title: Poor symptomatic tuberculosis screening practices in a quarter of health centres in Amhara Region, Ethiopia.
abstract: METHODS
  In 2011, Ethiopia introduced a strategy of symptomatic tuberculosis (TB) screening for patients attending out-patient services to increase identification of presumptive TB.
  
  
  OBJECTIVE
  To assess implementation and factors affecting symptomatic TB screening at out-patient departments in health centres in the Amhara Region, Ethiopia.
  
  
  METHODS
  Using a cross-sectional study design, 86 randomly selected public health centres providing DOTS were included in the study. Data were captured by reviewing TB registers and interviewing key informants at out-patient services.
  
  
  RESULTS
  Of 86 health centres, 24 (28%) had poor symptomatic TB screening practices, defined as screening <80% of attending out-patients. Having an actively functioning multidisciplinary health centre team to assess TB services (aOR 2.29, 95%CI 2.23-30.80) and partner support for TB activities (aOR 4.84, 95%CI 1.05-22.40) were associated with higher TB screening rates, whereas availability of antiretroviral therapy was negatively associated. In all health centres combined, 1.6% of out-patient department attendees were identified as having presumptive TB.
  
  
  CONCLUSIONS
  A quarter of health centres had poor symptomatic TB screening practices in the out-patient services in this study. Strengthening multidisciplinary teams and expanding partner support are recommended to improve TB screening practices at out-patient services in Ethiopia.
authors.affiliation: Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia ; Bahir Dar University, College of Medicine and Health Sciences, Bahir Dar, Ethiopia.
authors.forename: G B
authors.initials: GB
authors.lastname: Gebregergs
authors.affiliation: Bahir Dar Regional Health Research Laboratory Center, Bahir Dar, Ethiopia.
authors.forename: M
authors.initials: M
authors.lastname: Alemneh
authors.affiliation: Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
authors.forename: D N
authors.initials: DN
authors.lastname: Koye
authors.affiliation: Management Sciences for Health/HealTB, Addis Ababa, Ethiopia.
authors.forename: Y
authors.initials: Y
authors.lastname: Kassie
authors.affiliation: Private Health Sector Program (PHSP), Abt Associates Inc, Addis Ababa, Ethiopia.
authors.forename: M
authors.initials: M
authors.lastname: Assefa
authors.affiliation: Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.
authors.forename: W
authors.initials: W
authors.lastname: Ayalew
authors.affiliation: I-TECH, Addis Ababa, Ethiopia.
authors.forename: C
authors.initials: C
authors.lastname: Temesgen
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, The Netherlands ; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Klinkenberg
authors.affiliation: Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
authors.forename: T
authors.initials: T
authors.lastname: Tadesse
keywords: case finding; implementation; out-patients