title: Knowledge and perception of pulmonary tuberculosis in pastoral communities in the middle and Lower Awash Valley of Afar region, Ethiopia.
abstract: BACKGROUND
  Afar pastoralists live in the northeast of Ethiopia, confined to the most arid part of the country, where there is least access to educational, health and other social services. Tuberculosis (TB) is one of the major public health problems in Afar region. Lack of knowledge about TB could affect the health-seeking behaviour of patients and sustain the transmission of the disease within the community. In this study, we assessed the knowledge and perception of apparently healthy individuals about pulmonary tuberculosis (PTB) in pastoral communities of Afar.
  
  
  METHODS
  Between March and May 2009, a community-based cross-sectional questionnaire survey involving 818 randomly selected healthy individuals was conducted in pastoral communities of Afar region. Moreover, two focus group discussions (FGDs), one with men and one with women, were conducted in each of the study area to supplement the quantitative study.
  
  
  RESULTS
  The majority (95.6%) of the interviewees reported that they have heard about PTB (known locally as "Labadore"). However, the participants associated the cause of PTB with exposure to cold air (45.9%), starvation (38%), dust (21.8%) or smoking/chewing Khat (Catha edulis) (16.4%). The discussants also suggested these same factors as the cause of PTB. All the discussants and the majority (74.3%) of the interviewees reported that persistent cough as the main symptom of PTB. About 87.7% of the interviewees and all the discussants suggested that PTB is treatable with modern drugs. All the discussants and the majority (95%) of the interviewees mentioned that the disease can be transmitted from a patient to another person. Socio-cultural practices, e.g. sharing cups (87.6%), and house type (59.8%) were suggested as risk factors for exposure to PTB in the study areas, while shortage of food (69.7%) and chewing khat (53.8%) were mentioned as factors favouring disease development. Almost all discussants and a considerable number (20.4%) of the interviewees thought that men were the highest risk group to get PTB as well as playing a major role in the epidemiology of the disease.
  
  
  CONCLUSIONS
  The findings indicate that pastoral communities had basic awareness about the disease. Nevertheless, health education to transform their traditional beliefs and perceptions about the disease to biomedical knowledge is crucial.
authors.affiliation: Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia. dlegessem@yahoo.com
authors.forename: Mengistu
authors.initials: M
authors.lastname: Legesse
authors.forename: Gobena
authors.initials: G
authors.lastname: Ameni
authors.forename: Gezahegne
authors.initials: G
authors.lastname: Mamo
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.forename: Dawit
authors.initials: D
authors.lastname: Shawel
authors.forename: Gunnar
authors.initials: G
authors.lastname: Bjune
authors.forename: Fekadu
authors.initials: F
authors.lastname: Abebe
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D003153:Community Health Services; D003430:Cross-Sectional Studies; D003469:Culture; D005002:Ethiopia; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D058751:Livestock / Q000469:parasitology; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control / Q000523:psychology* / Q000635:transmission; D055815:Young Adult