Implementation fidelity of directly observed treatment, short-course for Tuberculosis in public health centers of Kembata Tembaro Zone, Southern Nations Nationalities and People Region, Ethiopia

Implementation fidelity of directly observed treatment, short-course for Tuberculosis in public health centers of Kembata Tembaro Zone, Southern Nations Nationalities and People Region, Ethiopia | 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 Implementation fidelity of directly observed treatment, short-course for Tuberculosis in public health centers of Kembata Tembaro Zone, Southern Nations Nationalities and People Region, Ethiopia Awoke Masrie, Tewodros Lemma Gorfu, Yisalemush Assefa, Samrawit Shawel, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4417845/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 Introduction: Ethiopia is one of 30 countries with high tuberculosis (TB) burden, with an incidence of 140 per 100,000 people. Kembata Tembaro Zone (KTZ) has lower tuberculosis case notification and treatment success rates, 60% and 82% respectively in 2019, as compared to the national and World Health Organization (WHO) targets. The aim of the present study was to evaluate the implementation fidelity of the directly observed treatment, short-course for Tuberculosis. Methods : A Multiple case study evaluation design with a mixed method was employed from May 10 to June 4, 2021. A total of 91 patients were interviewed. Similarly, a document review of 384 patients, 16 key informant interviews, and a resource inventory were conducted. The quantitative data were entered into Epi-Data (V4.0.64) and exported to Statistical Package for the Social Sciences version 26(SPSS 26) for analysis. The qualitative data were transcribed, translated, coded, categorized, and analyzed using thematic analysis. The overall implementation fidelity was measured based on the predetermined criteria. Results : The overall level of TB Direct Observed Treatment Short-course (DOTS) implementation fidelity was 73.9%, to which availability of resources (81%), provider’s adherence to the national guideline (73.1%), quality of TB DOTS delivery (75.9), and participant responsiveness contributed (63.9%). Conclusion : The overall level of implementation fidelity of TB DOTS services in the public health centers was at a low level based on the predetermined set of judgment criteria. Training should be provided to the providers, Acid-fast bacillus (AFB) reagents should be supplied, standard updated guidelines should be made available, and providers should strictly comply with the standard guidelines. There should also be a full-time assigned TB DOTS provider in the TB units. Health Policy Implementation fidelity Tuberculosis Directly Observed Treatment Short Course Kembata Tembaro Zone Introduction Mycobacterium tuberculosis (MTB), which is the causative agent of the disease TB may have killed more persons than any other microbial pathogens. TB is an infectious disease that is a significant contributor to poor health and a leading cause of death worldwide. Prior to the COVID-19 pandemic, TB was the primary cause of death caused by a single infectious agent, surpassing even HIV/AIDS( 1 , 2 ). Globally it is believed that approximately 10.6 million individuals contracted TB in 2021, representing a rise of 4.5% from the previous year's count of 10.1 million( 1 ). The incidence rate of TB increased by 3.6% from 2020 to 2021.There are 30 high TB burden countries which account for 87% of the global TB burden and 8 countries (India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh and South Africa) share 2/3rd of the total from the global burden. Africa shares 23% of the world TB incidence according to 2022 global TB report( 1 , 3 ). Ethiopia is one of the 30 high TB burden countries with an annual case detection and treatment success rate of 69% (140 per 100,000 populations) and 95% respectively. Around 0.7% of the new and 12% of the previously treated TB patients had Multidrug-Resistant Tuberculosis (MDR TB)( 4 ). As part of the world, Ethiopia has begun an effort to control TB in the early 1960s and DOTS were implemented in four pilot areas of the country since 1997( 2 , 5 ). The DOTS is an approach used to treat a TB patient in a way that is sensitive and supportive to the patient’s needs. The aim of the treatment is to cure the patient from TB, prevent death from TB disease and its late effects, prevent relapse, prevent the development of acquired drug resistance, and decrease transmission( 5 , 6 ). All TB-diagnosed patients are recommended to take their anti-TB medications under the direct observation of a treatment supporter. Ensuring adequate availability of anti TB drugs, laboratory reagents, medical supplies and equipment is needed for the successful implementation of DOTS( 6 ). A study conducted in health facilities of southern Ethiopia revealed that availability and accessibility of DOTS are determinants in a quarter of TB patients for implementation of the service( 7 ). Previous studies about the implementation status of DOTS in different parts of Ethiopia showed that service were given by professionals who were not got adequate training, incorrect prescription of anti-TB drug regimen and dose, improper sputum follow-up examination and poor patient-provider interaction were the major problems( 8 – 10 ). The annual case detection rate and treatment success rate in the study area in 2020 was 60% and 82% respectively which is lower than the country achievement (69% case detection and 95% treatment success rate ( 11 ). Even if the DOTs have been implemented in all public health centers of the study area since 1997, to our best knowledge no evaluation was conducted on the implementation status and implementation fidelity of DOTs. Therefore, this study is conducted in order to provide a full picture in the implementation of DOTs service. The study has assessed the availability of the needed resources, treatment adherence, quality of TB treatment delivery from patient’s perspective and patient’s responsiveness towards DOTS given in the health centers found in Kembata Tembaro zone, Southern Nations Nationalities and People Region, Ethiopia. Materials and methods Evaluation Design and Setting Facility based multiple case study design with a mixed method were employed and both qualitative and quantitative data were collected concurrently to evaluate the implementation fidelity of directly observed treatment of tuberculosis short course in Kembata Tembaro zone, Southern Nations, Nationalities and People’s region. The evaluation was conducted from May 10 to June 9, 2021. The cases of this study were public health centers found in Kembata Tembaro Zone. The zone has a total of 962,815 population in which females consists of 484,296. There are 10 administrative districts and the zone has one general hospital, 4 primary hospitals, 33 governmental and 3 non-governmental health centers and a total of 138 health posts. Variables and Measurements A formative evaluation approach was used to evaluate the implementation fidelity of directly observed treatment of TB. Adherence was assessed using 12 set of indicators to determine whether TB DOT providers adhere to the national TB treatment guideline. Quality of delivery was assessed using 18 set of indicators whether the TB DOT service given to patients attain some expected level of quality. Resource availability was measured using 88 set of indicators to determine whether the required essential drugs and medical supplies were supplied or not in the health facilities. Participant responsiveness was assessed by measuring the level of patient satisfaction to the TB DOT service using 8 items each containing a five-point Likert scale (1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied and 5 = very satisfied) alternatives. The overall Participant responsiveness was measured by the mean of the score given by patients on their level of satisfaction. This score was calculated with SPSS and their averages were taken to standardize and compare the present evaluation findings with other studies. Intervention complexity and facilitation strategies were measured qualitatively by interviewing the study participants. The indicators were given weight by the stakeholders before the evaluation and indicator scores were calculated by using this formula (Indicator score= \(\frac{\text{o}\text{b}\text{s}\text{e}\text{r}\text{v}\text{e}\text{d} \text{n}\text{u}\text{m}\text{b}\text{e}\text{r}\text{*}\text{i}\text{n}\text{d}\text{i}\text{c}\text{a}\text{t}\text{o}\text{r} \text{w}\text{e}\text{i}\text{g}\text{h}\text{t}}{\text{e}\text{x}\text{p}\text{e}\text{c}\text{t}\text{e}\text{d} \text{n}\text{u}\text{m}\text{b}\text{e}\text{r}}\) ). The judgment parameter was determined based on the calculated indicator score and set as high > = 85%, medium 75%-84.9%, low 60%-74.9% and poor < = 59.9%. Weight of indicators and dimensions were set as 25% for availability, 35% for adherence, 20% for quality of TB DOTS delivery and 20% for participant responsiveness. Sample size and sampling procedures For the quantitative study all medical records of TB patient who were on treatment during the evaluation period and additionally one year (July 2019 to June 2020) medical record of TB patients on unit TB register were reviewed. Moreover, all TB patients who came to the health center for DOT were interviewed and eight public health centers were assessed for availability of required resources for the service. For qualitative study, seven TB DOTS providers, s ix heads of public health centers and four district TB focal were interviewed. Among the total of 10 administrative districts (7 woredas and 3 town administrations) 50% of them were selected by a simple random sampling technique. Then 50% of health centers that are found in the selected administrative districts were selected randomly to be included in the study( 12 ). Accordingly, 8 public health centers from the administrative districts were selected. Data Collection tool and procedures The tools used to collect data were developed by referring different literatures, global and national tuberculosis treatment guidelines and recommendations ( 5 , 13 – 15 ). The tool consists of a structured questionnaire for patient exit interview, data extraction tool for document review ( S1 Table ), a checklist for resource inventory (S2 Table) and semi-structured in-depth interview guide for key informant interview. All tools were primarily developed in English, translated to Amharic, and translated back to English for consistency. Validity and reliability: validity of the data collection tool was measured by taking 5% of the sample in a health center which were not sampled in the study. Internal consistency of the results was measured across variables within the questionnaire with Cornbrash’s alpha. Accordingly, the measurement tool alpha level is in the recommended range (0.74). Four BSc nurses and two health officers were employed for data collection and supervision respectively. Training was given prior to data collection by the principal evaluator for both data collectors and supervisors for two days. Data management and analysis Quantitative data were checked for completeness and was edited, coded and entered in to Epi data (version 4.6) then exported to SPSS version 26 for analysis. Univariate analysis (including means, standard deviations, frequencies and percentages) was done and presented in tables and texts. Qualitative data were transcribed first and then translated and coded. The codes were categorized in to different categories and then thematized. Finally, the qualitative data were presented in narrative form to complement the quantitative findings. The evaluation findings were interpreted based on pre-determined judgment matrix. Additionally, the performance of each case (public health centers) was analyzed based on the collected data and displayed in table and narrate. Ethical consideration Ethical clearance was obtained from the institutional review board of Jimma University, faculty of public health with reference number JHRPGD/53/21, and permission letter were obtained from Kembata Tembaro Zone health department and from each facilities before data collection. Additionally, the study participants were informed about the purpose of the study and written informed consents (oral for clients who could not read and write) were obtained. The confidentiality of information was maintained by excluding personal identifiers, interviewing privately, and the signed consent forms are stored in lockable board. Appropriate COVID-19 preventive measures were practiced while collecting the data. Results A total of 384 TB patient records were reviewed from a unit TB register and for the smear positive pulmonary TB patient’s laboratory AFB register were reviewed to cross check whether sputum follow up tests were done at the end of 2nd, 5th and 6th month of their treatment. Among the 384 TB patients 89.6% of them reach continuation phase of treatment. More than half (51.8%) of patients were between the age 25 to 49 and 53.4% of them were males. Majority (66.9%) of TB patients are pulmonary TB patients. From the total 374(97.4%) are newly diagnosed patients ( Table 1 ). Table 1 Characteristics of TB patients recorded on unit TB register of Kembata Tembaro zone health centers, SNNPR, Ethiopia, 2021 Characteristics Frequency Percentage Age 15–24 128 33.3 25–49 185 51.8 >=50 57 14.8 Sex Male 205 53.6 Female 179 46.4 TB type Pulmonary 257 66.9 Extra pulmonary 127 33.3 Patient category New 374 97.4 Relapse 9 2.3 Treatment after failure 1 0.3 Adherence Content Among 384 TB patients 99.7% of them had received the correct anti-TB drug regimen and 96.3% of them received the correct dose during the intensive phase of treatment. However, during the continuation phase from 344 patients 87.2% and 82.8% of TB patients received the correct drug regimen and dose respectively. Nutritional assessment was done for 67.7% of TB patients and HIV test was offered for 91.7% of them ( Table 2 ) . Most of TB DOTS providers (n = 5) mentioned that there was unavailability of full time assigned DOTS providers in the TB treatment unit. One participant explained: “All health care workers whether being trained or not, gives a service in the TB unit. Therefore, most of the time professionals forget to measure the weight of the patient and even if they measure, they failed to record on unit TB register” (A 26-year-old male DOT provider). Other study participant added: “Even if the weight scale is not functional, I measure my patient’s weight in the medical OPD rooms. However, when other professionals deliver the service, they use the intensive phase measured weight” (A 25-year-old male TB DOTS Provider). Some of the key informants stated that nutritional assessment is measuring the patient’s weight. One participant expressed: “I think that assessing nutritional status of TB patient is measuring their weight during treatment initiation and at the end of 2nd month” (A 35-year-old female DOTS provider). Other study participants stated unavailability of height measuring tape is the reason why they didn’t assess their patient’s nutritional status. One participant clarified this issue: “Of course, nutritional assessment means calculating the patient’s body mass index (BMI) by measuring their weight and height, but I have no height measuring tape here in TB room” (A 36-year-old male DOTS provider). Of the individuals who were identified as having smear positive pulmonary TB, follow-up sputum examinations were conducted for 79% of them at the second month, 64.7% at the fifth month, and 66.9% at the sixth month of treatment. (Table 2 ). Failing to request for regular sputum follow up examination was observed in all of the health centers. One participant explained: “Even if I have ordered a sputum follow up request, the request paper frequently returns back without result and when I communicate with the laboratory professionals, they said there is no acid alcohol” (A 36-year-old male DOTS provider). Among 190 smear positive pulmonary TB patents drug susceptibility test was done for only 20.5% of them ( Table 2 ) . Some TB DOTS providers mentioned that they don’t know whether they have to send smear positive TB patient’s sample for drug susceptibility test or not. A participant elaborate on this issue: “I have been trained on comprehensive TB care 3 years back but no refreshment training after that and I have no idea about what drug sensitivity test is and where to send a sample” ( A 35-year-old female DOTS Provider). Frequency All 91 patients who were on treatment take their anti TB drug on daily basis without interruptions. Duration Among the 91 TB patients 5(5.5%), 77(84.6%) and 9(9.9%) of them take their daily DOTS in front of a health care provider for the first two weeks, for the intensive phase only and for both intensive & continuation phase respectively ( Table 2 ) . Table 2 Level of TB DOTS providers adherence among public health centers in Kembata Tembaro Zone, SNNPR, Ethiopia, 2021 Indicator Angecha (n, %) Funemura (n, %) Damboya (n, %) Teza (n, %) Doyogena (n, %) Durame (n, %) Hadero (n, %) Mare (n, %) Proportion of TB patient who had received standard anti TB treatment regimen during IP 38(100) 31(96.8) 49(100) 55(100) 48(100) 27(100) 89(100) 46(100) Proportion of TB patient who had received correct TB drug dose during IP 34(89.4) 31(96.8) 46(93.8) 54(98.1) 47(97.9) 27(100) 86(93.6) 45(97.8) Proportion of smear positive pulmonary TB patient for whom sputum follow up examination was done at the end of 2nd month of treatment 13(92.8) 6(42.8) 18(78.2) 55(100) 7(38.8) 6(75) 35(81.3) 24(96) Proportion of smear positive pulmonary TB patient for whom sputum follow up examination was done at the end of 5th month of treatment 11(78.5) 1( 9 ) 17(85) 23(88.4) 3( 20 ) 6(75) 14(41.1) 22(88) Proportion of smear positive pulmonary TB patient for whom sputum follow up examination was done at the end of 6th month of treatment 11(84.6) 1( 9 ) 17(85) 55(100) 1(6.6) 6(75) 15(48.3) 24(96) Proportion of TB patient whose BMI is calculated during treatment initiation 11(9.2) 6(18.7) 15(30.6) 55(100) 30(62.5) 21(77.7) 76(85.3) 46(100) Proportion of TB patients who were screened for HIV 37(97.3) 25(78.1) 45(91.8) 52(94.5) 33(68.7) 26(77.7) 88(98.8) 46(100) Proportion of pulmonary TB patient for whom drug susceptibility test was performed 0(0) 0(0) 0(0) 1(3.4) 0(0) 2( 20 ) 22(45.8) 15(93.3) Proportion of TB patients whose weight was measured at the end of IP 28(82.3) 12(50) 31(75.6) 47(97.9) 34(70.8) 20(86.9) 71(91) 44(95.6) Proportion of TB patient who had received standard anti TB treatment regimen during the continuation phase 32(91.4) 13(54.1) 34(82.9) 55(100) 37(82.2) 21(91.3) 70(85.3) 45(97.8) Proportion of TB patient who had received correct dose during the continuation phase 29(82.8) 12(50) 32(78) 45(93.7) 33(77.7) 21(91.3) 70(85.3) 43(95.5) Proportion of TB patients who had received their DOT for the intensive and continuation phase 0(0) 0(0) 0(0) 6(85.7) 0(0) 0(0) 0(0) 0(0) Overall Level of Adherence 62.17 (low) 38.8 (poor) 61.6 (low) 75 (medium) 48 (poor) 66.9 (low) 65.8 (low) 81.5 (medium) (Judgment > = 85 High levels, 75-84.9 Medium 60-74.9, Low < = 59.9 Poor) Most of DOT providers agree that appointing patients to come daily for drug collection was very difficult to them since the patients have to pay every day for transportation and the drugs also tired patients. One DOTS provider stated: “It is very exhausting for the patients to come daily for collecting drugs, therefore I will give them daily for the first two weeks then I will see their progress and appoint them to come every week by giving them a 1-week drug” (A 25-year-old male DOTS Provider). The overall level of adherence of health care providers towards the national TB treatment guideline was 73.11% which is in the low-level range as per the predetermined judgment criteria ( Table 3 ) . Table 3 Judgment Matrix for adherence sub-dimension on evaluation of TB DOTS in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021 Indicators E O W S A JP The proportion of TB patients who had received standard anti-TB treatment regimen during intensive phase 384 383 4 3.99 99.7 >=85 High level of adherence 75-84.9 Medium Level of Adherence 60-74.9 Low Level of Adherence <=59.9 Poor Level of Adherence The proportion of TB patients who had received the correct TB drug dose during intensive phase 384 370 4 3.85 96.4 The proportion of smear-positive pulmonary TB patients for whom sputum follow-up examination was done at the end of 2nd month of treatment 172 136 2 1.58 79.1 The proportion of smear-positive pulmonary TB patients for whom sputum follow-up examination was done at the end of 5th month of treatment 150 97 2 1.29 64.7 The proportion of smear positive pulmonary TB patients for whom sputum follow-up examination was done at the end of 6th month of treatment 145 97 2 1.34 66.9 Proportion of TB patients whose BMI is calculated during treatment initiation 384 260 2 1.35 67.7 The proportion of TB patients who were screened for HIV 384 352 2 1.83 91.7 Proportion of pulmonary TB patient for whom drug susceptibility test was performed 191 40 2 0.42 20.9 Proportion of TB patients whose weight was measured at the end of intensive phase 344 287 2 1.67 83.4 Proportion of TB patient who had received standard anti TB treatment regimen during the continuation phase 344 300 4 3.49 87.2 Proportion of TB patient who had received correct dose during the continuation phase 344 285 4 3.31 82.8 Proportion of TB patients who had received their DOT on daily basis 91 91 2 2 100 The proportion of TB patients who had received their DOT for the intensive and continuation phase 60 6 3 0.3 10 Overall Level of Adherence 73.1 Low *E: Expected, O: Observed, W: Weight, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) *100), JP: Judgment Parameter Moderating factors Socio demographic characteristics of Respondents A total of 91 TB patients were interviewed to assess the quality of TB DOTS delivery and the responsiveness of TB patients towards the DOTS delivered in the health centers. From 91 respondents, 51.6% of them were males. The mean age of respondents was 33.75(SD = 15.9) years and most 37.4% of the respondents were in the age group of 15 to 24. Majority (81.3%) of respondents were Protestants. Most (70.3%) of respondents were from rural and 37.4% of them can’t read and write. forty four percent of respondents were farmers by profession ( Table 4 ). Table 4 Socio-demographic characteristics of TB patients on treatment in Kembata Tembaro zone health centers, SNNPR, Ethiopia, 2021 (N = 91) Characteristics Frequency Percentage Age 15–24 34 37.4 25–34 15 16.5 35–44 20 21.9 >=45 22 24.2 Sex Male 47 51.6 Female 44 48.4 Religion Protestant 74 81.3 Orthodox 11 12.1 Muslim 5 5.5 Catholic 1 1.1 Residence Rural 64 70.3 Urban 27 29.7 Educational Status No formal Education 34 37.4 Primary 34 37.4 Secondary & above 23 25.3 Occupation Farmer 40 44 Student 30 33 Merchant 21 23 Quality of DOTS delivery Forty-four percent of patients responded that the waiting time before being served was unacceptable and 59% of them were not served by the same health care provider. Most (76%) of patients stated that they didn’t went to other health facility for TB services. A total of 43(47%) of patients were counseled on the importance of observed treatment. Sixty-nine percent of smear positive TB patients were told about the need for follow up sputum examination and 77% of them were told when the transmission stops. Around 85% of patients responded that health care providers were respectful and 62% of them mentioned that the providers listen them carefully. Fifty three percent of patients stated that the provider didn’t observe them while taking their drugs and 64% of patients close contacts were not screened for TB ( Table 5 ) . Table 5 Quality of TB DOTS delivery in public health centers found in Kembata Tembaro Zone, SNNPR, Ethiopia, 2021 Health Center Name Total Angecha (n, %) Funemura (n, %) Damboya (n, %) Teza (n, %) Doyogena (n, %) Durame (n, %) Hadero (n, %) AVAILABILITY OF TB SERVICES (n, %) Acceptability of waiting time before being served Yes 6(60) 8(53.3) 7(53.8) 4(57.1) 6(50) 3(42.8) 17(62.9) 51(56) Attended by same provider Yes 3(30) 2(13.3) 4(30.7) 2(28.5) 7(58.3) 4(57.1) 15(55.5) 37(40.6) Availability of anti TB drugs Yes 10(100) 6(40) 13(100) 7(100) 12(100) 7(100) 27(100) 82(90) Went to other facility for TB services No 7(70) 9(60) 9(69.3) 4(57.1) 10(83.3) 6(87.7) 19(70.4) 69(76) Availability of service during working hours Yes 5(50) 13(86.7) 8(61.5) 7(100) 9(75) 6(85.7) 21(77.8) 69(76) COMMUNICATION AND INFOTRMATION Counselled on when transmission stops Yes 4(50) 3(27.3) 7(87.5) 3(100) 4(80) 3(100) 23(100) 47(77) Counselled that TB is curable Yes 9(90) 9(60) 12(92.3) 7(100) 12(100) 7(100) 26(96.3) 82(90) Counselled on importance of observed treatment Yes 6(60) 6(40) 7(53.8) 4(57.1) 6(50) 3(42.8) 11(40.7) 43(47) Counselled on side effect of anti-TB drugs Yes 6(60) 8(53.3) 8(61.5) 7(100) 12(100) 7(100) 27(100) 75(82) Counselled on the need of sputum examination Yes 4(50) 7(63.6) 7(87.5) 3(100) 4(80) 3(100) 14(60.8) 42(69) Counselled on duration of treatment Yes 7(70) 6(40) 12(92.3) 7(100) 12(100) 7(100) 27(100) 78(86) PATIENT PROVIDER INTERACTION Provider treat with respect Yes 9(90) 11(73.3) 9(69.2) 7(100) 8(66.7) 7(100) 26(96.3) 77(85) Provider invite to room and offer chair Yes 9(90) 0(0) 10(76.9) 3(42.8) 0(0) 7(100) 27(100) 56(62) Provider listen carefully Yes 6(60) 5(33.3) 9(69.2) 3(42.8) 10(83.3) 4(57.1) 19(70.3) 56(62) Provider explain in a way you understand Yes 7(70) 10(66.7) 8(61.5) 5(71.4) 8(66.7) 4(57.1) 17(62.9) 59(65) Privacy respected Yes 4(40) 10(66.7) 7(53.8) 5(71.4) 7(58.3) 6(85.7) 17(62.9) 56(62) PROFESSIONAL COMPETENCE Provider observe while taking drugs Yes 6(60) 4(26.7) 6(46.1) 3(42.8) 0(0) 4(57.1) 20(74) 43(47) Provider examined your close contacts Yes 3(30) 5(33.3) 5(38.4) 3(42.8) 5(41.7) 3(42.8) 9(33.3) 33(36) Thirty-eight percent of patients weren’t invited to TB room and offered chair by the DOTS provider. As observed in many of the health centers the TB room is either a very narrow or built by a local material which is sub-standard. One participant explained: “As you have seen now the TB unit is very narrow and it can’t even accommodate more than a person at a time therefore, I only give them a drug through window like a shop keeper” (A 25-year-old male TB DOT provider). Another respondent added: “ It is very difficult to construct a new room for the TB unit from the health center budget and it is obvious that a quality service couldn’t be given in this situation” (A 42-year-old Woreda TB focal). Additionally, there is also lack of commitment among the TB DOTS providers. One study participant stated: “There is no shortage of anti TB drugs but what we encounter in frequent times is TB DOTS providers didn’t timely request the pharmacy store person using the internal facility request and report format” (A 34- year-old health center head). The overall quality of TB DOTS delivery in public health centers of Kembata Tembaro zone was 75.95% which is labeled as medium level as per the predetermined judgment criteria ( Table 6 ) . Table 6 Judgment Matrix for quality of TB DOTS delivery in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021 Indicators E O W S A JP The proportion of patients who respond that the waiting time before being served is acceptable 91 52 1 0.57 57.14 >=85 High level of DOTS delivery 75-84.9 Medium Level of DOTS delivery 60-74.9 Low Level of DOTS delivery <=59.9 Poor Level of DOTS delivery Proportion of patient who respond that they are served by the same provider 91 37 1 0.41 40.66 Proportion of patient who respond that anti-TB drugs are available when they require 91 82 1 0.9 90.11 Proportion of patient who respond that they went to other health center for TB services or treatment 91 28 1 0.31 30.77 Proportion of patient who respond that services were available during the working hours of the health center 91 69 1 0.76 75.82 The proportion of patient who respond that DOTS provider told them when they stop spreading the disease 91 70 1 0.77 76.92 Proportion of patient who respond that DOTS provider told them that TB can be cured 91 82 1 0.9 90.11 Proportion of patient who respond that DOTS provider told them about the importance of observed treatment 91 43 2 0.95 47.25 Proportion of patient who respond that the DOTS provider told them about side effects of TB drugs 91 75 1 0.82 82.42 Proportion of patient who respond that the DOTS provider told them about the need for sputum follow up tests 91 63 1 0.69 69.23 Proportion of patients who respond that the DOTS provider told them about the duration of TB treatment 91 80 1 0.88 87.91 Proportion of patient who responds that the TB care provider treat them with respect 91 77 1 0.85 84.62 The proportion of patients who respond that TB care provider invite them into the room and offered chair 91 56 1 0.62 61.54 The proportion of patient responds pond that the TB care provider listens to them carefully 91 56 1 0.62 61.54 The proportion of patient who respond that the TB care provider explains things in a way they understand 91 59 1 0.65 64.84 Proportion of patient who responds that the TB care provider respect their privacy during the examination 91 56 1 0.62 61.54 Proportion of patients who respond that the DOTS provider observed them while taking anti TB drug 91 43 2 0.95 47.25 Proportion of patients who respond that their close contacts were screened for TB in this health center 91 33 1 0.36 36.26 Overall Level of DOTS delivery 20 12.6 75.95 *E: Expected, O: Observed, W: Weight, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) *100), JP: Judgment Parameter Participant Responsiveness One third (66%) of patients were satisfied with the daily visiting of health center for treatment but 58.2% of them were satisfied with the time spent in waiting for the service. Majority (85.4%) of patients were satisfied with the availability of anti TB drugs while only 70% of them were satisfied with the availability of laboratory services when needed for sputum examination. The overall level of patient’s responsiveness towards the TB DOTS were 69.34% which is labeled as poor level according to the predetermined set of judgment criteria and it is comparable across all public health centers with the higher (77%) in Damboya health center and the lower (64.4%) in Funemura health center (Tables 7and 8) . Table 7 Level of responsiveness of TB patients to TB DOTS service in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021 Level of responsiveness Health Center Name Total (%) Angecha (%) Funemura (%) Damboya (%) Teza (%) Doyogena (%) Durame (%) Hadero (%) on the daily visiting of health center 70 71.7 77 60.7 66.7 53.5 61.1 66.2 with the working hours of TB clinic 75 71.7 78.8 71.4 72.9 60.7 73.1 72.8 with the time spent in waiting service 65 41.6 76.9 57.1 45.8 78.5 56.4 58.2 with the availability of anti TB drug 65 35 76.9 64.2 75 85.7 65.7 64.8 with the availability of laboratory service 68.7 70.4 75 83.3 75 66.6 66.3 70 with the friendliness of DOTS provider 75 75 75 67.8 66.7 82.1 82.4 76 to the providers respect 75 75 76.9 78.5 75 78.5 76.8 76.3 with the explanation of provider 67.5 75 80.7 67.8 68.7 78.5 74 73.6 Overall Responsiveness Level 70.15 64.4 77.15 68.8 68.2 73 69.4 69.1 Table 8 Judgment Matrix for participant responsiveness on TB DOTS in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021 Indicators E* O* W* S* A* Judgment Parameter Proportion of patient’s responsiveness on the daily visiting of health center for TB treatment 91 60 3 1.98 65.93 ≥ 85% = High Level of responsiveness 75% − 84.9% = Medium level of responsiveness 60% − 74.9% = Low level of responsiveness ≤ 59.9% = Poor level of responsiveness Proportion of patient’s responsiveness on the working hours of TB clinic 91 66 2 1.45 72.53 Proportion of patient’s responsiveness with the time spent in waiting for service 91 53 2 1.16 58.24 Proportion of patient’s responsiveness with the availability of anti-TB drugs 91 59 3 1.95 64.84 Proportion of patient’s responsiveness with the availability of laboratory service 91 64 3 2.11 70.33 Proportion of patient’s responsiveness with the friendliness of TB DOTS provider 91 70 2 1.54 76.92 Proportion of patient’s responsiveness with the DOTS provider respect and willingness to respond to questions 91 70 2 1.54 76.92 Proportion of patient’s responsiveness with the competence of DOTS provider 91 65 3 2.14 71.43 Overall Score of Participant Responsiveness 20 13.87 69.34 *E: Expected, O: Observed, W: Weight, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) *100) Facilitation Strategies Most Woredas (districts) give a regular supportive supervision to health centers every quarter and TB program is one of the areas of focus during supervision but there is no specific supportive supervision regarding the TB program. A 39-year-old woreda TB focal stated: "There was a quarterly meeting and supportive supervision in the TB program last year, which was organized with the assistance of the Challenge TB project. However currently, there is no organization available to organize such events, and the Woreda has insufficient funds to host them.” Another respondent added: "I have been working at the TB clinic for the past year and a half, but I have not yet receive any feedback regarding the services provided here" ( A 25-year-old DOTS provider ). There were no mechanisms to motivate the TB DOTS providers in the health centers. One of the DOTS providers explain the issue as follows "I don't receive any compensation for working at this clinic. I call patients when their treatment is interrupted, and sometimes I even pay for transportation to visit them at their home out of my own pocket" (A 29-year-old male TB DOTS provider). Intervention Complexity It is found out that most of the health centers use the national TB treatment guideline and there was no difficulty in understanding of the currently used protocols to treat patients. A TB DOTS provider mentioned: “I give the combination of RHZE drug for the first 2 months based on their weight and RH for the rest 4 months for pulmonary TB patients, but for extra pulmonary patients the duration of continuation phase may extend up to 10 months” ( A 40 -year-old female TB DOTS provider). Another participant added: “The TB medications are prepared in a kit and one kit it is enough for a patient who took 3 tabs per day and the blisters color differ for the drugs taken in the intensive and continuation phase” (A36-year-old male TB DOTS provider ). Almost all DOTS providers stated that daily DOTS provision to patients at the health center is challenging in the treatment of patients. A participant stated: “I want to follow the progress of my patients but appointing them to come daily for taking drug is very difficult as most of them are weak due to the disease and the cost of transportation is also a challenge for them” (A 26-year-old male TB DOTS provider ). A 35-year-old female DOTS provider added: Instead of appointing my patients to come daily to the health center, I give the patients drugs to the health extension worker and communicate with her about the patient’s progress Availability Human Resource: From the 8 TB DOTS providers half of them are health officers and the rest are nurses. Among the DOTS providers five of them have been trained on comprehensive TB care. Regarding experience all of them had at least 4 years of clinical experience and 3 of them had at least 2 years of experience in providing DOTS ( Table 9 ) . One of the key informant participants stated that: "Last year, we had two trained TB treatment professionals at our health center. However, both of them have left to work at the woreda hospital. We are currently providing TB treatment services with untrained health professionals" (A 27-year-old health center head). Another respondent added: “Due to shortage of budget, we couldn’t conduct refreshment training for professionals working in the TB Clinics” (A 42-year-old male woreda TB focal). Table 9 Distribution of human resource working in TB unit of Kembata Tembaro Zone health Centers, SNNPR, Ethiopia, 2021 HC name TB DOTS PROVIDER Profession Clinical experience (years) Experience in TB Clinic (years) Training Year training attended Angecha Nurse 10 1 Trained 2016 Funemura Health Officer 4 2 Trained 2018 Damboya Nurse 8 3 Trained 2019 Teza Health Officer 12 4 Trained 2020 Doyogena Nurse 10 6 Month Not trained Durame Health Officer 4 1 Not trained Hadero Health Officer 6 8 Month Not trained Mare Nurse 5 1 Trained 2020 Guideline and registrations: All public health centers had standard Unit TB and AFB registrations but there was no standard TB treatment guideline in two of them namely Doyogena and Mare health centers. One respondent described: “We have requested the woreda to give us a guideline but they reported that the guideline is not available then we have decided to copy the training manual and availed it in the TB unit” (A 34-year-old male head of health center). Drugs and Medical Supplies: Anti TB drugs were available in all of the public health centers but AFB reagent specifically acid alcohol were stock out in the past one month in two of the public health centers namely Doyogena and Mare health centers. Functional adult weight scale is available only in three of the public health center TB clinics namely Teza, Durame and Hadero health centers. A 45-year-old male woreda TB focal stated: “Previously there were NGO’s that supply reagents and other medical supplies but now no one is supporting the TB program and there is a frequent interruption of reagents in the health centers”. Additionally, there is a problem for availing reagents as stated by one of the health centers head: “Reagents especially acid alcohol is the frequently reported shortage and buying this reagent from market is possible but there is an issue of quality in the reagents that it is not guaranteed” ( A 34-year-old male health center head). The overall level of availability in the public health centers of Kembata Tembaro zone is 81% which is labeled as medium level as per the predetermined set of judgment criteria ( Table 10 ) . Table 10 Judgment Matrix for TB DOTS service resource availability in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021 Indicator E O W S A Judgment Parameter Proportion of health center with trained DOT provider 8 5 3 1.9 62.5 ≥ 85% = High Level 75% − 84.9% = Medium level 60% − 74.9% = Low level ≤ 59.9% = Poor Proportion of health center with TB treatment providing unit available 8 8 3 3 100 Proportion of health center with no stock out of anti TB drugs in the past 1-month period 8 8 3 3 100 Proportion of health center with no stock out of AFB reagent in the past 1- month period 8 6 4 3 75 Proportion of health center with functional adult weight scale in the TB unit 8 3 3 1.1 37.5 Proportion of health center with AFB registration 8 8 3 3 100 Proportion of health center with standard unit TB register 8 8 3 3 100 Proportion of health center with standard treatment guideline 8 6 3 2.25 75 Overall Score of Availability 25 20.25 81 *E: Expected, O: Observed, W: Weight, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) *100) Discussion The present evaluation findings shows that the overall level of fidelity of implementation in public health centers of Kembata Tembaro zone was at low level (73.9%) based on the judgment parameter. The adherence of health care providers to the national TB treatment guideline was at low level (73.1%) and the quality of TB treatment delivery was at medium level (75.95%). TB patient’s responsiveness towards the TB treatment service received was at low level (69.4%) and the availability of needed resources for TB treatment provision was at medium level (81.2%). Adherence: The national guideline recommends that an appropriate anti TB regimen with the correct dosage should be prescribed to all TB patients( 5 ). In line with this the current study shows almost all (99.7%) patients receive a correct drugs regimen during their intensive phase of treatment and more than eight in ten (87.2%) of patients during the continuation phase. This might be due to the easily understandable current treatment protocol and preparation of anti TB drugs in a combined form. This finding is comparable with the study conducted in south Asia which states around 90% of patients received a correct drug regimen( 16 ). Another study conducted in health facilities of Bahir Dar city administration also shows 94.4% of patients get the correct anti-TB drug regimen( 17 ). In addition to this the current study revealed that 96.3% and 82.8% of TB patients received a correct anti-TB drug dosage during their intensive and continuation phase respectively. This finding is comparable with a study conducted in Limmu genet district hospital, Oromia region which is 86.8% on both phases( 18 ). The current finding was lower than the study in south Asia, which is 100% during both phases of treatment. This difference might be due to the study conducted in south Asia has an inpatient TB care unit unlike our study setting. However the present study finding is higher than a study conducted in public health facilities of Southwest Ethiopia which is 91% during intensive and 52.7% during continuation phase ( 19 ). This difference might be due to the difference in the study setting, sample size, and method. Our study uses both qualitative and quantitative method, whereas the study in south west uses only quantitative method. Our study showed that sputum follow up examination for smear positive pulmonary TB patients were done at 2nd month of treatment for 79%, at 5th month 64.7%, and at 6th month for 66.9% of patients. However, the national TB treatment guideline recommends that AFB microscopy examination should be requested to all bacteriologically confirmed TB patients at the end of 2nd, 5th and 6th month of treatment( 5 ). The difference observed in the current study might be due to the absence of full time assigned trained health care provider in the TB units and due to the interruption of acid alcohol reagent. Another study conducted in public health facilities of Southern Nations Nationalities and Peoples Region showed that sputum smear examination was done for 63.8% at 2nd month, 18.4% at 5th month, and 17.8% at 6th month of treatment which is far below the finding of the current study( 20 ). The finding of the current study also shows a better result than the study in Limmu genet, Oromia region which states that only 55% of patients had sputum examination at the end of intensive phase( 18 ). The existence of the discrepancy might be due to different in study setting and method. Previous study only uses facilities from rural area where as our study uses both facility which have better access interms of human and material resource. It is recommended in the national guideline that all TB patients should be screened for HIV at the time of treatment initiation( 5 ). In the current study more than nine in ten (92%) of patients offered an HIV test and this might be due to the assignment of untrained health care providers in the TB unit. The current study finding is comparable with the study done in Nepal which is 91.5%( 21 ). Studies conducted in public health facilities of Debre tabor town, East Wollega and Wolaita Sodo zone shows an approximate result of 98.9%, 96% and 98% of patients screening for HIV respectively( 9 , 22 , 23 ). The national TB treatment guideline recommends that all pulmonary smear positive TB patients should get drug susceptibility tests( 5 ). In contrary with this, our evaluation showed that DST was done only for one fifth of pulmonary smear positive patients. This discrepancy might be due to knowledge gap of the TB DOTS providers due to lack of refreshment training. Findings from this study shows around 83% of patients weight was measured at the start of continuation phase of treatment. However, it is recommended in the national TB treatment guideline that all TB patient’s weight should be measured and kept on the proper drug dose at the end of intensive phase treatment( 5 ). This difference might be due to the lack of functional weight measuring scale in the TB unit and lack of commitment among the health care providers. The current study finding is comparable with the study done in South west Ethiopia which is 82.7% and higher than the finding of a study conducted in Debre tabor town which is 63% ( 19 , 22 ). This discrepancy might be because of the existence of differences in study period and sample size. Our evaluation showed that 73.11% of TB DOTS services were implemented in line with the national standards and revealed that many of the services were not consistent with the national guideline recommendations. Moderators Quality of TB DOT delivery The national TB treatment guideline recommends that TB care providers should be caring, respectful and compassionated while providing the service to all TB patients. In our study around 62% of patients were invited in to the room and offered chair by the TB DOT providers and this finding is congruent with the study done in Bahir Dar city administration which reported that 67% clients were invited to room offered chair ( 17 ). However, this is much lower than a study conducted in public health facilities of Ilu Aba Bor Zone which is 95.4%( 24 ). This difference might be due to the sub-standard level of TB units in most of the health centers in the current study area and difference in the compassionate care between health care providers. The current study shows about 47.3% of TB patients were told about the importance of observed treatment which is lower than a study conducted in Bahir Dar city administration and Ilu Aba Bor Zone which is 59.9% and 59.6% respectively ( 17 , 24 ). This discrepancy might be due to difference in measurement of the variable. In our study the variable was measured both in self-report and direct observation however, the study in Bahir Dar and Ilu Aba Bor uses only one of them. The present study revealed 64.8% of patients respond TB care provider explains things in a way they understand and this is lower than the study conducted in health facilities of North Shewa which was reported as 88.9% ( 25 ). The discrepancy might be due to the number of trained TB DOTS providers and the number of samples used in the studies. The overall quality of TB DOT services was 75.9%, which is medium and needs improvement. Participant Responsiveness Finding from our evaluation reveals that patient’s satisfaction towards the working hour appropriateness was 72.8% which is in line with the finding of the study conducted in North Shewa ( 25 ). Other study conducted in Ilu Aba Bor zone also shows an approximate result which reported 79%( 24 ). According to this study patients’ rate towards the respect given by the health care providers is 77% which is higher than both the study conducted in North Shewa and Ilu Aba Bor zone which was 72.5% and 67.9% respectively ( 24 , 25 ). This difference might be due to the study setting and out study included only health centers in which load of clients are less as compared to the study conducted in the Ilu Aba Bor zone which includes both health center and hospitals. Another reason might be due to the difference in delivering compassionate care among TB DOTS providers. In this study, patients’ satisfaction on the waiting time before being served is 58.2% which is congruent with the study conducted in Bahir Dar city which was 56.2% ( 17 ) but lower than a study done in North Shewa and Ilu Aba Bor Zone which were 74% and 77.8% respectively ( 24 , 25 ). The existence of the discrepancy might be due to the absence of full time assigned TB DOTS provider in the health centers. The other finding of the present study shows patients satisfaction towards the competence of TB DOTS provider is 71% which is lower than the study conducted in North Shewa Zone and Bahir Dar City administration which were 75% and 83.3% respectively ( 17 , 25 ). The difference might be due to the studies conducted in North Shewa and Bahir Dar included both health centers and hospitals where a service was delivered with advanced health professionals. Another reason could be due to the difference in the sample size used in the studies. Moreover, the findings showed extra pulmonary TB patients were more likely associated with dissatisfaction than pulmonary TB patients. This may be due to the long duration of treatment among the EPTB patients and the additional ancillary drugs prescribed for them. The satisfaction of patients with the overall TB DOT services was 69%, which is low and needs improvement. Availability of resources The findings of our evaluation showed that TB treatment unit, anti-TB drugs, AFB registers and unit TB registers were 100% available in the public health centers which is congruent with the guideline recommendation( 26 ). Other finding from this evaluation showed more than half of the public health centers had no functional adult weight scale in TB room. The national TB treatment guideline recommends an adequate and uninterrupted supply of reagents as part of programmatic activities to achieve sustainable program implementation( 5 ). The unavailability of AFB reagent was due to the phase out of the NGO that used to supply the public health centers and the issue of guarantee on the commercially available reagents. Moreover, TB DOTS were given by untrained professionals in more than one third of public health centers. This was due to turnover of trained professionals and the absence refreshment training due to budget shortage. This finding is lower than the service availability and readiness assessment conducted in public health facilities of Ethiopia which showed 71% of health centers has at least one trained health care provider on TB DOTS( 13 ). All of the health centers have a separate room for TB treatment but only two of them had a standard TB unit with a waiting room. World Health Organization (WHO) and Ethiopian Food and Drug Authority (EFDA) recommends that TB room should be at least located in 8 square meter, windows as large as a minimum of 150*200cm in an opposite direction to each other and wall as high as 2.5 meter. Accordingly, most (75%) of the health centers in the current study are below the standard and this might be because of COVID-19 pandemic demanded significant attention and resources, program managers were gave less attention to program which was true for other programs too, leading to inadequate resource allocation and infrastructure ( 5 , 14 ). The present evaluation revealed that one of the constraints in the provision of TB treatment is lack of necessary resources which had an implication that the service provision was below the required amount for targeted beneficiaries. Limitation of the study One of the limitations faced in this study were since the study were conducted at the health center level patients might respond in a relative positive way, social desirability bias, by fearing of being recognized. This issue was addressed by ensuring them that their response is only for research purpose. The other limitation was the difficulty in extracting the required data from a unit TB register since many of the recorded data were not recorded completely. This issue was mitigated by reviewing additional registers like laboratory AFB register and by methodological triangulation. Conclusion Resources for TB DOTS service are moderately available, but there is a shortage of trained health care providers and frequent stock outs of AFB reagents. Additionally, functional adult weight scales are not available at TB units. Adherence to DOTS provider guidelines is low, with substandard patient sputum follow up examinations, nutritional assessments, drug susceptibility tests, and weight monitoring. The study found that the quality of TB DOTS delivery is moderate. Specifically, patients were not always attended by the same provider, not consistently counseled on the importance of observed treatment or the need for sputum examination, and providers did not dedicate enough time to actively listen to their patients. Our study found a low level of patient responsiveness to the provided DOTS service. Patients reported dissatisfaction with the daily visits to the health center for TB treatment, long wait times, and patients perceived the DOTS providers as incompetent. The results of this evaluation can guide decision makers at various levels to address the specific problem areas and take appropriate action. Abbreviations AFB Acid-fast bacillus DOT Direct observed treatment DOTS Direct Observed Treatment Short-course HIV Human Immunodeficiency Virus MDR-TB Multidrug-Resistant Tuberculosis MTB Multidrug-Resistant Tuberculosis SNNPR፡ Southern Nations Nationalities and People Region TB Tuberculosis WHO World Health Organization. Declarations Acknowledgment We are very grateful to Jimma University for its technical and financial support. We would also like to thank Kembata Tembaro Zone health department staffs and all of the study participants who participated in this evaluation for their information and commitment. Our appreciation also goes to the data collectors and supervisors for their unreserved contribution. Authors’ contributions TL, developed the proposal, carried out data collection, conducted the analysis, was involved in reviewing the manuscript and had full access to all the data in the study and had final responsibility for the decision to submit for publication. BME and YS provided general guidance in overall study progress and participated in reviewing the proposal, reviewing the analysis and participating in final study document development. SS, AT, and TG participated in data collection management. AM and TL in analyzing the data and reviewing the manuscript draft. AM writes the first draft of the manuscript. All authors read and approved the final manuscript and are accountable for all aspects of the work. Funding This study did not receive any specific funding from external agencies. Nonetheless, the study budget was supported by the postgraduate school at Jimma University. It is important to note that the university did not have any involvement in the study design or conceptualization. Availability of data and materials Data will be available upon request from the corresponding authors. Disclosure All authors declared that they have no competing interest. References World Health organization (2022) Global tuberculosis report 2022. 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TB, TB/HIV Guideline 6th dition. 2017;(November) Additional Declarations The authors declare no competing interests. Supplementary Files Supplemetary1.docx Supplemetary2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4417845","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":302253007,"identity":"1a39c9c0-341f-494c-9aa3-334307bad965","order_by":0,"name":"Awoke Masrie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYHACZhjF+ABI8fCRooXZAKSFjXgtDAxsEmCSkHr+GcmHDT7m2NmbtzMfq/yaYyfDxsD88NENPFokbqQlJ87clpw45zBb2m3ZbclAh7EZG+fgs+Z2jvFh3m3MCRLMPGa3JbcxA7XwsEnj0yIP0vJ3W729BDP/t2LJbfWEtRgAtSQzbjvMOANoPuPHbYcJazG8/yzZsHfb8cQZzGzG0ozbjvOwMRPwi9yZw4clfm6rtpfgP/zwI4jBz9788DFe7yMDZh4wSaxyEGD8QYrqUTAKRsEoGDEAAM81QJKOm1X3AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0002-6648-5787","institution":"School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar","correspondingAuthor":true,"prefix":"","firstName":"Awoke","middleName":"","lastName":"Masrie","suffix":""},{"id":302255623,"identity":"198f70ec-7670-470c-a49f-5b63aba1a7d7","order_by":1,"name":"Tewodros Lemma Gorfu","email":"","orcid":"","institution":"Organization for social services health and Development (OSSHD)","correspondingAuthor":false,"prefix":"","firstName":"Tewodros","middleName":"Lemma","lastName":"Gorfu","suffix":""},{"id":302255624,"identity":"c9de46ab-3502-4d20-bb18-a71dc1d1c6d4","order_by":2,"name":"Yisalemush Assefa","email":"","orcid":"","institution":"Department of health policy and Management, public health faculty, Institute of Health Jimma University, Jimma, Oromia, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Yisalemush","middleName":"","lastName":"Assefa","suffix":""},{"id":302255625,"identity":"65eb932f-24db-40c4-8021-d0f910c9937b","order_by":3,"name":"Samrawit Shawel","email":"","orcid":"","institution":"School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar","correspondingAuthor":false,"prefix":"","firstName":"Samrawit","middleName":"","lastName":"Shawel","suffix":""},{"id":302255626,"identity":"a44954df-0454-4a5d-ae60-286cab633afe","order_by":4,"name":"Aklilu Tamire","email":"","orcid":"","institution":"School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar","correspondingAuthor":false,"prefix":"","firstName":"Aklilu","middleName":"","lastName":"Tamire","suffix":""},{"id":302255627,"identity":"9c9ad871-26e5-4f13-8a01-e4f0978ff870","order_by":5,"name":"Tilaye Gebru","email":"","orcid":"","institution":"School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Tilaye","middleName":"","lastName":"Gebru","suffix":""},{"id":302257315,"identity":"97e2b302-81c4-4e2a-aa3c-58733965eb7a","order_by":6,"name":"Berhane Megerssa Ereso","email":"","orcid":"","institution":"Department of health policy and Management, public health faculty, Institute of Health Jimma University, Jimma, Oromia, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Berhane","middleName":"Megerssa","lastName":"Ereso","suffix":""}],"badges":[],"createdAt":"2024-05-14 08:54:12","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4417845/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4417845/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56540150,"identity":"eec85156-bcf7-44f0-bd6b-b2cc2e2bcbeb","added_by":"auto","created_at":"2024-05-15 14:07:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1439711,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4417845/v1/4819dba9-65df-4d6e-954e-9233d416b4e6.pdf"},{"id":56539750,"identity":"86fd6072-8524-4055-ba82-3fac4e470792","added_by":"auto","created_at":"2024-05-15 13:59:14","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16318,"visible":true,"origin":"","legend":"","description":"","filename":"Supplemetary1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4417845/v1/543f13311c7f87521d7b9c22.docx"},{"id":56539751,"identity":"3f364160-ff32-47e1-9bb8-54ffbcd113ff","added_by":"auto","created_at":"2024-05-15 13:59:14","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15822,"visible":true,"origin":"","legend":"","description":"","filename":"Supplemetary2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4417845/v1/a0c6305deddec192f96b9997.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eImplementation fidelity of directly observed treatment, short-course for Tuberculosis in public health centers of Kembata Tembaro Zone, Southern Nations Nationalities and People Region, Ethiopia\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMycobacterium tuberculosis (MTB), which is the causative agent of the disease TB may have killed more persons than any other microbial pathogens. TB is an infectious disease that is a significant contributor to poor health and a leading cause of death worldwide. Prior to the COVID-19 pandemic, TB was the primary cause of death caused by a single infectious agent, surpassing even HIV/AIDS(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Globally it is believed that approximately 10.6\u0026nbsp;million individuals contracted TB in 2021, representing a rise of 4.5% from the previous year's count of 10.1\u0026nbsp;million(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The incidence rate of TB increased by 3.6% from 2020 to 2021.There are 30 high TB burden countries which account for 87% of the global TB burden and 8 countries (India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh and South Africa) share 2/3rd of the total from the global burden. Africa shares 23% of the world TB incidence according to 2022 global TB report(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEthiopia is one of the 30 high TB burden countries with an annual case detection and treatment success rate of 69% (140 per 100,000 populations) and 95% respectively. Around 0.7% of the new and 12% of the previously treated TB patients had Multidrug-Resistant Tuberculosis (MDR TB)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). As part of the world, Ethiopia has begun an effort to control TB in the early 1960s and DOTS were implemented in four pilot areas of the country since 1997(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The DOTS is an approach used to treat a TB patient in a way that is sensitive and supportive to the patient\u0026rsquo;s needs. The aim of the treatment is to cure the patient from TB, prevent death from TB disease and its late effects, prevent relapse, prevent the development of acquired drug resistance, and decrease transmission(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). All TB-diagnosed patients are recommended to take their anti-TB medications under the direct observation of a treatment supporter. Ensuring adequate availability of anti TB drugs, laboratory reagents, medical supplies and equipment is needed for the successful implementation of DOTS(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A study conducted in health facilities of southern Ethiopia revealed that availability and accessibility of DOTS are determinants in a quarter of TB patients for implementation of the service(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious studies about the implementation status of DOTS in different parts of Ethiopia showed that service were given by professionals who were not got adequate training, incorrect prescription of anti-TB drug regimen and dose, improper sputum follow-up examination and poor patient-provider interaction were the major problems(\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe annual case detection rate and treatment success rate in the study area in 2020 was 60% and 82% respectively which is lower than the country achievement (69% case detection and 95% treatment success rate (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Even if the DOTs have been implemented in all public health centers of the study area since 1997, to our best knowledge no evaluation was conducted on the implementation status and implementation fidelity of DOTs. Therefore, this study is conducted in order to provide a full picture in the implementation of DOTs service. The study has assessed the availability of the needed resources, treatment adherence, quality of TB treatment delivery from patient\u0026rsquo;s perspective and patient\u0026rsquo;s responsiveness towards DOTS given in the health centers found in Kembata Tembaro zone, Southern Nations Nationalities and People Region, Ethiopia.\u003c/p\u003e"},{"header":"Materials and methods Evaluation Design and Setting","content":"\u003cp\u003eFacility based multiple case study design with a mixed method were employed and both qualitative and quantitative data were collected concurrently to evaluate the implementation fidelity of directly observed treatment of tuberculosis short course in Kembata Tembaro zone, Southern Nations, Nationalities and People\u0026rsquo;s region. The evaluation was conducted from May 10 to June 9, 2021. The cases of this study were public health centers found in Kembata Tembaro Zone.\u003c/p\u003e \u003cp\u003eThe zone has a total of 962,815 population in which females consists of 484,296. There are 10 administrative districts and the zone has one general hospital, 4 primary hospitals, 33 governmental and 3 non-governmental health centers and a total of 138 health posts.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eVariables and Measurements\u003c/h2\u003e \u003cp\u003eA formative evaluation approach was used to evaluate the implementation fidelity of directly observed treatment of TB. Adherence was assessed using 12 set of indicators to determine whether TB DOT providers adhere to the national TB treatment guideline. Quality of delivery was assessed using 18 set of indicators whether the TB DOT service given to patients attain some expected level of quality. Resource availability was measured using 88 set of indicators to determine whether the required essential drugs and medical supplies were supplied or not in the health facilities.\u003c/p\u003e \u003cp\u003e Participant responsiveness was assessed by measuring the level of patient satisfaction to the TB DOT service using 8 items each containing a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;very dissatisfied, 2\u0026thinsp;=\u0026thinsp;dissatisfied, 3\u0026thinsp;=\u0026thinsp;neutral, 4\u0026thinsp;=\u0026thinsp;satisfied and 5\u0026thinsp;=\u0026thinsp;very satisfied) alternatives. The overall Participant responsiveness was measured by the mean of the score given by patients on their level of satisfaction. This score was calculated with SPSS and their averages were taken to standardize and compare the present evaluation findings with other studies. Intervention complexity and facilitation strategies were measured qualitatively by interviewing the study participants.\u003c/p\u003e \u003cp\u003eThe indicators were given weight by the stakeholders before the evaluation and indicator scores were calculated by using this formula (Indicator score=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\text{o}\\text{b}\\text{s}\\text{e}\\text{r}\\text{v}\\text{e}\\text{d} \\text{n}\\text{u}\\text{m}\\text{b}\\text{e}\\text{r}\\text{*}\\text{i}\\text{n}\\text{d}\\text{i}\\text{c}\\text{a}\\text{t}\\text{o}\\text{r} \\text{w}\\text{e}\\text{i}\\text{g}\\text{h}\\text{t}}{\\text{e}\\text{x}\\text{p}\\text{e}\\text{c}\\text{t}\\text{e}\\text{d} \\text{n}\\text{u}\\text{m}\\text{b}\\text{e}\\text{r}}\\)\u003c/span\u003e\u003c/span\u003e). The judgment parameter was determined based on the calculated indicator score and set as high\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;85%, medium 75%-84.9%, low 60%-74.9% and poor\u0026thinsp;\u0026lt;\u0026thinsp;=\u0026thinsp;59.9%. Weight of indicators and dimensions were set as 25% for availability, 35% for adherence, 20% for quality of TB DOTS delivery and 20% for participant responsiveness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample size and sampling procedures\u003c/h2\u003e \u003cp\u003eFor the quantitative study all medical records of TB patient who were on treatment during the evaluation period and additionally one year (July 2019 to June 2020) medical record of TB patients on unit TB register were reviewed. Moreover, all TB patients who came to the health center for DOT were interviewed and eight public health centers were assessed for availability of required resources for the service. For qualitative study, seven TB DOTS providers, \u003cb\u003es\u003c/b\u003eix heads of public health centers and four district TB focal were interviewed.\u003c/p\u003e \u003cp\u003eAmong the total of 10 administrative districts (7 woredas and 3 town administrations) 50% of them were selected by a simple random sampling technique. Then 50% of health centers that are found in the selected administrative districts were selected randomly to be included in the study(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Accordingly, 8 public health centers from the administrative districts were selected.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection tool and procedures\u003c/h3\u003e\n\u003cp\u003eThe tools used to collect data were developed by referring different literatures, global and national tuberculosis treatment guidelines and recommendations (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The tool consists of a structured questionnaire for patient exit interview, data extraction tool for document review (\u003cb\u003eS1 Table\u003c/b\u003e), a checklist for resource inventory \u003cb\u003e(S2 Table)\u003c/b\u003e and semi-structured in-depth interview guide for key informant interview. All tools were primarily developed in English, translated to Amharic, and translated back to English for consistency.\u003c/p\u003e \u003cp\u003eValidity and reliability: validity of the data collection tool was measured by taking 5% of the sample in a health center which were not sampled in the study. Internal consistency of the results was measured across variables within the questionnaire with Cornbrash\u0026rsquo;s alpha. Accordingly, the measurement tool alpha level is in the recommended range (0.74). Four BSc nurses and two health officers were employed for data collection and supervision respectively. Training was given prior to data collection by the principal evaluator for both data collectors and supervisors for two days.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eQuantitative data were checked for completeness and was edited, coded and entered in to Epi data (version 4.6) then exported to SPSS version 26 for analysis. Univariate analysis (including means, standard deviations, frequencies and percentages) was\u003c/p\u003e \u003cp\u003edone and presented in tables and texts. Qualitative data were transcribed first and then translated and coded. The codes were categorized in to different categories and then thematized. Finally, the qualitative data were presented in narrative form to complement the quantitative findings. The evaluation findings were interpreted based on pre-determined judgment matrix. Additionally, the performance of each case (public health centers) was analyzed based on the collected data and displayed in table and narrate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e Ethical clearance was obtained from the institutional review board of Jimma University, faculty of public health with reference number JHRPGD/53/21, and permission letter were obtained from Kembata Tembaro Zone health department and from each facilities before data collection. Additionally, the study participants were informed about the purpose of the study and written informed consents (oral for clients who could not read and write) were obtained. The confidentiality of information was maintained by excluding personal identifiers, interviewing privately, and the signed consent forms are stored in lockable board. Appropriate COVID-19 preventive measures were practiced while collecting the data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 384 TB patient records were reviewed from a unit TB register and for the smear positive pulmonary TB patient\u0026rsquo;s laboratory AFB register were reviewed to cross check whether sputum follow up tests were done at the end of 2nd, 5th and 6th month of their treatment. Among the 384 TB patients 89.6% of them reach continuation phase of treatment. More than half (51.8%) of patients were between the age 25 to 49 and 53.4% of them were males. Majority (66.9%) of TB patients are pulmonary TB patients. From the total 374(97.4%) are newly diagnosed patients \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003eCharacteristics of TB patients recorded on unit TB register of Kembata Tembaro zone health centers, SNNPR, Ethiopia, 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTB type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtra pulmonary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePatient category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNew\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreatment after failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAdherence\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eContent\u003c/h2\u003e \u003cp\u003eAmong 384 TB patients 99.7% of them had received the correct anti-TB drug regimen and 96.3% of them received the correct dose during the intensive phase of treatment. However, during the continuation phase from 344 patients 87.2% and 82.8% of TB patients received the correct drug regimen and dose respectively. Nutritional assessment was done for 67.7% of TB patients and HIV test was offered for 91.7% of them \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eMost of TB DOTS providers (n\u0026thinsp;=\u0026thinsp;5) mentioned that there was unavailability of full time assigned DOTS providers in the TB treatment unit. One participant explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;All health care workers whether being trained or not, gives a service in the TB unit. Therefore, most of the time professionals forget to measure the weight of the patient and even if they measure, they failed to record on unit TB register\u0026rdquo; (A 26-year-old male DOT provider).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOther study participant added:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Even if the weight scale is not functional, I measure my patient\u0026rsquo;s weight in the medical OPD rooms. However, when other professionals deliver the service, they use the intensive phase measured weight\u0026rdquo; (A 25-year-old male TB DOTS Provider).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome of the key informants stated that nutritional assessment is measuring the patient\u0026rsquo;s weight. One participant expressed:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think that assessing nutritional status of TB patient is measuring their weight during treatment initiation and at the end of 2nd month\u0026rdquo; (A 35-year-old female DOTS provider).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOther study participants stated unavailability of height measuring tape is the reason why they didn\u0026rsquo;t assess their patient\u0026rsquo;s nutritional status. One participant clarified this issue:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Of course, nutritional assessment means calculating the patient\u0026rsquo;s body mass index (BMI) by measuring their weight and height, but I have no height measuring tape here in TB room\u0026rdquo; (A 36-year-old male DOTS provider).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOf the individuals who were identified as having smear positive pulmonary TB, follow-up sputum examinations were conducted for 79% of them at the second month, 64.7% at the fifth month, and 66.9% at the sixth month of treatment. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFailing to request for regular sputum follow up examination was observed in all of the health centers. One participant explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Even if I have ordered a sputum follow up request, the request paper frequently returns back without result and when I communicate with the laboratory professionals, they said there is no acid alcohol\u0026rdquo; (A 36-year-old male DOTS provider).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAmong 190 smear positive pulmonary TB patents drug susceptibility test was done for only 20.5% of them \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Some TB DOTS providers mentioned that they don\u0026rsquo;t know whether they have to send smear positive TB patient\u0026rsquo;s sample for drug susceptibility test or not. A participant elaborate on this issue:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I have been trained on comprehensive TB care 3 years back but no refreshment training after that and I have no idea about what drug sensitivity test is and where to send a sample\u0026rdquo; ( A 35-year-old female DOTS Provider).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFrequency\u003c/h2\u003e \u003cp\u003eAll 91 patients who were on treatment take their anti TB drug on daily basis without interruptions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDuration\u003c/h2\u003e \u003cp\u003eAmong the 91 TB patients 5(5.5%), 77(84.6%) and 9(9.9%) of them take their daily DOTS in front of a health care provider for the first two weeks, for the intensive phase only and for both intensive \u0026amp; continuation phase respectively \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\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\u003eLevel of TB DOTS providers adherence among public health centers in Kembata Tembaro Zone, SNNPR, Ethiopia, 2021\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=\"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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAngecha (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFunemura (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDamboya (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTeza (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDoyogena (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDurame (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHadero (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMare (n, %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patient who had received standard anti TB treatment regimen during IP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(96.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e89(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e46(100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patient who had received correct TB drug dose during IP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(96.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46(93.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54(98.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47(97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e86(93.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45(97.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of smear positive pulmonary TB patient for whom sputum follow up examination was done at the end of 2nd month of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(92.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e24(96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of smear positive pulmonary TB patient for whom sputum follow up examination was done at the end of 5th month of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(78.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23(88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14(41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e22(88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of smear positive pulmonary TB patient for whom sputum follow up examination was done at the end of 6th month of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15(48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e24(96)\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 \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"9\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patient whose BMI is calculated during treatment initiation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(9.2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(18.7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(30.6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55(100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30(62.5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21(77.7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e76(85.3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e46(100)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patients who were screened for HIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(91.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52(94.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33(68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26(77.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e88(98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e46(100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of pulmonary TB patient for whom drug susceptibility test was performed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22(45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15(93.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patients whose weight was measured at the end of IP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(82.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47(97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34(70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20(86.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e71(91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e44(95.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patient who had received standard anti TB treatment regimen during the continuation phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(91.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34(82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37(82.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21(91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70(85.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45(97.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patient who had received correct dose during the continuation phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45(93.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33(77.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21(91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70(85.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e43(95.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patients who had received their DOT for the intensive and continuation phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Level of Adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.17 (low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.8 (poor)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.6 (low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75 (medium)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48 (poor)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e66.9 (low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e65.8 (low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e81.5 (medium)\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(Judgment\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;85 High levels, 75-84.9 Medium 60-74.9, Low\u0026thinsp;\u0026lt;\u0026thinsp;=\u0026thinsp;59.9 Poor)\u003c/p\u003e \u003cp\u003eMost of DOT providers agree that appointing patients to come daily for drug collection was very difficult to them since the patients have to pay every day for transportation and the drugs also tired patients. One DOTS provider stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It is very exhausting for the patients to come daily for collecting drugs, therefore I will give them daily for the first two weeks then I will see their progress and appoint them to come every week by giving them a 1-week drug\u0026rdquo; (A 25-year-old male DOTS Provider).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe overall level of adherence of health care providers towards the national TB treatment guideline was 73.11% which is in the low-level range as per the predetermined judgment criteria \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\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\u003eJudgment Matrix for adherence sub-dimension on evaluation of TB DOTS in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eJP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of TB patients who had received standard anti-TB treatment regimen during intensive phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e99.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003e\u0026gt;=85 High level of adherence\u003c/p\u003e \u003cp\u003e75-84.9 Medium Level of Adherence\u003c/p\u003e \u003cp\u003e\u003cb\u003e60-74.9 Low Level of Adherence\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026lt;=59.9 Poor Level of Adherence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of TB patients who had received the correct TB drug dose during intensive phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of smear-positive pulmonary TB patients for whom sputum follow-up examination was done at the end of 2nd month of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e79.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of smear-positive pulmonary TB patients for whom sputum follow-up examination was done at the end of 5th month of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e64.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of smear positive pulmonary TB patients for whom sputum follow-up examination was done at the end of 6th month of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e66.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patients whose BMI is calculated during treatment initiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.35\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e67.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of TB patients who were screened for HIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of pulmonary TB patient for whom drug susceptibility test was performed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patients whose weight was measured at the end of intensive phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e83.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patient who had received standard anti TB treatment regimen during the continuation phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patient who had received correct dose during the continuation phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e82.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of TB patients who had received their DOT on daily basis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of TB patients who had received their DOT for the intensive and continuation phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Level of Adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e73.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e*E: Expected, O: Observed, W: Weight, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) *100), JP: Judgment Parameter\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=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eModerating factors\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eSocio demographic characteristics of Respondents\u003c/h2\u003e \u003cp\u003eA total of 91 TB patients were interviewed to assess the quality of TB DOTS delivery and the responsiveness of TB patients towards the DOTS delivered in the health centers. From 91 respondents, 51.6% of them were males. The mean age of respondents was 33.75(SD\u0026thinsp;=\u0026thinsp;15.9) years and most 37.4% of the respondents were in the age group of 15 to 24. Majority (81.3%) of respondents were Protestants. Most (70.3%) of respondents were from rural and 37.4% of them can\u0026rsquo;t read and write. forty four percent of respondents were farmers by profession \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003eSocio-demographic characteristics of TB patients on treatment in Kembata Tembaro zone health centers, SNNPR, Ethiopia, 2021 (N\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.7\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 \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\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 \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary \u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\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 \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eQuality of DOTS delivery\u003c/h2\u003e \u003cp\u003eForty-four percent of patients responded that the waiting time before being served was unacceptable and 59% of them were not served by the same health care provider. Most (76%) of patients stated that they didn\u0026rsquo;t went to other health facility for TB services. A total of 43(47%) of patients were counseled on the importance of observed treatment. Sixty-nine percent of smear positive TB patients were told about the need for follow up sputum examination and 77% of them were told when the transmission stops. Around 85% of patients responded that health care providers were respectful and 62% of them mentioned that the providers listen them carefully. Fifty three percent of patients stated that the provider didn\u0026rsquo;t observe them while taking their drugs and 64% of patients close contacts were not screened for TB \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\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\u003eQuality of TB DOTS delivery in public health centers found in Kembata Tembaro Zone, SNNPR, Ethiopia, 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"15\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"11\" nameend=\"c13\" namest=\"c3\"\u003e \u003cp\u003eHealth Center Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c15\" namest=\"c14\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAngecha (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFunemura (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDamboya (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTeza (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eDoyogena (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eDurame (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eHadero (n, %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eAVAILABILITY OF TB SERVICES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e(n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcceptability of waiting time before being served\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e6(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e3(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e17(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e51(56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttended by same provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e7(58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e15(55.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e37(40.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailability of anti TB drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e12(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e27(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e82(90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWent to other facility for TB services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(69.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e10(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e6(87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e19(70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e69(76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailability of service during working hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e9(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e6(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e21(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e69(76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCOMMUNICATION AND INFOTRMATION\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselled on when transmission stops\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e4(80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e23(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e47(77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselled that TB is curable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e9(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e12(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e26(96.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e82(90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselled on importance of observed treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e6(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e3(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e11(40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e43(47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselled on side effect of anti-TB drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e12(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e27(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e75(82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselled on the need of sputum examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7(63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e4(80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e14(60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e42(69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselled on duration of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e12(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e27(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e78(86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePATIENT PROVIDER INTERACTION\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvider treat with respect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11(73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e26(96.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e77(85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvider invite to room and offer chair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e27(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e56(62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvider listen carefully\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e19(70.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e56(62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvider explain in a way you understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e17(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e59(65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivacy respected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e6(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e17(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e56(62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePROFESSIONAL COMPETENCE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvider observe while taking drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e20(74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e43(47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvider examined your close contacts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e3(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e9(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e33(36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThirty-eight percent of patients weren\u0026rsquo;t invited to TB room and offered chair by the DOTS provider. As observed in many of the health centers the TB room is either a very narrow or built by a local material which is sub-standard. One participant explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;As you have seen now the TB unit is very narrow and it can\u0026rsquo;t even accommodate more than a person at a time therefore, I only give them a drug through window like a shop keeper\u0026rdquo;\u003c/em\u003e (A 25-year-old male TB DOT provider).\u003c/p\u003e \u003cp\u003eAnother respondent added:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIt is very difficult to construct a new room for the TB unit from the health center budget and it is obvious that a quality service couldn\u0026rsquo;t be given in this situation\u0026rdquo;\u003c/em\u003e (A 42-year-old Woreda TB focal).\u003c/p\u003e \u003cp\u003eAdditionally, there is also lack of commitment among the TB DOTS providers. One study participant stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There is no shortage of anti TB drugs but what we encounter in frequent times is TB DOTS providers didn\u0026rsquo;t timely request the pharmacy store person using the internal facility request and report format\u0026rdquo;\u003c/em\u003e (A 34- year-old health center head).\u003c/p\u003e \u003cp\u003eThe overall quality of TB DOTS delivery in public health centers of Kembata Tembaro zone was 75.95% which is labeled as medium level as per the predetermined judgment criteria \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cb\u003e)\u003c/b\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\u003eJudgment Matrix for quality of TB DOTS delivery in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eJP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of patients who respond that the waiting time before being served is acceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"18\" rowspan=\"19\"\u003e \u003cp\u003e\u0026gt;=85 High level of DOTS delivery\u003c/p\u003e \u003cp\u003e\u003cb\u003e75-84.9 Medium Level of DOTS delivery\u003c/b\u003e\u003c/p\u003e \u003cp\u003e60-74.9 Low Level of DOTS delivery\u003c/p\u003e \u003cp\u003e\u0026lt;=59.9 Poor Level of DOTS delivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who respond that they are served by the same provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who respond that anti-TB drugs are available when they require\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who respond that they went to other health center for TB services or treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who respond that services were available during the working hours of the health center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of patient who respond that DOTS provider told them when they stop spreading the disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who respond that DOTS provider told them that TB can be cured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who respond that DOTS provider told them about the importance of observed treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who respond that the DOTS provider told them about side effects of TB drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who respond that the DOTS provider told them about the need for sputum follow up tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patients who respond that the DOTS provider told them about the duration of TB treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who responds that the TB care provider treat them with respect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of patients who respond that TB care provider invite them into the room and offered chair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of patient responds pond that the TB care provider listens to them carefully\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe proportion of patient who respond that the TB care provider explains things in a way they understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient who responds that the TB care provider respect their privacy during the examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patients who respond that the DOTS provider observed them while taking anti TB drug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patients who respond that their close contacts were screened for TB in this health center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Level of DOTS delivery\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 \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e12.6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e75.95\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e*E: Expected, O: Observed, W: Weight, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) *100), JP: Judgment Parameter\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=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Responsiveness\u003c/h2\u003e \u003cp\u003eOne third (66%) of patients were satisfied with the daily visiting of health center for treatment but 58.2% of them were satisfied with the time spent in waiting for the service. Majority (85.4%) of patients were satisfied with the availability of anti TB drugs while only 70% of them were satisfied with the availability of laboratory services when needed for sputum examination. The overall level of patient\u0026rsquo;s responsiveness towards the TB DOTS were 69.34% which is labeled as poor level according to the predetermined set of judgment criteria and it is comparable across all public health centers with the higher (77%) in Damboya health center and the lower (64.4%) in Funemura health center \u003cb\u003e(Tables\u0026nbsp;7and 8)\u003c/b\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\u003eLevel of responsiveness of TB patients to TB DOTS service in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021\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=\"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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" 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\u003eLevel of responsiveness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eHealth Center Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAngecha (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFunemura (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDamboya (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTeza (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDoyogena (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDurame (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHadero (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eon the daily visiting of health center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e66.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewith the working hours of TB clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e73.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e72.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewith the time spent in waiting service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e56.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e58.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewith the availability of anti TB drug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e65.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e64.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewith the availability of laboratory service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e66.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e66.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewith the friendliness of DOTS provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e82.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e82.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eto the providers respect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e76.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e76.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewith the explanation of provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e73.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Responsiveness Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e69.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \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\u003eJudgment Matrix for participant responsiveness on TB DOTS in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eE*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eO*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eW*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eS*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eJudgment Parameter\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient\u0026rsquo;s responsiveness on the daily visiting of health center for TB treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;85% = High Level of responsiveness\u003c/p\u003e \u003cp\u003e75% \u0026minus;\u0026thinsp;84.9% =\u003c/p\u003e \u003cp\u003eMedium\u003c/p\u003e \u003cp\u003elevel of responsiveness\u003c/p\u003e \u003cp\u003e\u003cb\u003e60% \u0026minus;\u0026thinsp;74.9% =\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eLow level of responsiveness\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026le;\u0026thinsp;59.9% = Poor level of responsiveness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient\u0026rsquo;s responsiveness on the working hours of TB clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient\u0026rsquo;s responsiveness with the time spent in waiting for service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient\u0026rsquo;s responsiveness with the availability of anti-TB drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient\u0026rsquo;s responsiveness with the availability of laboratory service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient\u0026rsquo;s responsiveness with the friendliness of TB DOTS provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient\u0026rsquo;s responsiveness with the DOTS provider respect and willingness to respond to questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of patient\u0026rsquo;s responsiveness with the competence of DOTS provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Score of Participant Responsiveness\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 \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e69.34\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e*E: Expected, O: Observed, W: Weight, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) *100)\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=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFacilitation Strategies\u003c/h2\u003e \u003cp\u003eMost Woredas (districts) give a regular supportive supervision to health centers every quarter and TB program is one of the areas of focus during supervision but there is no specific supportive supervision regarding the TB program.\u003c/p\u003e \u003cp\u003eA 39-year-old woreda TB focal stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"There was a quarterly meeting and supportive supervision in the TB program last year, which was organized with the assistance of the Challenge TB project. However currently, there is no organization available to organize such events, and the Woreda has insufficient funds to host them.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother respondent added:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I have been working at the TB clinic for the past year and a half, but I have not yet receive any feedback regarding the services provided here\" (\u003c/em\u003eA 25-year-old DOTS provider\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThere were no mechanisms to motivate the TB DOTS providers in the health centers. One of the DOTS providers explain the issue as follows\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I don't receive any compensation for working at this clinic. I call patients when their treatment is interrupted, and sometimes I even pay for transportation to visit them at their home out of my own pocket\"\u003c/em\u003e (A 29-year-old male TB DOTS provider).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eIntervention Complexity\u003c/h2\u003e \u003cp\u003e It is found out that most of the health centers use the national TB treatment guideline and there was no difficulty in understanding of the currently used protocols to treat patients.\u003c/p\u003e \u003cp\u003eA TB DOTS provider mentioned:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I give the combination of RHZE drug for the first 2 months based on their weight and RH for the rest 4 months for pulmonary TB patients, but for extra pulmonary patients the duration of continuation phase may extend up to 10 months\u0026rdquo;\u003c/em\u003e ( A 40 -year-old female TB DOTS provider).\u003c/p\u003e \u003cp\u003eAnother participant added:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The TB medications are prepared in a kit and one kit it is enough for a patient who took 3 tabs per day and the blisters color differ for the drugs taken in the intensive and continuation phase\u0026rdquo;\u003c/em\u003e (A36-year-old male TB DOTS provider\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAlmost all DOTS providers stated that daily DOTS provision to patients at the health center is challenging in the treatment of patients. A participant stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I want to follow the progress of my patients but appointing them to come daily for taking drug is very difficult as most of them are weak due to the disease and the cost of transportation is also a challenge for them\u0026rdquo;\u003c/em\u003e (A 26-year-old male TB DOTS provider\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eA 35-year-old female DOTS provider added:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eInstead of appointing my patients to come daily to the health center, I give the patients drugs to the health extension worker and communicate with her about the patient\u0026rsquo;s progress\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eAvailability\u003c/h2\u003e \u003cp\u003eHuman Resource: From the 8 TB DOTS providers half of them are health officers and the rest are nurses. Among the DOTS providers five of them have been trained on comprehensive TB care. Regarding experience all of them had at least 4 years of clinical experience and 3 of them had at least 2 years of experience in providing DOTS \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eOne of the key informant participants stated that:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Last year, we had two trained TB treatment professionals at our health center. However, both of them have left to work at the woreda hospital. We are currently providing TB treatment services with untrained health professionals\"\u003c/em\u003e (A 27-year-old health center head).\u003c/p\u003e \u003cp\u003eAnother respondent added:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Due to shortage of budget, we couldn\u0026rsquo;t conduct refreshment training for professionals working in the TB Clinics\u0026rdquo;\u003c/em\u003e (A 42-year-old male woreda TB focal).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of human resource working in TB unit of Kembata Tembaro Zone health Centers, SNNPR, Ethiopia, 2021\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHC name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eTB DOTS PROVIDER\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical experience (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExperience in TB Clinic (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTraining\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eYear training attended\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngecha\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunemura\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDamboya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoyogena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 Month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot trained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDurame\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot trained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHadero\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 Month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot trained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e Guideline and registrations: All public health centers had standard Unit TB and AFB registrations but there was no standard TB treatment guideline in two of them namely Doyogena and Mare health centers. One respondent described:\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We have requested the woreda to give us a guideline but they reported that the guideline is not available then we have decided to copy the training manual and availed it in the TB unit\u0026rdquo;\u003c/em\u003e (A 34-year-old male head of health center).\u003c/p\u003e \u003cp\u003eDrugs and Medical Supplies: Anti TB drugs were available in all of the public health centers but AFB reagent specifically acid alcohol were stock out in the past one month in two of the public health centers namely Doyogena and Mare health centers. Functional adult weight scale is available only in three of the public health center TB clinics namely Teza, Durame and Hadero health centers.\u003c/p\u003e \u003cp\u003eA 45-year-old male woreda TB focal stated: \u003cem\u003e\u0026ldquo;Previously there were NGO\u0026rsquo;s that supply reagents and other medical supplies but now no one is supporting the TB program and there is a frequent interruption of reagents in the health centers\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAdditionally, there is a problem for availing reagents as stated by one of the health centers head: \u003cem\u003e\u0026ldquo;Reagents especially acid alcohol is the frequently reported shortage and buying this reagent from market is possible but there is an issue of quality in the reagents that it is not guaranteed\u0026rdquo;\u003c/em\u003e ( A 34-year-old male health center head).\u003c/p\u003e \u003cp\u003eThe overall level of availability in the public health centers of Kembata Tembaro zone is 81% which is labeled as medium level as per the predetermined set of judgment criteria \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eJudgment Matrix for TB DOTS service resource availability in public health centers of Kembata Tembaro Zone, SNNPR, Ethiopia, 2021\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eJudgment Parameter\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of health center with trained DOT provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;85% = High Level\u003c/p\u003e \u003cp\u003e\u003cb\u003e75% \u0026minus;\u0026thinsp;84.9% =\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eMedium\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003elevel\u003c/b\u003e\u003c/p\u003e \u003cp\u003e60% \u0026minus;\u0026thinsp;74.9% =\u003c/p\u003e \u003cp\u003eLow level\u003c/p\u003e \u003cp\u003e\u0026le;\u0026thinsp;59.9% = Poor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of health center with TB treatment providing unit available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of health center with no stock out of anti TB drugs in the past 1-month period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of health center with no stock out of AFB reagent in the past 1- month period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of health center with functional adult weight scale in the TB unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of health center with AFB registration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of health center with standard unit TB register\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of health center with standard treatment guideline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Score of Availability\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 \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e*E: Expected, O: Observed, W: Weight, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) *100)\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":"Discussion","content":"\u003cp\u003eThe present evaluation findings shows that the overall level of fidelity of implementation in public health centers of Kembata Tembaro zone was at low level (73.9%) based on the judgment parameter. The adherence of health care providers to the national TB treatment guideline was at low level (73.1%) and the quality of TB treatment delivery was at medium level (75.95%). TB patient\u0026rsquo;s responsiveness towards the TB treatment service received was at low level (69.4%) and the availability of needed resources for TB treatment provision was at medium level (81.2%).\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eAdherence:\u003c/h2\u003e \u003cp\u003eThe national guideline recommends that an appropriate anti TB regimen with the correct dosage should be prescribed to all TB patients(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In line with this the current study shows almost all (99.7%) patients receive a correct drugs regimen during their intensive phase of treatment and more than eight in ten (87.2%) of patients during the continuation phase. This might be due to the easily understandable current treatment protocol and preparation of anti TB drugs in a combined form. This finding is comparable with the study conducted in south Asia which states around 90% of patients received a correct drug regimen(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Another study conducted in health facilities of Bahir Dar city administration also shows 94.4% of patients get the correct anti-TB drug regimen(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to this the current study revealed that 96.3% and 82.8% of TB patients received a correct anti-TB drug dosage during their intensive and continuation phase respectively. This finding is comparable with a study conducted in Limmu genet district hospital, Oromia region which is 86.8% on both phases(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The current finding was lower than the study in south Asia, which is 100% during both phases of treatment. This difference might be due to the study conducted in south Asia has an inpatient TB care unit unlike our study setting. However the present study finding is higher than a study conducted in public health facilities of Southwest Ethiopia which is 91% during intensive and 52.7% during continuation phase (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This difference might be due to the difference in the study setting, sample size, and method. Our study uses both qualitative and quantitative method, whereas the study in south west uses only quantitative method.\u003c/p\u003e \u003cp\u003eOur study showed that sputum follow up examination for smear positive pulmonary TB patients were done at 2nd month of treatment for 79%, at 5th month 64.7%, and at 6th month for 66.9% of patients. However, the national TB treatment guideline recommends that AFB microscopy examination should be requested to all bacteriologically confirmed TB patients at the end of 2nd, 5th and 6th month of treatment(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The difference observed in the current study might be due to the absence of full time assigned trained health care provider in the TB units and due to the interruption of acid alcohol reagent. Another study conducted in public health facilities of Southern Nations Nationalities and Peoples Region showed that sputum smear examination was done for 63.8% at 2nd month, 18.4% at 5th month, and 17.8% at 6th month of treatment which is far below the finding of the current study(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The finding of the current study also shows a better result than the study in Limmu genet, Oromia region which states that only 55% of patients had sputum examination at the end of intensive phase(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The existence of the discrepancy might be due to different in study setting and method. Previous study only uses facilities from rural area where as our study uses both facility which have better access interms of human and material resource.\u003c/p\u003e \u003cp\u003eIt is recommended in the national guideline that all TB patients should be screened for HIV at the time of treatment initiation(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In the current study more than nine in ten (92%) of patients offered an HIV test and this might be due to the assignment of untrained health care providers in the TB unit. The current study finding is comparable with the study done in Nepal which is 91.5%(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Studies conducted in public health facilities of Debre tabor town, East Wollega and Wolaita Sodo zone shows an approximate result of 98.9%, 96% and 98% of patients screening for HIV respectively(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe national TB treatment guideline recommends that all pulmonary smear positive TB patients should get drug susceptibility tests(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In contrary with this, our evaluation showed that DST was done only for one fifth of pulmonary smear positive patients. This discrepancy might be due to knowledge gap of the TB DOTS providers due to lack of refreshment training.\u003c/p\u003e \u003cp\u003eFindings from this study shows around 83% of patients weight was measured at the start of continuation phase of treatment. However, it is recommended in the national TB treatment guideline that all TB patient\u0026rsquo;s weight should be measured and kept on the proper drug dose at the end of intensive phase treatment(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This difference might be due to the lack of functional weight measuring scale in the TB unit and lack of commitment among the health care providers. The current study finding is comparable with the study done in South west Ethiopia which is 82.7% and higher than the finding of a study conducted in Debre tabor town which is 63% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This discrepancy might be because of the existence of differences in study period and sample size.\u003c/p\u003e \u003cp\u003e Our evaluation showed that 73.11% of TB DOTS services were implemented in line with the national standards and revealed that many of the services were not consistent with the national guideline recommendations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eModerators\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eQuality of TB DOT delivery\u003c/strong\u003e \u003cp\u003e The national TB treatment guideline recommends that TB care providers should be caring, respectful and compassionated while providing the service to all TB patients. In our study around 62% of patients were invited in to the room and offered chair by the TB DOT providers and this finding is congruent with the study done in Bahir Dar city administration which reported that 67% clients were invited to room offered chair (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). However, this is much lower than a study conducted in public health facilities of Ilu Aba Bor Zone which is 95.4%(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This difference might be due to the sub-standard level of TB units in most of the health centers in the current study area and difference in the compassionate care between health care providers.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe current study shows about 47.3% of TB patients were told about the importance of observed treatment which is lower than a study conducted in Bahir Dar city administration and Ilu Aba Bor Zone which is 59.9% and 59.6% respectively (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This discrepancy might be due to difference in measurement of the variable. In our study the variable was measured both in self-report and direct observation however, the study in Bahir Dar and Ilu Aba Bor uses only one of them.\u003c/p\u003e \u003cp\u003eThe present study revealed 64.8% of patients respond TB care provider explains things in a way they understand and this is lower than the study conducted in health facilities of North Shewa which was reported as 88.9% (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The discrepancy might be due to the number of trained TB DOTS providers and the number of samples used in the studies. The overall quality of TB DOT services was 75.9%, which is medium and needs improvement.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eParticipant Responsiveness\u003c/strong\u003e \u003cp\u003eFinding from our evaluation reveals that patient\u0026rsquo;s satisfaction towards the working hour appropriateness was 72.8% which is in line with the finding of the study conducted in North Shewa (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Other study conducted in Ilu Aba Bor zone also shows an approximate result which reported 79%(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). According to this study patients\u0026rsquo; rate towards the respect given by the health care providers is 77% which is higher than both the study conducted in North Shewa and Ilu Aba Bor zone which was 72.5% and 67.9% respectively (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This difference might be due to the study setting and out study included only health centers in which load of clients are less as compared to the study conducted in the Ilu Aba Bor zone which includes both health center and hospitals. Another reason might be due to the difference in delivering compassionate care among TB DOTS providers.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eIn this study, patients\u0026rsquo; satisfaction on the waiting time before being served is 58.2% which is congruent with the study conducted in Bahir Dar city which was 56.2% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) but lower than a study done in North Shewa and Ilu Aba Bor Zone which were 74% and 77.8% respectively (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The existence of the discrepancy might be due to the absence of full time assigned TB DOTS provider in the health centers. The other finding of the present study shows patients satisfaction towards the competence of TB DOTS provider is 71% which is lower than the study conducted in North Shewa Zone and Bahir Dar City administration which were 75% and 83.3% respectively (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The difference might be due to the studies conducted in North Shewa and Bahir Dar included both health centers and hospitals where a service was delivered with advanced health professionals. Another reason could be due to the difference in the sample size used in the studies.\u003c/p\u003e \u003cp\u003eMoreover, the findings showed extra pulmonary TB patients were more likely associated with dissatisfaction than pulmonary TB patients. This may be due to the long duration of treatment among the EPTB patients and the additional ancillary drugs prescribed for them. The satisfaction of patients with the overall TB DOT services was 69%, which is low and needs improvement.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAvailability of resources\u003c/strong\u003e \u003cp\u003eThe findings of our evaluation showed that TB treatment unit, anti-TB drugs, AFB registers and unit TB registers were 100% available in the public health centers which is congruent with the guideline recommendation(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Other finding from this evaluation showed more than half of the public health centers had no functional adult weight scale in TB room.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe national TB treatment guideline recommends an adequate and uninterrupted supply of reagents as part of programmatic activities to achieve sustainable program implementation(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The unavailability of AFB reagent was due to the phase out of the NGO that used to supply the public health centers and the issue of guarantee on the commercially available reagents.\u003c/p\u003e \u003cp\u003eMoreover, TB DOTS were given by untrained professionals in more than one third of public health centers. This was due to turnover of trained professionals and the absence refreshment training due to budget shortage. This finding is lower than the service availability and readiness assessment conducted in public health facilities of Ethiopia which showed 71% of health centers has at least one trained health care provider on TB DOTS(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll of the health centers have a separate room for TB treatment but only two of them had a standard TB unit with a waiting room. World Health Organization (WHO) and Ethiopian Food and Drug Authority (EFDA) recommends that TB room should be at least located in 8 square meter, windows as large as a minimum of 150*200cm in an opposite direction to each other and wall as high as 2.5 meter. Accordingly, most (75%) of the health centers in the current study are below the standard and this might be because of COVID-19 pandemic demanded significant attention and resources, program managers were gave less attention to program which was true for other programs too, leading to inadequate resource allocation and infrastructure (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe present evaluation revealed that one of the constraints in the provision of TB treatment is lack of necessary resources which had an implication that the service provision was below the required amount for targeted beneficiaries.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eLimitation of the study\u003c/h2\u003e \u003cp\u003eOne of the limitations faced in this study were since the study were conducted at the health center level patients might respond in a relative positive way, social desirability bias, by fearing of being recognized. This issue was addressed by ensuring them that their response is only for research purpose. The other limitation was the difficulty in extracting the required data from a unit TB register since many of the recorded data were not recorded completely. This issue was mitigated by reviewing additional registers like laboratory AFB register and by methodological triangulation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eResources for TB DOTS service are moderately available, but there is a shortage of trained health care providers and frequent stock outs of AFB reagents. Additionally, functional adult weight scales are not available at TB units. Adherence to DOTS provider guidelines is low, with substandard patient sputum follow up examinations, nutritional assessments, drug susceptibility tests, and weight monitoring. The study found that the quality of TB DOTS delivery is moderate. Specifically, patients were not always attended by the same provider, not consistently counseled on the importance of observed treatment or the need for sputum examination, and providers did not dedicate enough time to actively listen to their patients.\u003c/p\u003e \u003cp\u003eOur study found a low level of patient responsiveness to the provided DOTS service. Patients reported dissatisfaction with the daily visits to the health center for TB treatment, long wait times, and patients perceived the DOTS providers as incompetent. The results of this evaluation can guide decision makers at various levels to address the specific problem areas and take appropriate action.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAFB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcid-fast bacillus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDOT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDirect observed treatment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDOTS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDirect Observed Treatment Short-course\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDR-TB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMultidrug-Resistant Tuberculosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMTB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMultidrug-Resistant Tuberculosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSNNPR፡ Southern Nations Nationalities and People Region\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTuberculosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are very grateful to Jimma University for its technical and financial support. We would also like to thank\u0026nbsp;Kembata Tembaro Zone health department staffs\u0026nbsp;and all of the study participants who participated in this evaluation for their information and commitment. Our appreciation also goes to the data collectors and supervisors for their unreserved contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTL, developed the proposal, carried out data collection, conducted the analysis, was involved in reviewing the manuscript and had full access to all the data in the study and had final responsibility for the decision to submit for publication. BME and YS provided general guidance in overall study progress and participated in reviewing the proposal, reviewing the analysis and participating in final study document development. SS, AT, and TG participated in data collection management. AM and TL in analyzing the data and reviewing the manuscript draft. AM writes the first draft of the manuscript. All authors read and approved the final manuscript and are accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific funding from external agencies. Nonetheless, the study budget was supported by the postgraduate school at Jimma University. It is important to note that the university did not have any involvement in the study design or conceptualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be available upon request from the corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declared that they have no competing interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health organization (2022) Global tuberculosis report 2022. Geneva: Licence: CC BY-NC-SA 3.0 IGO\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas M, Daniel (2006) The history of tuberculosis. Respir Med 100(11):1862\u0026ndash;1870\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2020) Global tuberculosis report 2020. Geneva: Licence: CC BY-NC-SA 3.0 IGO\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2019) Global tuberculosis report 2019. Geneva. Geneva: CC BY-NC-SA 3.0 IGO\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFederal Ministry of Health Ethiopia (2017) National guidelines for TB, DR-TB and Leprosy in Ethiopia, 6th edn. Ministry of health, Addis Ababa\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFederal Ministry of Health Ethiopia. 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Indo Am J Pharm Res. ;7(02)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalkew A et al (2020) Quality of Care Delivered to Tuberculosis Patients among Public Hospitals in Central Northeast Ethiopia. Ethiop J Health Sci 30(5):671\u0026ndash;680\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTB_ TB HIV 6th FMoH. TB, TB/HIV Guideline 6th dition. 2017;(November)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"Implementation fidelity, Tuberculosis, Directly Observed Treatment Short Course, Kembata Tembaro Zone","lastPublishedDoi":"10.21203/rs.3.rs-4417845/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4417845/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eEthiopia is one of 30 countries with high tuberculosis (TB) burden, with an incidence of 140 per 100,000 people. Kembata Tembaro Zone (KTZ) has lower tuberculosis case notification and treatment success rates, 60% and 82% respectively in 2019, as compared to the national and World Health Organization (WHO) targets. The aim of the present study was to evaluate the implementation fidelity of the directly observed treatment, short-course for Tuberculosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A Multiple case study evaluation design with a mixed method was employed from May 10 to June 4, 2021. A total of 91 patients were interviewed. Similarly, a document review of 384 patients, 16 key informant interviews, and a resource inventory were conducted. The quantitative data were entered into Epi-Data (V4.0.64) and exported to Statistical Package for the Social Sciences version 26(SPSS 26) for analysis. The qualitative data were transcribed, translated, coded, categorized, and analyzed using thematic analysis. The overall implementation fidelity was measured based on the predetermined criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The overall level of TB Direct Observed Treatment Short-course (DOTS) implementation fidelity was 73.9%, to which availability of resources (81%), provider’s adherence to the national guideline (73.1%), quality of TB DOTS delivery (75.9), and participant responsiveness contributed (63.9%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The overall level of implementation fidelity of TB DOTS services in the public health centers was at a low level based on the predetermined set of judgment criteria. Training should be provided to the providers, Acid-fast bacillus (AFB) reagents should be supplied, standard updated guidelines should be made available, and providers should strictly comply with the standard guidelines. There should also be a full-time assigned TB DOTS provider in the TB units.\u003c/p\u003e","manuscriptTitle":"Implementation fidelity of directly observed treatment, short-course for Tuberculosis in public health centers of Kembata Tembaro Zone, Southern Nations Nationalities and People Region, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-15 13:59:10","doi":"10.21203/rs.3.rs-4417845/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":"33d1d501-74f1-40e7-9feb-14de6406c8c1","owner":[],"postedDate":"May 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":31890075,"name":"Health Policy"}],"tags":[],"updatedAt":"2024-05-15T13:59:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-15 13:59:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4417845","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4417845","identity":"rs-4417845","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}