American International Health Alliance, Inc.

Tuberculosis Knowledge, Attitudes & Practices Survey

Notice for interviewers: 1. If the answer to the first question is no, do not continue - go to the next respondent. 2. In cases of multiple choices, present the respondent with all possible choices.

1. Have you heard about the disease called Tuberculosis? Yes No

2. What symptoms can show that a person has TB? (Multiple answers) Coughing with sputum Coughing for over 3 weeks Periodical increases of temperature for over 3 weeks Blood in sputum Loss of appetite Night sweating Pain in the chest Total weakness, inertia Weight loss Other (specify)___________________________________________________ I do not know 3. Have you or anyone in your family ever had any of these symptoms? (If answer no go to question 6) Yes No Dont know/dont remember

4. If yes, did they see a doctor? Yes No Dont know/dont remember

5. If no doctor was seen, why not? Felt better No money to see doctor Too busy Was far from medical institutions Fear of doctor Fear of TB Trying to treat symptoms at home Other (specify):__________________________________________________________________

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6. Is TB contagious? (If answers no/ dont know go to question 8) Yes No Dont know

7. If yes, how is TB transmitted? (Multiple answer is possible) Through the air when coughing Through blood Through handshake with an infected person Sexually transmitted Sharing food with infected person Youre born with it Other (specify) _______________________________ I dont know 8. Do you think TB is curable? Yes No Dont know

9. Which symptoms would make you go to a health facility to have a TB test? (Multiple answers) Coughing with sputum Coughing for over 3 weeks Periodical increases of temperature for over 3 weeks Blood in sputum Loss of appetite Night sweating Pain in the chest Total weakness, inertia Weight loss Other (specify)___________________________________________________ I do not know 10. If you had TB signs where would you go to get medical service? (Multiple answers is possible) Your family doctor Pulmonologyst Hospital Polyclinic TB cabinet Other I do not know
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11. Have you or your relatives ever had TB? Yes No Dont know

12. Have you ever had a friend, neighbor, or schoolmate with TB? Yes No Dont know

13. If yes, do you/would you visit them in their home? Yes 14. If no, why not? Fear of disease Other (specify)_____________________________________________________ 15. If someone has TB will they try to hide the disease from others? (If answer no go to question 17) Yes No Dont know No Dont know

16. If yes, why? (Multiple answers) Because they will lose job Because they will lose friends Because people will avoid them Because no-one will marry them Other (specify) _____________________________________________________ 17. Do you think it is shameful to have TB? (If answer no go to question 19) Yes No Dont know

18. If yes, why? (Multiple answers) This is a disease of asocial people Because the person with TB can lose job Because everybody will avoid person with TB Other (specify) _______________________________________________________ 19. A sick relative has completed TB treatment in a hospital. Would you take him to your home for aftercare? Yes No I do not know

20. If someone has TB will others treat them differently? (If answer no go to question 22) Yes No
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I do not know

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21. If yes, how? Will support them and feel for them Will avoid them Other (specify)__________________________________________________________ 22. Have you been told about TB last 12 months? (If answer no go to question 24) Yes 23. If yes, who? Family doctor Nurse Father, mother, relatives Friend Colleague (in school, on the office) Other (specify) _________________________________________________________________ 24. Have you received any information about TB in the last 6 months? (If answer no go to question 26) Yes No No I do not know

25. If yes, from which sources? Friends, acquaintances, relatives Other medical workers Newspapers Radios TV Booklets, leaflets Lectures Other____________________________________ 26. Demographic data Gender Male Female Age ___________________________ Education Primary High school Community college University, post-graduate
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Residence Urban area Rural area