires and review checklists through document review and face-to-face interviews. Information was obtained from healthcare providers, MDR-TB patients, and relatives of MDR-TB patients. Primary data were collected directly from healthcare professionals providing treatment to MDR-TB patients, as well as from patients infected with MDR-TB and their relatives. The data collection team consisted of two BSc nurses, one clinical nurse, and one diploma-level porter. 4.11. Data Quality Control To ensure data quality, the questionnaire was translated into local languages (Amharic and Afaan Oromo). A pre-test was conducted on 5% of the sample outside the actual study area, and necessary corrections were made to the questionnaire based on the results of the pre-test data analysis. The principal investigator provided training to the data collectors on the study objectives, data collection methods, and ethical considerations during data collection. Data collectors were also familiarized with the data collection tools. Supervision was conducted by the principal investigator to check the completeness and consistency of the collected information, and timely corrections were made as needed. 4.12. Data Processing and Analysis Data were entered into Epi Info version 7 and exported to SPSS version 20 for processing and analysis. Descriptive statistics were computed to summarize the characteristics of the study participants. A logistic regression model was fitted to identify associations between independent and dependent variables. Both crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Independent variables that showed an association with the dependent variable at a p-value less than 0.2 in the bivariate analysis were included in the initial multivariable logistic regression model. Variables with a p-value less than 0.05 were considered statistically significant. Model fitness was assessed using the Hosmer-Lemeshow chi-square test, and multicollinearity was evaluated using collinearity diagnostic statistics, including the correlation matrix, variance inflation factor (VIF), and tolerance test. Results were presented in text, tables, graphs, and charts, depending on the type of data. 4.13. Ethical Consideration Ethical approval was obtained from the Research and Ethical Review Board of the Department of Public Health, Rift Valley University, Abichu Campus. Official permission letters were obtained from the Addis Ababa Health Office and the respective public health facilities. The purpose and importance of the study were explained to all participants, and written informed consent was obtained prior to data collection. Participation was voluntary, and participants were informed of their right to refuse or withdraw at any time without consequences. Confidentiality of the information was maintained throughout the study. 4.14. Dissemination of Finding The finding of this study will be submitted to Rift Valley University Abichu Campus department of public health, by hard and softcopy. Besides the document will be given for organizations likeAddis Ababa Health Office and Addis Ababacity of Public Health facility. Publication will be attempted and presented in different seminars, meetings, conferences and workshops. 5 Result 5.1. Socio-Demographic Characteristics of the respondents Two hundred ninety four respondents returned completely filled questionnaires, which gave a response rate of 96 percentages. Majority of respondent are female 318 (72.8).The mean age of the study participants was 55 years, the majority respondent age are less than 68 317(72.5%). Among the respondents, 319 (72.8%) single 91(20.7%) married, and 27 (6.2%) Separated and widowed. The mean monthly income for the respondents was 1-500 Eth birr. The detailed socio-demographic characteristics of the respondents are presented in Table 2 . Table 2 Socio-Demographic Characteristics of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia. Characteristics Frequency Percentage Sex Male 119 27.2 Female 318 72.8 Age 87 45 10.3 Religion Muslim 257 58.7 Orthodox 87 19.9 Protestant 84 19.2 Catholic 9 2.1 Ethnicity Oromo 199 45.4 Amhara 179 40.9 Tigrie 42 9.6 Guragei 6 1.4 Welayita 9 2.1 Other 2 0.5 Marital Statues Single 319 72.8 Married 91 20.8 Separated and widowed 27 6.2 Number of child NO 266 60.7 1–5 151 34.5 > 6 20 4.6 Monthly income No income 39 8.9 1-500birr 343 78.5 501-1000birr 17 3.9 1001–3000 16 3.7 > 3000 22 5 Occupation Unemployed and student 11 2.5 Civil servant 124 28.3 Daily laborer 51 11.6 Pensioned 31 7.1 Merchant 16 3.7 Farmer 85 19.4 Other 119 27.2 5.2: Knowledge about MDR TB Two hundred and five (46.9%) of the study participants said they didn’t know the meaning of MDR TB of which 143(32.7%) said I don’t know. Whereas 88 (20.1%) responded they know about meaning of MDR TB. Majority of respondent they didn’t know MDR TB transmitted by sneezing and coughing 377(86.1%). Majority of respondent they didn’t know MDR TB curable disease 352(82.4%). The detailed knowledge-related responses are presented in Table 3 . Table 3 Knowledge about MDR TB of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia. Characteristics Frequency Percentage Do you know the meaning of MDR TB Yes 88 20.1 No 205 46.9 I don’t know 143 32.7 Could MDR TB come from cold Yes 59 13.5 No 230 52.5 I don’t know 148 33.8 Could MDR TB transmitted by sneezing and coughing Yes 60 13.7 No 233 53.2 I don’t know 144 32.9 Is that MDR TB curable disease Yes 85 19.4 No 208 47.5 I don’t know 144 32.9 Do you smoke cigarette Yes 248 56.8 No 189 43.2 Do you drinking alcohol Yes 243 55.6 No 194 44.4 Do MDR TB transmit from over crowding Yes 62 14.2 No 212 48.4 I don’t know 163 37.3 Do one acquire by drinking dirty water Yes 76 17.4 No 234 53.4 I don’t know 127 29 A person can get MDR TB by Germs Yes 70 16 No 238 54.3 I don’t know 129 29.5 A person can get TB by shearing Injections Yes 79 18 No 199 45.4 I don’t know 159 36.3 Is that possible to prevent MDR TB Yes 70 16 No 229 52.3 I don’t know 138 31.5 Is TB curable disease Yes 65 14.8 No 209 47.7 I don’t know 163 37.2 5.3 .Knowledge about quality of care When asked about whether they feel that good quality care when you came 51(11.6%) said very much, two hundred respondent (47.5%)same what and one hundred twenty six (28.8) not sure. Majority of respondent 284(64.8%) side health providers didn’t tell them about the side effects of MDR TB drugs. The detailed responses regarding knowledge and perceptions about the quality of care are presented in Table 4 . Table 4 Knowledge about quality of care of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia. Characteristics Frequency Percentage Do you feel that good quality care when you came very much 51 11.6 some what 208 47.5 not sure 126 28.8 Little 52 11.9 Do you feel something good when you see MDR TB patients very much 51 11.6 some what 206 47.0 not sure 125 28.5 Little 55 12.6 Do you hate patients because of their illness very much 51 11.6 some what 216 49.3 not sure 121 27.6 Little 49 11.2 Are you afraid of MDR TB patients because of their illness very much 51 11.6 some what 219 50.0 not sure 122 27.9 Little 45 10.3 If relative of yours become ill with MDR TB would you be willing to care Yes 70 16.0 No 367 84.0 If you found that had tb would you tell to others Yes 183 41.9 No 254 58.1 Do the health providers in this facility tell you about the side effects of MDR TB drugs? Yes 153 34.9 No 284 64.8 Do the health providers in this facility tell you about the need for sputum tests at given points during your treatment schedule? Yes 139 31.7 No 298 68.0 Do the health providers in this facility tell you about the duration of the MDR TB treatment? Yes 117 26.7 No 320 73.1 5.4. Supply or quality of drugs/laboratory reagents Three hundred respondent fifty tow (80.4%) encounter shortage of drugs and lab reagent. Majority of respondent mentioned MDR TB treatment card are partially filled 218(49.8%) and followed by not filled which is 152(34.7%). Detailed information on drug supply, laboratory reagents, and documentation practices is presented in Table 5 . Table 5 Supply or quality of drugs/laboratory reagents of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia. Characteristics Frequency Percentage Where did you gate drugs and laboratory reagent Government 437 99.8 How you encounter shortage of drugs and lab reagent Yes 352 80.4 No 85 19.4 How do you assure quality of Anti TB drugs Patient cure 224 51.1 looking expire date 213 48.6 How do you assure quality of laboratory reagents pt cure 224 51.1 looking expedite 213 48.6 MDR TB treatment card form completely filled 67 15.3 partially filled 218 49.8 not filled 152 34.7 MDR TB register completely filled 104 23.8 partially filled 205 46.8 not filled 128 29.2 Request for sputum examination completely filled 62 14.2 partially filled 214 48.9 not filled 161 36.8 Laboratory register for culture DST filled completely filled 54 12.3 partially filled 220 50.2 not filled 163 37.2 Quarterly report on MDR TB case finding completely filled 59 13.5 partially filled 216 49.3 not filled 162 37.0 Quarterly report on MDR TB case enrolment completely filled 59 13.5 partially filled 214 48.9 not filled 164 37.4 5.5. Adherence of TB patients and MDR-TB detection status. Two hundred twenty eight (52.1%) respondent TB MDR major problem in our health facility and 209(47.8%) respondent TB MDR not major problem in our health facility. for a question related to MDRTB detection status in their health facility 236 (53.9%) side it is good and 142(32.4%) respondent side it is poor. Majority of respondent side screening of MDRTB suspects is at OPD room. Detailed findings are presented in Table 6 . Table 6 Adherence of TB patients and MDR-TB detection status of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia Characteristics Frequency Percentage Is TB and TBMDR major problem in your health facility Yes 228 52.1 No 209 47.8 How do you describe the trend TBMDR Increasing 62 14.2 Decreasing 204 46.6 Stable 171 39.0 How do you see adherence status or dot strategy of TB patients related one day 67 15.3 two days 194 44.3 >three days 176 40.2 Do you encounter possible causes risk factors for adherence side effect 47 10.7 Transportation 227 51.8 Stigma 118 26.9 Other 45 10.3 How do you see MDRTB detection status in your health facility Very good 59 13.5 Good 236 53.9 Poor 142 32.4 Where and who do screening of MDRTB suspects Triage 59 13.5 OPD 219 50.0 In patient 159 36.3 whatgapsweaknessesavailableinyourfacilityrelatedtoMDRTBdetection lack of triage 55 12.6 lack of test facility 221 50.5 in appropriate result 161 36.8 How do you see the regimens related to TB control program in your facility very good 65 14.8 Good 201 45.9 Poor 171 39.0 Do you have Appropriate or new guidelines Yes 179 40.8 No 258 58.9 Availability of guidelines Yes 141 32.2 No 296 67.6 Adequacy of TB or MDR TB trained human resource Yes 250 57.1 No 181 42.7 Commitment of professional in MDR TB detection very good 70 16.0 Good 197 45.0 Poor 170 38.8 5.6. Quality of care This study shown that 284 (64.8%) respondent said health providers in this facility didn’t tell them when they are stop spreading MDR TB to others and 153 (34.9%) they know when they are stop spreading MDR TB to others.Regarding to importance of observed treatment 298 (68%) didn’t know the benefit of DOT. Detailed results are presented in Table 7 . Table 7 Quality of care of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia. Do the health providers in this facility tell you when you stop spreading MDR TB to others? YES 153 34.9 NO 284 64.8 Do the health providers in this facility tell you that MDR TB can be cured? Yes 115 26.3 No 322 73.5 Do the health providers in this facility tell you about the importance of observed treatment Yes 139 31.7 No 298 68.0 Transform from quality 5.7 Association between socio-demographic characteristics and quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa , The association of independent variables with quality of MDR TB cares both bivariate and multivariable analyses were done. In the bivariate analysis, sex, average monthly income, MDR TB treatment, sputum test, drug effect, Is that TB MDR curable disease, hate patients because of their illness, encounter shortage of drugs and lab reagent, assure quality of laboratory reagents, MDR TB treatment card form, encounter possible causes risk factors for adherence, screening of MDRTB suspects and regimens related to TB control program in your facility showed an association with quality of MDR TB cares at p value < 0.25 and they were candidate for multivariable logistic regression analysis. Among the variables entered to multivariable logistic regression,sex and screening of MDRTB suspects were significantly associated with quality of MDR TB cares at p < 0.05. Those respondents who were male [AOR: 2.062(1.289, 3.289)] were more likely to receive quality of MDR TB care as compared to respondents who are female. The majority of the respondent screening of MDRTB suspects at in patient service unit are significant [AOR: 0.528(0.33, 0.843)] more likely screened than other service unit. Detailed results are presented in Table 8 . Table 8 Quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Variable Category Quality of care COR (95% CI) AOR(95% CI) p. value mean value > 5 mean value < 5 sex of respondent Female 93(29.2%) 225(70.8%) 1 1 1 Male 54(45.4%) 65(54.6%) 0.489, (0.322,0.768) 2.062(1.289,3.289) 0.002 Were screening of MDRTB suspects Triage 17(28.8%) 42(71.2%) 1 1 1 OPD 60(27.4%) 159(72.6%) 0.932(0.493,1.763) 0.551(0.274,1.107) 0.094 In patient 70(44%) 89(56%) 1.943(1.020,0.702) 0.528(0.33,0.843) 0.007 6 Discussion This study assessed the prevalence, quality of care, and health-related quality of life (HRQoL) among patients infected with multidrug-resistant tuberculosis (MDR-TB) in Addis Ababa. The findings are discussed in relation to previously published literature. Prevalence of MDR-TB MDR-TB remains a major global health challenge, with WHO reporting that in 2018, an estimated 10 million people suffered from TB, and approximately 1.2 million TB deaths occurred among HIV-negative individuals, with an additional 251,000 deaths among people living with HIV (WHO, 2019). The highest burden of TB occurs in South-East Asia, Africa, and the Western Pacific, with India, China, and Indonesia accounting for the largest proportion of cases (WHO, 2019). Regionally, studies in Ethiopia and other high-burden settings demonstrate substantial MDR-TB prevalence. For instance, a study conducted in Axum town, Tigray region, found a prevalence of 18.5% among the study population, with rifampicin mono-resistance as a proxy for MDR-TB at 3.5%. The distribution varied by zone, with Western Zone showing the highest proportion (31%) (Axum study). Factors associated with MDR-TB occurrence included age, while sex, residence, educational status, family size, income, alcohol use, smoking, and imprisonment were not significantly associated. These findings align with global evidence highlighting the role of previous TB treatment interruptions, long treatment duration, poor follow-up, and social determinants such as HIV infection, alcohol consumption, and cigarette smoking as key drivers of MDR-TB (Gandhi et al., 2010; WHO, 2016). Furthermore, studies from the Philippines emphasize the need for patient education on treatment adherence, adverse events, and misconceptions about TB to prevent delays in diagnosis and treatment and reduce treatment loss to follow-up, particularly in patients with alcohol use disorders (Philippines study, 2018). Quality of Care for MDR-TB Patients Quality of care is central to effective MDR-TB management and is defined as “fitness for use,” encompassing patient-centeredness, safety, equity, and effectiveness (WHO, 2016). Globally, only 25% of DR-TB patients receive appropriate treatment, reflecting both access and quality gaps (WHO, 2016). Inadequate diagnostic capacity, inappropriate drug regimens, and insufficient social support are major drivers of poor outcomes, with patient-centered care often neglected (Satyanarayana et al., 2015; Das et al., 2015). The treatment for MDR-TB is complex, involving multiple drugs over 9–24 months, often including daily injectable agents associated with severe adverse effects such as permanent hearing loss (WHO, 2019). Despite updated WHO recommendations discouraging routine use of injectables, many programs continue their use due to cost considerations, contributing to poor patient experiences. In addition, oral medications also present challenges, including high pill burden and drug-related adverse events. Prior studies in India and Ethiopia indicate that DR-TB patients face staffing shortages, paternalistic healthcare provider attitudes, and lack of engagement in care, further compromising quality (Bach et al., 2019; Datta et al., 2017). These challenges highlight the need for continuous monitoring of quality of care, patient-centered interventions, and adherence to international treatment standards. Health-Related Quality of Life (HRQoL) HRQoL measures the impact of disease and treatment on patients’ physical, mental, and social well-being (Leidy et al., 1999; Dion et al., 2004). In chronic diseases like MDR-TB, mental and social well-being are often as critical as physical health (Sherbourne et al., 1999). MDR-TB treatment, characterized by long duration, adverse effects, and social stigma, significantly reduces HRQoL (WHO, 2011; WHO, 2015). Previous studies in low-resource settings show that HRQoL is frequently compromised among MDR-TB patients due to treatment-related adverse events, lengthy therapy, social isolation, and psychological distress (Chamla, 2004; WHO, 2013). Patients may also experience financial and social burdens, which further affect adherence and overall quality of life. Assessing HRQoL provides critical insights into the real-world impact of MDR-TB treatment and identifies areas for intervention beyond traditional clinical outcomes such as bacteriological cure or treatment completion. Implications The findings of this study corroborate previous literature, indicating that MDR-TB management faces challenges related to prevalence, treatment quality, and patient well-being. Effective interventions require a holistic approach that integrates timely diagnosis, appropriate treatment regimens, psychosocial support, patient education, and routine assessment of HRQoL. These measures will improve treatment adherence, reduce morbidity and mortality, and enhance overall patient experiences. 7 Strength and Limitation of the study 7.1 Strength of the study Great attention given for data quality from data collection to analyzing by using standardized and qualified statistical soft was Epi info data and SPSS. Adequate sample size was applied according to double population proportion formula using epi info. 7.2 Limitation of the study This study is cross sectional, where causal relationship between the independent and dependent variables cannot be established. The findings in this study may be prone to recall bias as they are based on participants’ reported experiences 8. Conclusion and Recommendations 8.1. Conclusion Based on the findings of this study, the two major dimensions of quality of care perceived as most important by MDR-TB patients are administrative quality, including patient support and availability of services, and interpersonal quality, including provider-patient interaction, communication, and information provision. Despite these strengths, notable gaps remain, such as inadequate information given to patients regarding the disease, treatment progress, and potential side effects, as well as limited facilities and psychosocial support. The prevalence and risk factors for MDR-TB, including treatment interruptions, poor follow-up, HIV co-infection, and substance use, further highlight the challenges in delivering effective care. Health-related quality of life and treatment adherence are directly affected by these gaps, emphasizing the need for more patient-centered approaches. Therefore, MDR-TB control programs should prioritize patient-centered care, enhance education and communication, strengthen psychosocial support, and improve service accessibility to enhance adherence, treatment outcomes, and overall well-being of MDR-TB patients. 8.2. Recommendations Based on our study the following recommendations are made. For Ministry Of Health In order to address the needs of MDR TB patients based on their perception of quality of care we recommend including and implementing patient centered approaches. Develop standardized training on interaction / communication skills for providers. For Health Facility Ensure easy access for patients to information about MDR TB and the treatment such as through printing media. The health facility must prepare checklist that can be used to assess the patient’s perception on the quality of services and patient satisfaction. Declarations Ethical Considerations: Ethical approval was obtained from the Research and Ethical Review Board of the Department of Public Health, Rift Valley University, Abichu Campus. Permission to conduct the study was also obtained from the administration of ALERT Hospital, Addis Ababa, where the research was conducted. Participation in the study was voluntary. After a detailed explanation of the study objectives and procedures, written informed consent was obtained from all participants. Confidentiality and privacy of participants were maintained throughout the data collection process. All procedures were conducted in accordance with the Declaration of Helsinki. Consent for Publication : Not applicable. Human Ethics and Consent to Participate Declarations: Not applicable. Availability of Data and Materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing Interests: The authors declare that they have no competing interests. Funding: We didn’t receive any funding for this study. Authors’ Contributions: KAH, AZB and DJB conceived the study, designed the methodology, collected and analyzed data, and drafted the manuscript. All authors critically reviewed the manuscript, contributed to revisions, and approved the final version. All authors take responsibility for the accuracy and integrity of the work. Acknowledgements: The author extends sincere gratitude to ALERT Hospital, Addis Ababa, for allowing the study to be conducted. Appreciation is also extended to Rift Valley University, Abichu Campus, Department of Public Health, and to all study participants for their cooperation and valuable contributions. References Published sources: Aggarwal A N, 2010. Health-related quality of life: a neglected aspect of pulmonary tuberculosis. Lung India; 27: 1–3. Chamla D., 2004.The assessment of patients’ health-related quality of life during tuberculosis treatment in Wuhan, Int J Tuberc Lung Dis. Sep;8(9):1100-6. Creswell, J. W., 2003. Research Design. Thousand Oaks, CA: Sage PublicationsDas J, Kwan A, Daniels B, et al., 2015. Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study. Lancet Infect Dis.;15(11):1305–13. Deribew, A. et al., 2018. Tuberculosis Burden in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study. Published in Ethiopian Journal of Health Sciences.Sep; 28(5): 519–528 Dion MJ, Tousignant P, Bourbeau J, Menzies D, Schwartzman K. Feasibility and reliability of health-related quality of life measurements among tuberculosis patients. Qual Life Res. 2004;13(3):653–65. Duraisamy K, Mrithyunjayan S, Ghosh S, et al., 2014. Does alcohol consumption during multidrug-resistant tuberculosis treatment affect outcome? A population-based study in Kerala, India. Ann Am Thorac Soc.; 11: 712–715. Frieden TR, Fujiwara PI, Washko RM, Hamburg MA. Tuberculosis in New York City -- turning the tide.NEngl J Med1995;333:229-233. Guo N, Marra F, Marra C a., 2009. Measuring health-related qualityof life in tuberculosis: a systematic review. Health Qual Life Outcomes; 7: 14. Hennessy C H,Moriarty D G, ZackMM, Scherr PA, Brackbill R., 1994. Measuring health-related quality of life for public health surveillance. Public Health Rep; 109: 665–672. Leidy NK, Revicki DA, Genesté B. 1999. Recommendations for evaluating thevalidity of quality of life claims for labeling and promotion. VALUE Heal.;2(2):113. Satyanarayana S, Subbaraman R, Shete P, et al., 2015. Quality of tuberculosis care in India: a systematic review. Int J Tuberc Lung Dis.;19(7):751–63 Sherbourne CD, Sturm R, Wells KB. What outcomes matter to patients? JGen Intern Med. 1999;14(6):357–63. WHO, 2015.Global tuberculosis report, 2015. WHO/HTM/TB/2015.22. Geneva, SwitzerlandWHO, 2016.Globaltuberculosis report, 2016. WHO/HTM/TB/2016.13. Geneva, Switzerland WHO, 2019.World Tuberculosis Report 2019.Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO Internet sources: BUSPH, 2013.Multiple Drug Resistant Tuberculosis [Retrieved: 20/12/2019]. Available at: http://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/MDR-TB/MDR-TB2.html China. Int J Tuberc Lung Dis. 2004;8:1100 [cited 2015 May 5]; Available from: http://www.ingentaconnect.com/content/iuatld/ijtld/2004/00000008/00000009/art00010. WHO, 2011. Implement the Global Plan To Stop Tb 2011–2015WHO, 2013.Definitions and reporting framework for tuberculosis – 2013 revision.papers2://publication/uuid/E6143945- WHO, 2013.Definitions and reporting framework for tuberculosis – 2013 revision.papers2://publication/uuid/E6143945-51F7-485A-8C89-FAB2C7DF4F43. WHO,2016a.http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua¼1 Accessed December 2019. 19.WHO, 2016b. "Diagnosis and notification of multidrug-resistant TB"World Health Organization (WHO) .Retrieved December 2019 Prevalence and Factors Associated with Multidrug-ResistantTuberculosis (MDR-TB) among Presumptive MDR-TB Patients inTigray Region, Northern EthiopiaKibriti Mehari,1,2 Tsehaye Asmelash,2,3 HaftamuHailekiros ,2 Tewolde Wubayehu,3Hagos Godefay,4 Tadele Araya,2 and MuthupandianSaravanan 2 Factors Associated with Loss to Follow-up during Treatment forMultidrug-Resistant Tuberculosis,the Philippines, 2012–2014 Thelma E. Tupasi, Anna Marie Celina G. Garfin, Ekaterina V. Kurbatova, Joan M. Mangan,Ruth Orillaza-Chi, Leilani C. Naval, Glenn I. Balane, Ramon Basilio, Alexander Golubkov,Evelyn S. Joson, Woo-jin Lew, Vivian Lofranco, MariquitaMantala, Stuart Pancho, Jesus N. Sarol Jr . Additional Declarations No competing interests reported. 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INTRODUCTION","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1Background\u003c/h2\u003e \u003cp\u003eA kind of tuberculosis infection known as multi-drug-resistant tuberculosis (MDR-TB) is brought on by bacteria that are resistant to at least two of the most potent first-line anti-TB treatments, isoniazid and rifampin. Extensively drug-resistant tuberculosis (XDR-TB) is a kind of tuberculosis that is resistant to line drugs [\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvery year, millions of people suffer from tuberculosis (TB), which remains a major global health concern. Every year, tuberculosis (TB) affects the health of over 10.4\u0026nbsp;million people globally, leading to about 1.8\u0026nbsp;million TB-related fatalities, with resource-constrained nations accounting for 95% of these deaths [1]. When compared to new TB cases, the frequency of MDR-TB is significant in Sub-Saharan nations, particularly among previously treated TB individuals [\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvery year, there are about 500,000 instances of multidrug resistant tuberculosis (MDR-TB) [3], 3% of these cases are treated, and MDR-TB causes over 100,000 fatalities. Furthermore, extensively drug-resistant (XDR) MDR-TB infections accounted for up to 10% of cases [4]. MDR-TB is characterized by resistance to both isoniazid and rifampicin; MDR-TB with added resistance to any fluoroquinolone and at least one of the three second-line injectable medications\u0026mdash;amikacin, capreomycin, and kanamycin\u0026mdash;is known as XDR [\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEthiopia was listed as one of the thirty countries with the highest TB burden (TB, TB/HIV, and MDR-TB) in a recent World Health Organization (WHO) study of high TB-related burden countries. TB is still one of Ethiopia's top causes of death. The 2017 WHO study said that the prevalence of MDR-TB in Ethiopia was 2.7% among newly diagnosed cases and 14% among those that had already received treatment, while the prevalence of TB/HIV co-infection was estimated to be 8% of the afflicted population [6]. Furthermore, a number of Ethiopian investigations revealed that the prevalence of MDR-TB was 31.4% in Jimma [7], 28% in Addis Ababa [8], 46.3% in Addis Ababa [9], and 5% in Northwest Ethiopia [\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRapid MDR-TB transmission is a serious global public health issue, particularly for nations with limited resources, and it poses a significant obstacle to TB control initiatives. Furthermore, the sub-Saharan region, including Ethiopia, has been unable to effectively control MDR-TB due to a number of linked variables, including high TB prevalence, inadequate treatment, and restricted access to healthcare [11]. Lastly, the quick spread of XDR-TB has lately surfaced as an additional difficulty for TB control initiatives [\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Statement of the problem\u003c/h2\u003e \u003cp\u003eThe advent of extremely drug-resistant TB further hampers efforts to address the issue, particularly in developing nations like Ethiopia. MDR-TB is a man-made disease caused by inadequate anti-TB treatment. One of Ethiopia's biggest problems is diagnosing and treating MDR-TB. One of the most common infectious diseases nowadays is MDR-TB. MDR TB affects about one-third of the world's population, with developing nations accounting for the majority of these infections [1]. Ethiopia was placed 15th out of 27 high-burden MDR-TB countries in the 2014 World Health Organization (WHO) TB report, with an estimated MDR rate of 1.6% (0.9%\u0026ndash;2.8%) for new cases and 12 (5.6%\u0026ndash;21%) for retreatment cases [5].\u003c/p\u003e \u003cp\u003e The majority of MDR-TB cases are the consequence of human error, which can be caused by a single or a combination of factors related to drug supply management, inappropriate guidelines, poor adherence, poor infection control practices, poor storage conditions, incorrect dosage or combination, poor organization, lack of information, lack of treatment monitoring, and inadequate DOTS strategy implementation. The management of MDR-TB will be an integrated part of the NTP, organized by all health professionals, cognizant of the community's MDR-TB transmission, and executed through the current health care delivery system.\u003c/p\u003e \u003cp\u003eTreatment adherence increases the likelihood of a successful cure for MDR TB. It is anticipated that in order to successfully treat tuberculosis, the patient will need to take anti-tuberculosis medications for several months. Multidrug resistant tuberculosis (MDR) cases, high mortality rates, and high treatment costs are all consequences of non-adherence to tuberculosis treatment. These raise the burden of tuberculosis on the country, its allies, and local communities. Numerous studies have been conducted to determine what elements affect non-adherence in different contexts. Cultural customs, lifestyle, and economic status are just a few of the variables that might vary based on certain population contexts and their characteristics.\u003c/p\u003e \u003cp\u003eAssessment of MDR-TB is particularly important for the research area because, in addition to the gaps in TB and MDR-TB detection and treatment in developing nations, Addis Ababa is a densely populated location with a large influx of people from neighboring regions as well as within the region. Because the city is one of the channels for illicit and subpar anti-TB contraband drugs, it is also susceptible to counterfeit anti-TB medications. Therefore, the purpose of this study is to evaluate the prevalence and potential risk factors for MDR-TB, which is crucial for treating and preventing both TB and MDR-TB.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Literature review","content":"\u003cp\u003eThe literature review considers both conceptual and empirical studies in order to obtain existing information on the proposed research. The main aspects in this chapter are treatment of multidrug resistant tuberculosis, its prevalence, treatment regimen and factors resulting in quality of health care.\u003c/p\u003e \u003cp\u003eThe aim of literature review is to prepare a summary on existing literature and to contribute towards study in this area. The general idea from the past literature suggests that there is shortcoming in the quality of TB care provided to patients infected with multidrug resistant tuberculosis. Data demonstrate frequent delays in the diagnosis of MDR/RR-TB and globally less than one quarter of the estimated MDR/RR-TB patients are detected and reported to national surveillance systems (WHO, 2016). Empirical management of TB without drug susceptibility testing (DST), inappropriate drug regimens, and insufficient attention to concurrent social support for patients to facilitate treatment completion are major drivers of DR-TB.\u003c/p\u003e \u003cp\u003eThere have been no systematic reviews on the quality of care provided to patients infected with DR-TB, and critical gaps in service delivery among studies involving patients with DR-TB have been reported. Satyanarayanaet al. (2015) found one study that \u0026ldquo;examined quality of care for DR-TB, which identified that only 39% of healthcare providers reported conducting DST for eligible TB cases\u0026rdquo; Moreover, using simulated patients, Das et al. (2015) found that that even among qualified, trained doctors in India, a DST was rarely ordered for a simulated patient with classic TB symptoms and a clear history of previous, incomplete therapy. Quality TB care is patient-centric care that is consistent with international standards, delivered in an accessible, timely, safe, effective, efficient and equitable manner. Questionnaire shall be designed in order to understand disease, quality of care and quality of life among multidrug resistant tuberculosis patients and will be administered at health centers in Addis Ababa. Drug-resistant strains of \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e (MTB) arise from spontaneous chromosomal mutations at a predictable low frequency, but a study done by Gandhetal. revealed that selection pressure that is caused by inappropriate utilize of anti-TB drugs results in the emerging of resistant MTB. Similarly, a study done in Ethiopia identified long treatment, poor treatment follow up \u0026amp; interruption of treatment were identified as risk factors for significant increases in MDR-TB. Other studies done in Ethiopia and China also revealed that HIV infection, cigarette smoking, and alcohol drinking, overpopulated, and weak DOTS (Directly Observed Treatment Short-course) program were the major risk factors for spread of MDR-TB infection.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Prevalence of Multidrug Resistant Tuberculosis\u003c/h2\u003e \u003cp\u003eOne of the top ten causes of death globally, tuberculosis continues to be a significant source of illness. An estimated 10.0\u0026nbsp;million (range: 9.0\u0026ndash;11.1\u0026nbsp;million) people worldwide have tuberculosis (TB) in 2018; this figure has been comparatively steady in recent years. With an average of about 130 new cases per 100,000 people annually, the burden of disease varies greatly between nations, ranging from less than five to more than 500.\u003c/p\u003e \u003cp\u003eIn 2018, there were an estimated 1.2\u0026nbsp;million (range: 1.1\u0026ndash;1.3\u0026nbsp;million) TB fatalities among HIV-negative individuals (a 27% decrease from 1.7\u0026nbsp;million in 2000), and an additional 251,000 deaths (range: 223,000\u0026ndash;281,000) among HIV-positive individuals (a 60% decrease from 620,000 in 2000). All age groups are affected by tuberculosis (TB), although men (\u0026ge;\u0026thinsp;15 years old) bear the brunt of the disease, accounting for 57% of all cases in 2018. In contrast, women made up 32% and children under the age of 15 made up 11%. People living with HIV (PLHIV) accounted for 8.6% of all TB cases (WHO, 2019).\u003c/p\u003e \u003cp\u003eGeographically, the WHO areas of South-East Asia (44%), Africa (24%), and the Western Pacific (18%) accounted for the majority of TB cases in 2018. The Eastern Mediterranean (8%), the Americas (3%), and Europe (3%) had lower numbers. India (27%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria (4%), Bangladesh (4%), and South Africa (3%) were the eight nations that made up two thirds of the global total. 87% of cases worldwide were found in these and 22 other nations on the WHO's list of 30 high TB burden countries (WHO, 2019).\u003c/p\u003e \u003cp\u003eAccording to a study done in Tigrai Regain Axum Town, the prevalence of MDR-TB was 37/200 (18.5%). However, the prevalence of MDR-TB/RMP resistance was 7 (3.5%) when RMP mono-resistance (RMP-MR) was taken into account as a proxy indicator for MDR-TB. In descending order, the percentages of MDR-TB cases in each zone were as follows: Western (31%), Southern (22.6%), Eastern (20%), Northwest (19.4%), Central (13.9%), Southeast (13.3%), and Mekelle Zone (0%)Factors Linked to the Occurrence of MDR-TBAge was statistically linked to MDR-TB after controlling for possible confounding variables (AOR: 1.06, 95%CI 1.00\u0026ndash;1.11).\u003c/p\u003e \u003cp\u003eHowever, there was no correlation found between the incidence of MDR-TB and sex, site of residence, educational status, having a windowed home, family size, income, alcohol consumption, cigarette smoking, or incarceration. Patients and their loved ones should be given a detailed explanation of the study conducted in the Philippines regarding the rationale for extended treatment and the consequences of treatment interruptions. Before beginning treatment, it is also essential to inform patients about anticipated side effects. Patients may be deterred from seeing traditional healers by patient education that dispels prevalent misconceptions regarding tuberculosis, preventing a delayed diagnosis and course of treatment (26). Compared to control patients, case patients had significantly higher rates of alcohol misuse documented in their medical records. Numerous studies have shown a link between alcohol abuse or alcohol use disorders and loss to follow-up during MDRTB treatment (13\u0026ndash;15, 27); one small randomized clinical trial showed better TB outcomes for patients in groups randomly assigned to receive behavioral counseling or naltrexone integrated into TB care (28). This conclusion, along with similar findings from other studies, necessitates further research to evaluate the impact of managing alcohol use as part of TB clinical treatment and screening for alcohol dependency using standard assessment techniques.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Quality of care of MDR-TB patients\u003c/h2\u003e \u003cp\u003e\"Fitness for use\" is the definition of quality. Organizational excellence is the outcome of an organization's application of the quality principle. The four fundamental tenets of quality management at a healthcare facility are: doing the right thing the first time and every time, continual improvement, listening to patient concerns, and teamwork among all healthcare personnel. The idea and set of guiding principles that serve as the cornerstone for the organization's ongoing improvement is quality of care. All procedures aimed at meeting the demands of MDR-TB patients are referred to as quality of care. Drug-resistant tuberculosis (DR-TB) is one of the major infections contributing to the worldwide health problem caused by antibiotic resistance. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[1]\u003c/span\u003e.\u003c/p\u003e \u003cp\u003ePoor quality care is widespread in the field, despite the fact that inadequate access to diagnosis and treatment for DR-TB remains a major challenge\u0026mdash;only 160,684 of the 558,000 people predicted to become ill with DR-TB each year were identified, and only 139,114 (25%) of them began treatment [2]. In the field of DR-TB treatment, this is evident not only in the 65% treatment success rate worldwide but also in other subtle ways [3]. Safety, equity, and efficacy are all quality dimensions; patient centeredness is a phrase that has recently entered the TB field's lexicon [4], if not its real practices.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[5]\u003c/span\u003e Where DR-TB has to be improved immediately. However, for a variety of reasons, including the fact that measures of successful therapy are mostly focused on bacteriologic outcomes, little is known regarding quality in the routine management of DR-TB [6].Serious issues with the diagnosis and treatment of DR-TB are highlighted by three recent \"cascade\" reviews [7], [8], and [9]. However, there is little literature that reports systematic evaluations of the quality of DR-TB treatment. In actuality, the treatment of DR-TB in settings with limited resources has just been recognized as an essential and practical approach during the past 20 years \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[10]\u003c/span\u003e. Previous efforts to control tuberculosis concentrated on preventing drug-susceptible TB patients from developing resistance while undergoing treatment [11], ignoring the fact that the majority of drug-resistant tuberculosis (DR-TB) is transmitted through primary transmission [12], and placing the blame squarely on those who have TB. There is still a propensity to blame those who have the illness for their potentially fatal situation \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[13]\u003c/span\u003e, and this may be one of the reasons DR-TB quality of care has received so little research.\u003c/p\u003e \u003cp\u003eThe limited studies that have been conducted on MDR-TB and quality demonstrate that people who contract DR-TB have a terrible experience; one study participant summed it up by saying, \"I cry every day\" [14]. Studies on the quality of life of people with DR-TB become crucial in the lack of official quality of care evaluations [15]. People with DR-TB had poor quality of life assessments, particularly in the physical and psychological areas, according to a recent mixed-methods study conducted in India \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[16]\u003c/span\u003e. Similar poor quality experiences for individuals with DR-TB have been documented in other qualitative investigations [17], [18], [19], and [20]. These experiences include low engagement in care, paternalistic attitudes of TB physicians, and staffing shortages or absences that significantly jeopardize DR-TB services. Many factors influence how people with DR-TB perceive the quality of their care [21]. Some of these, such as pill burden, frequent use of injectable medicines, adverse events, and a long course of therapy, can be linked to the treatment regimens themselves \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[22]\u003c/span\u003e. DR-TB treatment is quite difficult. The regimens administered to patients with DR-TB are complicated, with a global \"success rate\" of about 65% [23]. Five to seven different medications are administered over a period of nine to twenty-four months in the most popular regimens [24]. The most problematic of these agents is the daily injection that, until recently, was the mainstay of most DR-TB regimens, despite the fact that there is little scientific evidence to support the use of this class of medications and that up to one in three recipients experience permanent hearing loss \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[25]\u003c/span\u003e. Only one of these medications (amikacin) should be used when there are no other treatment options and only if there is proven susceptibility to it and formal hearing assessments can be performed, according to a recent update to the WHO's guidelines regarding the routine use of injectable agents [26]. Despite this, a lot of programs are still using these drugs and do not intend to phase them out of treatment plans anytime soon, partly due to their low cost. While the harm caused by injectable pharmaceuticals has received a lot of attention, oral medications used to treat DR-TB can provide poor quality experiences for those who have the illness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Health Related Quality of life of MDR-TB patients\u003c/h2\u003e \u003cp\u003eThe result of providing patients with MDR-TB with high-quality care is their health-related quality of life (HRQoL). According to Leidy et al. (1999) and Dion et al. (2004), HRQoL is \"the extent to which a disease and its treatment(s) affect a patient's subjective perception of physical, mental, and social wellbeing on a daily basis.\" In addition to their physical health, patients with chronic illnesses place a great priority on their emotional and social well-being (Sherbourne et al., 1999).\u003c/p\u003e \u003cp\u003eThe idea of evaluating health status beyond traditional indicators, such mortality and morbidity, has expanded the importance of monitoring HRQoL (WHO, 2013). The impact of illnesses and related morbidities on daily activities and functions is measured by HRQoL. Because of this, HRQoL evaluation has emerged as a critical health outcome and a topic of interest for researchers, policy makers, and medical professionals. To determine the best course of action for enhancing the health and quality of life of TB patients, an HRQoL evaluation is essential (Chamla, 2004).\u003c/p\u003e \u003cp\u003e\"There is a dearth of literature about anti-TB drug-induced mortality, morbidity, and loss in quality of life, particularly in low-resource settings,\" according to a 2015 WHO progress report on MDR-TB treatment (WHO, 2011). The current study assesses the etiology, prevalence, transmission, and standard of care of patients with multidrug-resistant tuberculosis in Addis Ababa, Ethiopia's health facilities. Therefore, this study will assist close the gap in reported outcomes among MDR-TB patients and give much-needed information about the quality of care, the impact of MDR-TB therapy, and the health-related quality of life of MDR-TB patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Conceptual framework\u003c/h2\u003e \u003cp\u003eFigure 1Conceptual framework\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5significance of the study\u003c/h2\u003e \u003cp\u003eAssessment of the incidence and prevalence of MDR-TB is an important program indicator, as it adds knowledge to the existing TB Challenge Programme. It is essential to reach practical recommendations to improve the quality of services and enhance outcomes for MDR-TB patients, thereby reducing mortality and morbidity.\u003c/p\u003e \u003cp\u003eThe findings of this study can serve as evidence for governmental and non-governmental organizations working in the area of MDR-TB, particularly in TB activities at national, regional, and district levels, by providing basic information on factors influencing DOTS. These results will alert planners and program managers to design appropriate intervention strategies that contribute to the reduction of MDR-TB and improve the health status of vulnerable populations.\u003c/p\u003e \u003cp\u003eFurthermore, this study provides baseline data that can be used by program implementers and researchers for future planning and investigations.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. OBJECTIVES","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1. General objective\u003c/h2\u003e \u003cp\u003eTo assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Specific objectives\u003c/h2\u003e \u003cp\u003eTo determine the level of quality of MDR TB care among multi-drug resistance in health facilities in Addis Ababa, Ethiopia\u003c/p\u003e \u003cp\u003eTo identify factors associated with quality of MDR TB care among multi-drug resistance tuberculosis patients in health facilities in Addis Ababa, Ethiopia.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Material and methods","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Study area and Study period\u003c/h2\u003e \u003cp\u003eThe study was conducted in Addis Ababa City Administration, Ethiopia, from March 1 to May 30, 2020, at a government hospital. Addis Ababa, the capital city of Ethiopia, covers an area of approximately 526.99 km\u0026sup2; and, according to the 2017 census, has a total population of 4,687,593. The city is administratively divided into 10 sub-cities and 99 woredas. Among these, KolfeKeranio, Yeka, and Nifas Silk-Lafto are the most densely populated sub-cities.\u003c/p\u003e \u003cp\u003eAddis Ababa is ethnically diverse, representing the majority of Ethiopia\u0026rsquo;s ethnic groups due to its status as the national capital. Religiously, Ethiopian Orthodox Christianity is the dominant faith, accounting for 74.7% of the population, followed by Islam (16.2%), Protestant Christianity (7.77%), and Catholicism (0.48%).\u003c/p\u003e \u003cp\u003eAccording to the Ministry of Health 2017 report, the city hosts six hospitals, 92 health centers, and 750 private clinics under federal administration, along with 30 additional hospitals managed by other authorities (excluding police and armed forces facilities). Certain hospitals and health centers provide MDR-TB DOTS and serve as designated testing sites. Among these, ALERT Hospital is one of the established MDR-TB treatment centers.\u003c/p\u003e \u003cp\u003eThe ALERT MDR-TB Center was founded in March 2011 (Gregorian calendar) under the ALERT Center, which is a federal hospital and training institution supported by the USAID Challenge TB Project. The unit has expanded its services to include the management of patients with pre-extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB). The MDR-TB unit is staffed by one internist, three general practitioners, one pharmacy professional, seven nurses, one phlebotomist, two cleaners, one social worker, one IT service provider, and one runner.\u003c/p\u003e \u003cp\u003eAs of March 2017 (Ethiopian calendar), a total of 416 patients had ever been enrolled in the ALERT MDR-TB program. Of these, 109 patients were on active follow-up, 144 had completed treatment, 88 were cured, 24 were lost to follow-up, 41 had died, 4 experienced treatment failure, 6 were transferred out, and 14 were transferred in. The overall treatment success rate was estimated at 75.6%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.2 study design\u003c/h2\u003e \u003cp\u003eCross-sectional study was conducted using quantitative data collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Study population\u003c/h2\u003e \u003cp\u003eThe source population consisted of infectious cases of multidrug-resistant pulmonary tuberculosis in the Addis Ababa region. The study population included all smear-positive multidrug-resistant pulmonary tuberculosis cases who visited the outpatient departments of the study centers between March and August 2020.\u003c/p\u003e \u003cp\u003eThe study subjects were recruited from two groups of patients: smear-positive multidrug-resistant tuberculosis patients with no previous exposure to MDR-TB, and smear-positive MDR-TB patients with more than one month of exposure to MDR-TB.\u003c/p\u003e \u003cp\u003eSmear-positive TB patients with no previous exposure to tuberculosis drugs were classified as new cases (not exposed to MDR-TB), while those with previous exposure to MDR-TB treatment for at least one month were classified as the re-treatment group. The re-treatment group comprised defaulters, treatment failures, relapses, and/or chronic cases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Inclusion\u003c/h2\u003e \u003cp\u003eAll smear positive cases with no previous treatment for multidrug resistance tuberculosis or with previous treatment for tuberculosis for at least one month were included. Smear positive cases who declined to participate in the study,\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Exclusion criteria\u003c/h2\u003e \u003cp\u003ePatients Who received anti-TB treatment but for less than onemonth, all smear negative cases, patients with extra-pulmonary tuberculosis and patient who doesn\u0026rsquo;t hear or deaf patient were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.6Source and type of data\u003c/h2\u003e \u003cp\u003eThe study utilized both primary and secondary data sources. Primary data were collected from healthcare professionals involved in the treatment of MDR-TB, patients diagnosed with MDR-TB, their relatives, and community members residing in Addis Ababa. Data collection was carried out through one-to-one discussions with respondents. Secondary data were obtained through an extensive review of published and unpublished literature, workshop proceedings, relevant national policies, development strategies, and academic journals aligned with the study objectives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.7Sampling technique and sample size\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e4.7.1. Sample size Determination\u003c/h2\u003e \u003cp\u003eThe required sample size was determined using the single population proportion formula:\u003c/p\u003e \u003cp\u003eProportion (p): proportion of multi-drug resistance TB used in Tigrai region, Axum town 18%, 2019\u003c/p\u003e \u003cp\u003eLevel of confidence\u0026thinsp;=\u0026thinsp;95%\u003c/p\u003e \u003cp\u003eLevel of significance\u0026thinsp;=\u0026thinsp;5%\u003c/p\u003e \u003cp\u003eMargin of error (d)\u0026thinsp;=\u0026thinsp;5%\u003c/p\u003e \u003cp\u003e\u003cimg 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\" width=\"253\" height=\"91\"\u003e\u003c/p\u003e \u003cp\u003en-The minimum sample size required\u003c/p\u003e \u003cp\u003ep- Estimated proportion of MDR TB\u003c/p\u003e \u003cp\u003ed- Margin of error\u003c/p\u003e \u003cp\u003eZ \u003csub\u003e(α/2)\u003c/sub\u003e2\u0026thinsp;=\u0026thinsp;Standard normal value at (1 \u0026ndash;α/2)\u003c/p\u003e \u003cp\u003eSample size (n) = (1.96)\u003csup\u003e2\u003c/sup\u003e * 0.18(1\u0026ndash;0.18)/ (0.05)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSample size\u0026thinsp;=\u0026thinsp;226.8\u003c/p\u003e \u003cp\u003eBy considering non-response rate of 10% 206.4*10%=22\u003c/p\u003e \u003cp\u003eFinally, the total sample size (n) was 227\u0026thinsp;+\u0026thinsp;22\u0026thinsp;=\u0026thinsp;249.\u003c/p\u003e \u003cp\u003eThe required sample size for the second objective was determined using the double population proportion formula with Epi Info version 7.2.2.6 StatCalc software, as presented below. Factors that showed significant association with the corresponding odds ratio in previous studies were selected to calculate the sample size. As summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003esample size determination for specific objective two\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePower\u003c/p\u003e \u003cp\u003e(1-β)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThe proportion of outcome among exposed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThe proportion of outcome among unexposed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u0026thinsp;+\u0026thinsp;Non-response rate (10%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor Quality care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e49.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdverse event\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e94.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment success\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e77.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFor the second objective\u003c/b\u003e, the required sample size was calculated using the double population proportion formula with the StatCalc program of Epi Info version 7. Factors associated with the quality of MDR-TB care among multidrug-resistant tuberculosis patients were used, with a 95% confidence interval, 80% power, and a 1:1 ratio of the two populations. Adjusted odds ratios from previous studies were applied, and a 10% non-response rate was included. Based on a treatment success rate of 65% (AOR\u0026thinsp;=\u0026thinsp;1.9) and adding 10% for non-response, the required sample size was 454. Finally, the largest sample size of 454 was used, as it was sufficient to cover the sample size needed for all study objectives.\u003c/p\u003e \u003cp\u003eFinally the largest sample size will be used \u003cb\u003e454\u003c/b\u003e because of it can encompass the sample size needed for all objectives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e4.7.2. Sampling technique\u003c/h2\u003e \u003cp\u003eThe research shall employ simple random sampling technique among stakeholders at various healthcarefacilities in Alert Hospital Addis Ababa. The target sample for the study include healthcare providers, patients infected with MDR-TB, relatives of MDR-TB patients, community members living in Addis Ababa and its periphery.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.8. Study Variables\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003ch2\u003e4.8.1 Dependent variable\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eQuality of MDR-TB care and service\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e4.8.2Independent variables\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHealthcare facility\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSocioeconomic background\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eType of disease (MDR-TB)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEffectiveness of treatment\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEfficiency of treatment\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTreatment accessible to the patient\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSafety of the treatment\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTreatment available to the patient on time\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCompliance\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTolerance\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEquitable treatment to all patients\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eConsistently high quality of anti-TB medications\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMethod of treatment (Processes) consistent with international standards (including lab \u0026amp; diagnosis)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.9. Data Collection Tools\u003c/h2\u003e \u003cp\u003eData were collected using structured, interviewer-administered questionnaires. The questionnaires were initially developed in English and then translated into local languages (Amharic and Afaan Oromo). Three sets of questionnaires were prepared: one for MDR-TB patients, another for community members and relatives of patients, and a third for healthcare professionals. All questionnaires were pre-tested for reliability and validity, with Cronbach\u0026rsquo;s alpha greater than 0.70 considered acceptable.\u003c/p\u003e \u003cp\u003eThe questionnaires included both closed-ended and open-ended questions to capture quantitative data. They were divided into two sections: the first section collected socio-demographic characteristics of respondents, while the second section included detailed questions related to clinical outcomes, quality of care, health-related quality of life, perceptions, attitudes, and beliefs among MDR-TB patients, their relatives, and the community. Responses for Likert-scale questions were measured on a five-point scale ranging from strongly disagree (1) to strongly agree (5) to assess degrees of attitudes and opinions.\u003c/p\u003e \u003cp\u003eIn addition, semi-structured interviews were conducted with selected key informants to obtain more in-depth information. During these interviews, researchers probed further by asking related questions for clarification and elaboration.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.10. Data collection procedures\u003c/h2\u003e \u003cp\u003eData were collected using structured questionnaires and review checklists through document review and face-to-face interviews. Information was obtained from healthcare providers, MDR-TB patients, and relatives of MDR-TB patients. Primary data were collected directly from healthcare professionals providing treatment to MDR-TB patients, as well as from patients infected with MDR-TB and their relatives.\u003c/p\u003e \u003cp\u003eThe data collection team consisted of two BSc nurses, one clinical nurse, and one diploma-level porter.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e4.11. Data Quality Control\u003c/h2\u003e \u003cp\u003eTo ensure data quality, the questionnaire was translated into local languages (Amharic and Afaan Oromo). A pre-test was conducted on 5% of the sample outside the actual study area, and necessary corrections were made to the questionnaire based on the results of the pre-test data analysis.\u003c/p\u003e \u003cp\u003eThe principal investigator provided training to the data collectors on the study objectives, data collection methods, and ethical considerations during data collection. Data collectors were also familiarized with the data collection tools. Supervision was conducted by the principal investigator to check the completeness and consistency of the collected information, and timely corrections were made as needed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.12. Data Processing and Analysis\u003c/h2\u003e \u003cp\u003eData were entered into Epi Info version 7 and exported to SPSS version 20 for processing and analysis. Descriptive statistics were computed to summarize the characteristics of the study participants. A logistic regression model was fitted to identify associations between independent and dependent variables. Both crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Independent variables that showed an association with the dependent variable at a p-value less than 0.2 in the bivariate analysis were included in the initial multivariable logistic regression model. Variables with a p-value less than 0.05 were considered statistically significant.\u003c/p\u003e \u003cp\u003eModel fitness was assessed using the Hosmer-Lemeshow chi-square test, and multicollinearity was evaluated using collinearity diagnostic statistics, including the correlation matrix, variance inflation factor (VIF), and tolerance test. Results were presented in text, tables, graphs, and charts, depending on the type of data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003e4.13. Ethical Consideration\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e\u003cb\u003e was obtained from the Research and Ethical Review Board of the Department of Public Health, Rift Valley University, Abichu Campus. Official permission letters were obtained from the Addis Ababa Health Office and the respective public health facilities. The purpose and importance of the study were explained to all participants, and written informed consent was obtained prior to data collection. Participation was voluntary, and participants were informed of their right to refuse or withdraw at any time without consequences. Confidentiality of the information was maintained throughout the study.\u003c/b\u003e\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003e4.14. Dissemination of Finding\u003c/h2\u003e \u003cp\u003eThe finding of this study will be submitted to Rift Valley University Abichu Campus department of public health, by hard and softcopy. Besides the document will be given for organizations likeAddis Ababa Health Office and Addis Ababacity of Public Health facility. Publication will be attempted and presented in different seminars, meetings, conferences and workshops.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Result","content":"\u003cdiv id=\"Sec33\" class=\"Section2\"\u003e \u003ch2\u003e5.1. Socio-Demographic Characteristics of the respondents\u003c/h2\u003e \u003cp\u003eTwo hundred ninety four respondents returned completely filled questionnaires, which gave a response rate of 96 percentages. Majority of respondent are female 318 (72.8).The mean age of the study participants was 55 years, the majority respondent age are less than 68 317(72.5%). Among the respondents, 319 (72.8%) single 91(20.7%) married, and 27 (6.2%) Separated and widowed. The mean monthly income for the respondents was 1-500 Eth birr. The detailed socio-demographic characteristics of the respondents are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e69\u0026ndash;86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOromo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTigrie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuragei\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWelayita\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Statues\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparated and widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-500birr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e501-1000birr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1001\u0026ndash;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed and student\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePensioned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003e5.2: Knowledge about MDR TB\u003c/h2\u003e \u003cp\u003eTwo hundred and five (46.9%) of the study participants said they didn\u0026rsquo;t know the meaning of MDR \u003cb\u003eTB\u003c/b\u003e of which 143(32.7%) said I don\u0026rsquo;t know. Whereas 88 (20.1%) responded they know about meaning of MDR TB. Majority of respondent they didn\u0026rsquo;t know MDR TB transmitted by sneezing and coughing 377(86.1%). Majority of respondent they didn\u0026rsquo;t know MDR TB curable disease 352(82.4%). The detailed knowledge-related responses are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge about MDR TB of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you know the meaning of MDR TB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCould MDR TB come from cold\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCould MDR TB transmitted by sneezing and coughing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIs that MDR TB curable disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you smoke cigarette\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you drinking alcohol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo MDR TB transmit from over crowding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo one acquire by drinking dirty water\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA person can get MDR TB by Germs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA person can get TB by shearing Injections\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIs that possible to prevent MDR TB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIs TB curable disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec35\" class=\"Section2\"\u003e \u003ch2\u003e5.3 .Knowledge about quality of care\u003c/h2\u003e \u003cp\u003eWhen asked about whether they feel that good quality care when you came 51(11.6%) said very much, two hundred respondent (47.5%)same what and one hundred twenty six (28.8) not sure. Majority of respondent 284(64.8%) side health providers didn\u0026rsquo;t tell them about the side effects of MDR TB drugs. The detailed responses regarding knowledge and perceptions about the quality of care are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge about quality of care of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you feel that good quality care when you came\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003every much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esome what\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLittle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you feel something good when you see MDR TB patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003every much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esome what\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLittle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you hate patients because of their illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003every much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esome what\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLittle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAre you afraid of MDR TB patients because of their illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003every much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esome what\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLittle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf relative of yours become ill with MDR TB would you be willing to care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf you found that had tb would you tell to others\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo the health providers in this facility tell you about the side effects of MDR TB drugs?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo the health providers in this facility tell you about the need for sputum tests at given points during your treatment schedule?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo the health providers in this facility tell you about the duration of the MDR TB treatment?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec36\" class=\"Section2\"\u003e \u003ch2\u003e5.4. Supply or quality of drugs/laboratory reagents\u003c/h2\u003e \u003cp\u003eThree hundred respondent fifty tow (80.4%) encounter shortage of drugs and lab reagent. Majority of respondent mentioned MDR TB treatment card are partially filled 218(49.8%) and followed by not filled which is 152(34.7%). Detailed information on drug supply, laboratory reagents, and documentation practices is presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSupply or quality of drugs/laboratory reagents of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhere did you gate drugs and laboratory reagent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow you encounter shortage of drugs and lab reagent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow do you assure quality of Anti TB drugs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient cure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elooking expire date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow do you assure quality of laboratory reagents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ept cure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elooking expedite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMDR TB treatment card form\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecompletely filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epartially filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMDR TB register\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecompletely filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epartially filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRequest for sputum examination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecompletely filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epartially filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory register for culture DST filled\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecompletely filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epartially filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQuarterly report on MDR TB case finding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecompletely filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epartially filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQuarterly report on MDR TB case enrolment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecompletely filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epartially filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot filled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003e5.5. Adherence of TB patients and MDR-TB detection status.\u003c/h2\u003e \u003cp\u003eTwo hundred twenty eight (52.1%) respondent TB MDR major problem in our health facility and 209(47.8%) respondent TB MDR not major problem in our health facility. for a question related to MDRTB detection status in their health facility 236 (53.9%) side it is good and 142(32.4%) respondent side it is poor. Majority of respondent side screening of MDRTB suspects is at OPD room. Detailed findings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdherence of TB patients and MDR-TB detection status of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs TB and TBMDR major problem in your health facility\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow do you describe the trend TBMDR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreasing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreasing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow do you see adherence status or dot strategy of TB patients related\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eone day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etwo days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;three days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you encounter possible causes risk factors for adherence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eside effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStigma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow do you see MDRTB detection status in your health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhere and who do screening of MDRTB suspects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ewhatgapsweaknessesavailableinyourfacilityrelatedtoMDRTBdetection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elack of triage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elack of test facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ein appropriate result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow do you see the regimens related to TB control program in your facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003every good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you have Appropriate or new guidelines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAvailability of guidelines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdequacy of TB or MDR TB trained human resource\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommitment of professional in MDR TB detection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003every good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec38\" class=\"Section2\"\u003e \u003ch2\u003e5.6. Quality of care\u003c/h2\u003e \u003cp\u003eThis study shown that 284 (64.8%) respondent said health providers in this facility didn\u0026rsquo;t tell them when they are stop spreading MDR TB to others and 153 (34.9%) they know when they are stop spreading MDR TB to others.Regarding to importance of observed treatment 298 (68%) didn\u0026rsquo;t know the benefit of DOT. Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuality of care of the respondents to assess the quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo the health providers in this facility tell you when you stop spreading MDR TB to others?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo the health providers in this facility tell you that MDR TB can be cured?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo the health providers in this facility tell you about the importance of observed treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTransform from quality\u003c/b\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003e5.7 Association between socio-demographic characteristics and quality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa\u003c/b\u003e,\u003c/p\u003e \u003cp\u003eThe association of independent variables with quality of MDR TB cares both bivariate and multivariable analyses were done. In the bivariate analysis, sex, average monthly income, MDR TB treatment, sputum test, drug effect, Is that TB MDR curable disease, hate patients because of their illness, encounter shortage of drugs and lab reagent, assure quality of laboratory reagents, MDR TB treatment card form, encounter possible causes risk factors for adherence, screening of MDRTB suspects and regimens related to TB control program in your facility showed an association with quality of MDR TB cares at p value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 and they were candidate for multivariable logistic regression analysis. Among the variables entered to multivariable logistic regression,sex and screening of MDRTB suspects were significantly associated with quality of MDR TB cares at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThose respondents who were male [AOR: 2.062(1.289, 3.289)] were more likely to receive quality of MDR TB care as compared to respondents who are female.\u003c/p\u003e \u003cp\u003eThe majority of the respondent screening of MDRTB suspects at in patient service unit are significant [AOR: 0.528(0.33, 0.843)] more likely screened than other service unit. Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuality of MDR TB care and associated factors among multi-drug resistance in health facilities in Addis Ababa,\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eQuality of care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep. value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emean value\u0026thinsp;\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emean value\u0026thinsp;\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003esex of respondent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93(29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e225(70.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(45.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65(54.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.489, (0.322,0.768)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.062(1.289,3.289)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWere screening of MDRTB suspects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42(71.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159(72.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.932(0.493,1.763)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.551(0.274,1.107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70(44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89(56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.943(1.020,0.702)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.528(0.33,0.843)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"6 Discussion","content":"\u003cp\u003eThis study assessed the prevalence, quality of care, and health-related quality of life (HRQoL) among patients infected with multidrug-resistant tuberculosis (MDR-TB) in Addis Ababa. The findings are discussed in relation to previously published literature.\u003c/p\u003e \u003cp\u003ePrevalence of MDR-TB\u003c/p\u003e \u003cp\u003eMDR-TB remains a major global health challenge, with WHO reporting that in 2018, an estimated 10\u0026nbsp;million people suffered from TB, and approximately 1.2\u0026nbsp;million TB deaths occurred among HIV-negative individuals, with an additional 251,000 deaths among people living with HIV (WHO, 2019). The highest burden of TB occurs in South-East Asia, Africa, and the Western Pacific, with India, China, and Indonesia accounting for the largest proportion of cases (WHO, 2019).\u003c/p\u003e \u003cp\u003eRegionally, studies in Ethiopia and other high-burden settings demonstrate substantial MDR-TB prevalence. For instance, a study conducted in Axum town, Tigray region, found a prevalence of 18.5% among the study population, with rifampicin mono-resistance as a proxy for MDR-TB at 3.5%. The distribution varied by zone, with Western Zone showing the highest proportion (31%) (Axum study). Factors associated with MDR-TB occurrence included age, while sex, residence, educational status, family size, income, alcohol use, smoking, and imprisonment were not significantly associated. These findings align with global evidence highlighting the role of previous TB treatment interruptions, long treatment duration, poor follow-up, and social determinants such as HIV infection, alcohol consumption, and cigarette smoking as key drivers of MDR-TB (Gandhi et al., 2010; WHO, 2016).\u003c/p\u003e \u003cp\u003eFurthermore, studies from the Philippines emphasize the need for patient education on treatment adherence, adverse events, and misconceptions about TB to prevent delays in diagnosis and treatment and reduce treatment loss to follow-up, particularly in patients with alcohol use disorders (Philippines study, 2018).\u003c/p\u003e \u003cp\u003eQuality of Care for MDR-TB Patients\u003c/p\u003e \u003cp\u003eQuality of care is central to effective MDR-TB management and is defined as \u0026ldquo;fitness for use,\u0026rdquo; encompassing patient-centeredness, safety, equity, and effectiveness (WHO, 2016). Globally, only 25% of DR-TB patients receive appropriate treatment, reflecting both access and quality gaps (WHO, 2016). Inadequate diagnostic capacity, inappropriate drug regimens, and insufficient social support are major drivers of poor outcomes, with patient-centered care often neglected (Satyanarayana et al., 2015; Das et al., 2015).\u003c/p\u003e \u003cp\u003eThe treatment for MDR-TB is complex, involving multiple drugs over 9\u0026ndash;24 months, often including daily injectable agents associated with severe adverse effects such as permanent hearing loss (WHO, 2019). Despite updated WHO recommendations discouraging routine use of injectables, many programs continue their use due to cost considerations, contributing to poor patient experiences. In addition, oral medications also present challenges, including high pill burden and drug-related adverse events. Prior studies in India and Ethiopia indicate that DR-TB patients face staffing shortages, paternalistic healthcare provider attitudes, and lack of engagement in care, further compromising quality (Bach et al., 2019; Datta et al., 2017). These challenges highlight the need for continuous monitoring of quality of care, patient-centered interventions, and adherence to international treatment standards.\u003c/p\u003e \u003cp\u003eHealth-Related Quality of Life (HRQoL)\u003c/p\u003e \u003cp\u003eHRQoL measures the impact of disease and treatment on patients\u0026rsquo; physical, mental, and social well-being (Leidy et al., 1999; Dion et al., 2004). In chronic diseases like MDR-TB, mental and social well-being are often as critical as physical health (Sherbourne et al., 1999). MDR-TB treatment, characterized by long duration, adverse effects, and social stigma, significantly reduces HRQoL (WHO, 2011; WHO, 2015).\u003c/p\u003e \u003cp\u003ePrevious studies in low-resource settings show that HRQoL is frequently compromised among MDR-TB patients due to treatment-related adverse events, lengthy therapy, social isolation, and psychological distress (Chamla, 2004; WHO, 2013). Patients may also experience financial and social burdens, which further affect adherence and overall quality of life. Assessing HRQoL provides critical insights into the real-world impact of MDR-TB treatment and identifies areas for intervention beyond traditional clinical outcomes such as bacteriological cure or treatment completion.\u003c/p\u003e \u003cp\u003eImplications\u003c/p\u003e \u003cp\u003eThe findings of this study corroborate previous literature, indicating that MDR-TB management faces challenges related to prevalence, treatment quality, and patient well-being. Effective interventions require a holistic approach that integrates timely diagnosis, appropriate treatment regimens, psychosocial support, patient education, and routine assessment of HRQoL. These measures will improve treatment adherence, reduce morbidity and mortality, and enhance overall patient experiences.\u003c/p\u003e"},{"header":"7 Strength and Limitation of the study","content":"\u003cp\u003e \u003cb\u003e7.1 Strength of the study\u003c/b\u003e \u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eGreat attention given for data quality from data collection to analyzing by using standardized and qualified statistical soft was Epi info data and SPSS.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e Adequate sample size was applied according to double population proportion formula using epi info.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cdiv id=\"Sec41\" class=\"Section2\"\u003e \u003ch2\u003e7.2 Limitation of the study\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis study is cross sectional, where causal relationship between the independent and dependent variables cannot be established.\u003c/p\u003e \u003cp\u003eThe findings in this study may be prone to recall bias as they are based on participants\u0026rsquo; reported experiences\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"8. Conclusion and Recommendations","content":"\u003cdiv id=\"Sec43\" class=\"Section2\"\u003e \u003ch2\u003e8.1. Conclusion\u003c/h2\u003e \u003cp\u003eBased on the findings of this study, the two major dimensions of quality of care perceived as most important by MDR-TB patients are administrative quality, including patient support and availability of services, and interpersonal quality, including provider-patient interaction, communication, and information provision. Despite these strengths, notable gaps remain, such as inadequate information given to patients regarding the disease, treatment progress, and potential side effects, as well as limited facilities and psychosocial support.\u003c/p\u003e \u003cp\u003eThe prevalence and risk factors for MDR-TB, including treatment interruptions, poor follow-up, HIV co-infection, and substance use, further highlight the challenges in delivering effective care. Health-related quality of life and treatment adherence are directly affected by these gaps, emphasizing the need for more patient-centered approaches.\u003c/p\u003e \u003cp\u003eTherefore, MDR-TB control programs should prioritize patient-centered care, enhance education and communication, strengthen psychosocial support, and improve service accessibility to enhance adherence, treatment outcomes, and overall well-being of MDR-TB patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec44\" class=\"Section2\"\u003e \u003ch2\u003e8.2. Recommendations\u003c/h2\u003e \u003cp\u003eBased on our study the following recommendations are made.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFor Ministry Of Health\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn order to address the needs of MDR TB patients based on their perception of quality of care we recommend including and implementing patient centered approaches.\u003c/p\u003e \u003cp\u003eDevelop standardized training on interaction / communication skills for providers.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFor Health Facility\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEnsure easy access for patients to information about MDR TB and the treatment such as through printing media.\u003c/p\u003e \u003cp\u003eThe health facility must prepare checklist that can be used to assess the patient\u0026rsquo;s perception on the quality of services and patient satisfaction.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations:\u0026nbsp;\u003c/strong\u003eEthical approval was obtained from the Research and Ethical Review Board of the Department of Public Health, Rift Valley University, Abichu Campus. Permission to conduct the study was also obtained from the administration of ALERT Hospital, Addis Ababa, where the research was conducted. Participation in the study was voluntary. After a detailed explanation of the study objectives and procedures, written informed consent was obtained from all participants. Confidentiality and privacy of participants were maintained throughout the data collection process. All procedures were conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate Declarations:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eWe didn\u0026rsquo;t receive any funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u0026nbsp;\u003c/strong\u003eKAH, AZB and DJB conceived the study, designed the methodology, collected and analyzed data, and drafted the manuscript. All authors critically reviewed the manuscript, contributed to revisions, and approved the final version. All authors take responsibility for the accuracy and integrity of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe author extends sincere gratitude to ALERT Hospital, Addis Ababa, for allowing the study to be conducted. Appreciation is also extended to Rift Valley University, Abichu Campus, Department of Public Health, and to all study participants for their cooperation and valuable contributions.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003ePublished sources:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eAggarwal A N, 2010. Health-related quality of life: a neglected aspect of pulmonary tuberculosis. Lung India; 27: 1\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eChamla D., 2004.The assessment of patients\u0026rsquo; health-related quality of life during tuberculosis treatment in Wuhan, Int J Tuberc Lung Dis. Sep;8(9):1100-6.\u003c/li\u003e\n \u003cli\u003eCreswell, J. W., 2003. Research Design. Thousand Oaks, CA: Sage PublicationsDas J, Kwan A, Daniels B, et al., 2015. Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study. Lancet Infect Dis.;15(11):1305\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003eDeribew, A. et al., 2018. Tuberculosis Burden in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study. Published in Ethiopian Journal of Health Sciences.Sep; 28(5): 519\u0026ndash;528\u003c/li\u003e\n \u003cli\u003eDion MJ, Tousignant P, Bourbeau J, Menzies D, Schwartzman K. Feasibility and reliability of health-related quality of life measurements among tuberculosis patients. Qual Life Res. 2004;13(3):653\u0026ndash;65.\u003c/li\u003e\n \u003cli\u003eDuraisamy K, Mrithyunjayan S, Ghosh S, et al., 2014. Does alcohol consumption during multidrug-resistant tuberculosis treatment affect outcome? A population-based study in Kerala, India. Ann Am Thorac Soc.; 11: 712\u0026ndash;715.\u003c/li\u003e\n \u003cli\u003eFrieden TR, Fujiwara PI, Washko RM, Hamburg MA. Tuberculosis in New York City -- turning the tide.NEngl J Med1995;333:229-233.\u003c/li\u003e\n \u003cli\u003eGuo N, Marra F, Marra C a., 2009. Measuring health-related qualityof life in tuberculosis: a systematic review. Health Qual Life Outcomes; 7: 14.\u003c/li\u003e\n \u003cli\u003eHennessy C H,Moriarty D G, ZackMM, Scherr PA, Brackbill R., 1994. Measuring health-related quality of life for public health surveillance. Public Health Rep; 109: 665\u0026ndash;672.\u003c/li\u003e\n \u003cli\u003eLeidy NK, Revicki DA, Genest\u0026eacute; B. 1999. Recommendations for evaluating thevalidity of quality of life claims for labeling and promotion. VALUE Heal.;2(2):113.\u003c/li\u003e\n \u003cli\u003eSatyanarayana S, Subbaraman R, Shete P, et al., 2015. Quality of tuberculosis care in India: a systematic review. Int J Tuberc Lung Dis.;19(7):751\u0026ndash;63\u003c/li\u003e\n \u003cli\u003eSherbourne CD, Sturm R, Wells KB. What outcomes matter to patients? JGen Intern Med. 1999;14(6):357\u0026ndash;63.\u003c/li\u003e\n \u003cli\u003eWHO, 2015.Global tuberculosis report, 2015. WHO/HTM/TB/2015.22. Geneva, SwitzerlandWHO, 2016.Globaltuberculosis report, 2016. WHO/HTM/TB/2016.13. Geneva, Switzerland WHO, 2019.World Tuberculosis Report 2019.Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eInternet sources:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003col class=\"decimal_type\" start=\"14\"\u003e\n \u003cli\u003e\u003ccite\u003eBUSPH, 2013.Multiple Drug Resistant Tuberculosis [Retrieved: 20/12/2019]. Available at:\u0026nbsp;\u003c/cite\u003ehttp://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/MDR-TB/MDR-TB2.html\u003c/li\u003e\n \u003cli\u003eChina. Int J Tuberc Lung Dis. 2004;8:1100 [cited 2015 May 5]; Available from: http://www.ingentaconnect.com/content/iuatld/ijtld/2004/00000008/00000009/art00010.\u003c/li\u003e\n \u003cli\u003eWHO, 2011. Implement the Global Plan To Stop Tb 2011\u0026ndash;2015WHO, 2013.Definitions and reporting framework for tuberculosis \u0026ndash; 2013 revision.papers2://publication/uuid/E6143945-\u003c/li\u003e\n \u003cli\u003eWHO, 2013.Definitions and reporting framework for tuberculosis \u0026ndash; 2013 revision.papers2://publication/uuid/E6143945-51F7-485A-8C89-FAB2C7DF4F43.\u003c/li\u003e\n \u003cli\u003eWHO,2016a.http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua\u0026frac14;1 Accessed December 2019.\u003c/li\u003e\n \u003cli\u003e\u003ccite\u003e19.WHO, 2016b.\u003c/cite\u003e\u0026quot;Diagnosis and notification of multidrug-resistant TB\u0026quot;World Health Organization\u003ccite\u003e\u0026nbsp;(WHO)\u003c/cite\u003e.Retrieved December 2019\u003c/li\u003e\n \u003cli\u003ePrevalence and Factors Associated with Multidrug-ResistantTuberculosis (MDR-TB) among Presumptive MDR-TB Patients inTigray Region, Northern EthiopiaKibriti Mehari,1,2 Tsehaye Asmelash,2,3 HaftamuHailekiros ,2 Tewolde Wubayehu,3Hagos Godefay,4 Tadele Araya,2 and MuthupandianSaravanan 2\u003c/li\u003e\n \u003cli\u003eFactors Associated with Loss to Follow-up during Treatment forMultidrug-Resistant Tuberculosis,the Philippines, 2012\u0026ndash;2014\u003c/li\u003e\n \u003cli\u003eThelma E. Tupasi, Anna Marie Celina G. Garfin, Ekaterina V. Kurbatova, Joan M. Mangan,Ruth Orillaza-Chi, Leilani C. Naval, Glenn I. Balane, Ramon Basilio, Alexander Golubkov,Evelyn S. Joson, Woo-jin Lew, Vivian Lofranco, MariquitaMantala, Stuart Pancho, Jesus N. Sarol Jr\u003cstrong\u003e.\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8367521/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8367521/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMulti-drug resistant tuberculosis (MDR-TB) remains a critical public health challenge worldwide and in Ethiopia, where treatment success largely depends on the quality of care. Assessing the quality of MDR-TB services and identifying associated factors is vital for improving treatment outcomes and controlling transmission.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo assess the quality of MDR-TB care and associated factors among patients receiving treatment at ALERT Hospital, Addis Ababa, Ethiopia, in 2020.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was conducted among 294 MDR-TB patients selected using systematic random sampling. Data were collected through structured questionnaires and patient records. Descriptive statistics were used to summarize socio-demographic characteristics, knowledge, and care-related variables. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with quality of care at a 95% confidence level.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 294 respondents (96% response rate), the majority were female (72.8%) and aged 51\u0026ndash;68 years (29.9%). Knowledge about MDR-TB was generally low; only 20.1% knew its meaning, and 19.4% recognized it as a curable disease. Most respondents (64.8%) reported not being informed about drug side effects, 68.0% were not told about sputum test requirements, and 73.1% were unaware of treatment duration. Shortages of drugs and laboratory reagents were reported by 80.4%, and MDR-TB treatment cards were often partially (49.8%) or not filled (34.7%). Adherence to directly observed treatment (DOT) was poor, with transportation (51.8%) and stigma (26.9%) cited as major barriers. In multivariable analysis, male patients were more likely to receive quality care [AOR\u0026thinsp;=\u0026thinsp;2.06; 95% CI: 1.29\u0026ndash;3.29], while screening at inpatient units was significantly associated with reduced likelihood of receiving quality care [AOR\u0026thinsp;=\u0026thinsp;0.53; 95% CI: 0.33\u0026ndash;0.84].\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study revealed suboptimal quality of MDR-TB care characterized by poor patient knowledge, inadequate provider\u0026ndash;patient communication, frequent drug shortages, and incomplete patient records. Improving patient education, strengthening provider communication, ensuring uninterrupted drug and reagent supply, and adopting patient-centered approaches are essential to enhance MDR-TB care and treatment outcomes.\u003c/p\u003e","manuscriptTitle":"Quality Of Care And Associated Factors Among Patients With Multi-Drug Resistant Tuberculosis Receving Treatment In Alert Hospital Addis Ababa,Ethiopia, 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:57:34","doi":"10.21203/rs.3.rs-8367521/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0f30ab1d-a86f-495d-bf4c-925fd22efc28","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T07:25:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:57:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8367521","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8367521","identity":"rs-8367521","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}