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Background Health seeking behavior is one of the challenges affecting tuberculosis (TB) control program because of its high risk to prolonged diseases transmission and poor treatment outcome. Although there are few primary studies that reported diversified magnitudes of health seeking behavior among presumptive TB patients in Ethiopia, there is no review study that attempted to summarize the available evidence. Thus, this review was aimed to estimate the proportion of health care seeking behavior from health facility and to summarize the reasons why individuals with presumptive TB are not seeking health care in Ethiopia. Method A systematic review and meta-analysis study was conducted on primary studies that reported proportion of health seeking behavior among presumptive TB patients. Electronic databases: PubMed, Google Scholar and Science Direct were searched to retrieve studies published in English language from Ethiopia without restricting publication year. In addition, bibliographies of included studies were also screened to retrieve potential studies. The keywords “health seeking”, “health seeking behavior”, “TB suspects” and “presumptive TB” were used both in Medical Subject Heading (MeSH) and free text. Random effects meta-analysis model was used to estimate the pooled proportions of health care seeking and not seeking behaviors. Stata version 14 was used for data analysis. Result Five studies which involved 3230 patients with presumptive TB were included into this review. The pooled estimated proportion of health care seeking behavior among presumptive TB patients from health facilities was 65% (95% CI, 54–76%), while the pooled proportion of not seeking health care from any sources was 17% (95% CI;6–27%). In addition, 18% (95% CI; 5–30%) of presumptive TB patients were seeking health care from inappropriate sources. Being female, younger age, low income status, absence of previous TB treatment history, low education status were the risk factors that associated with low health care seeking behavior. Conclusion Considerable proportion of patients with presumptive TB were not seeking health care from health facilities or seeks care from inappropriate sources in Ethiopia. Implementing efforts that could improve health care seeking behavior is vital to prevent prolonged disease transmission through immediate treatment commencement.

Background The diagnoses of active smear negative PTB, remains difficult. As a result, treatment is often carried out empirically relaying on clinical criteria. The distribution and magnitude of smear negative PTB, smear negative MDR-TB and associated factors in the same day diagnosis strategy are not clearly known in the study area. Therefore, this study aimed to determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear negative pulmonary tuberculosis patients in Addis Ababa, Ethiopia. Methods Analytic cross sectional study design was used. A total of 418 smear negative presumptive pulmonary TB patients were enrolled from selected health facilities since August 01, 2017 to January 5, 2018. Sputum samples were examined by Ziehl Neelsen microscopy, Xpert MTB/RIF assay and Culture. Drug susceptibility testing was performed by line probe assay and BACTEC MGIT 960 system. These laboratory tests were performed in Ethiopian Public Health Institute, National TB Reference Laboratory. Data was analyzed by SPSS Ver.20. Results From the total of 418 enrolled patients, 27 (6.5%) were Xpert MTB/ RIF and 26 (6.4%) were culture confirmed smear negative PTB patients. The positivity rate among male and female was 10.2 and 3.5% (p = 0.005) respectively. From 26 culture positive isolates 3 (11.54%) were MDR TB; from MDR-TB confirmed isolates 2/23 (8.7%) were among new and 1/3 (33.3%) was among retreatment smear negative presumptive pulmonary TB patients. All Rifampicin resistant smear negative pulmonary TB isolates by Xpert MTB/ RIF assay were found to be MDR TB and 7/26 (26.9%) isolates were INH mono resistant. History of migration found to be a potential factor for developing smear negative pulmonary TB. Conclusion In this study a significant proportion of smear negative pulmonary TB was diagnosed. Furthermore, a high smear negative multi drug resistant (MDR) TB and other mono drug resistant TB prevalence was confirmed. Due to the limitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are missed to be diagnosed and transmission continues in the community.

Background: Most tuberculosis (TB) patients were not visiting heath facility but transmit disease to healthy individuals in the community for longer time in Ethiopia. This study was aimed at estimating duration of delay for initiation of anti-TB treatment by smear positive pulmonary TB in south Ethiopia and assesses its determinants of patient related factors associated with unacceptable delay for medication of TB. Methods: a cross-sectional study design was used to recruit 218 consecutive smear positive pulmonary TB patients visiting there hospitals in Gamo Goffa Zone. A structured questionnaire was used to collect information on socio demographic, economic, behavioral factors and co morbidity with HIV from the study units. The median delay was used as cut-off point to dichotomize acceptable delay from unacceptable one. Pearson chi square and logistic regressions were used to assess association between patient factors and longer delay before treatment. Results: The median delay for initiation of anti-TB medication by smear positive pulmonary TB patients was 35 days. Fifteen of the study participants were HIV positive and equal number of TB patients involved had previous history of TB. Socio-demographic factors significantly associated with longer delay for treatment of TB in Univariate analysis were place of residence, level of education and marital status while economic factors associated were monthly income, whether the house is owned or rented and ceiling status of the house. However, after controlling the effect of confounding variables only place of residence and monthly income remained statistically significant. TB patients from rural area were 2.82 times at increased risk to delay for longer days than those living in the town (p-value= 0.021). Similarly, patients having monthly income of 450 or less Ethiopian birr were 4.96 times more likely to delay for longer time than those who had no regular monthly income (p-value=0.003). Conclusion: Smear positive pulmonary TB patients delay for more days before taking anti-TB medications which renders them noninfectious after a few weeks of treatment began. They were transmitting the disease in the community making prevention and control more difficult. Those living in the rural area and earn least amount of money per month transmit the disease for longer time. Civil servants who earn the least salary per month had significant increment in the salary recently that might prevent their delay. However, access to diagnosis and treatment of TB for people living in the rural area should be improved so as to help the walk towards the millennium development goal targets.