Additional file 1: Questionnaire

Please fill in the blanks and mark the answer that you think best answers the question.

Demographics
1. What is your age?
a. __________
2. What is your gender?
a. Male
b. Female
3. What is your highest level of educational attainment?
a) Primary School
b) Secondary School
c) Professional Technical training
d) University
4. In which health centre do you currently work? _____________________________
5. What is your profession within said health centre? (for example: doctor, nurse,
laboratory staff, activist, medical agent, etc)
6. How long have you worked within said health centre?
a. Less than one year
b. One to five years
c. Five to ten years
d. More than ten years
7. How long have you cared for patients with tuberculosis or presumptive cases of
tuberculosis?
a. Less than one year
b. One to five years
c. Five to ten years
d. More than ten years
e. Never
8. How many patients treated for tuberculosis have you cared for in the last 6 monts?
a. 0 – <10
b. 10 - <40
c. >40
9. Are you directly involved in tuberculosis control activities?
a. Yes
b. No

If yes, please specify: __________________________________________

10. Have you ever received tuberculosis-specific training?

a. Yes
b. No
11. In the past 6 months have you received any tuberculosis-specific training?
a. Yes
b. No
 12. Have you ever been sick with tuberculosis?
a. Yes
b. No
13. Has someone you are in close contact with ever been sick with tuberculosis (for
example: family members, spouse, etc)?
a. Yes
b. No

Knowledge
Tuberculosis Basics
1. What is the causative agent of tuberculosis?
a. Mycobacterium tuberculosis
b. Mycobacterium avium
c. Mycobacterium pneumoniae
d. Mycobacterium leprae
2. Is tuberculosis a transmissible disease?
a. Yes
b. No
3. How does tuberculosis spread?
a. Sexually
b. By droplet spread
c. By direct contact
d. By sharing needles
4. Which group of people is at higher risk of developing tuberculosis?
a. Patients with COPD
b. Patients with HIV
c. Males
d. People living in tropical areas
5. If a person contracts tuberculosis, what is the likelihood they will develop active
tuberculosis within the immediate time frame? (The closest answer will be accepted)
a. 90%
b. 60%
c. 40%
d. 10%
6. What type of preventive measures can you take as health care professional if you are
dealing with a tuberculosis patient or a suspect of tuberculosis:

Please briefly explain:______________________________________________________

_______________________________________________________________________

7. Have you ever heard of the Tuberculosis Infection Control Plan for your Health Unit?
a. Yes
b. No
8. If yes, have you received training on its content?
c. Yes

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 d. No

Tuberculosis Diagnosis
1. What is the most common symptom of pulmonary tuberculosis?
a. Haemoptysis
b. Persistent and high fever
c. Loss of weight
d. Persistent cough
2. What is the best diagnostic tool for tuberculosis?
a. Blood culture
b. Skin test
c. Culture
d. Sputum microscopy

3. TB diagnosis in children is more difficult than in adults?

a. yes
b. no

If yes, briefly explain_________________________________________________________

4. How many sputum samples are necessary for diagnosis?

a. 1
b. 2
c. 3
d. 4
5. When should the initial sputum sample be taken?
a. After waiting 2 – 3 hours following triage
b. Immediately
c. The next morning
d. When the patient has arrived at the laboratory and is ready to give a sample
6. How should a sputum sample be stored before laboratory analysis?
a. In culture medium
b. At room temperature
c. Sputum samples cannot be stored – they should be sent to the laboratory
urgently
d. In the fridge
7. Do you know what Gene Xpert is?
a. Yes
b. No
If yes: What is it? _______________________________________________

Tuberculosis Treatment
1. Is tuberculosis a curable disease?
a. Yes
b. No

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2. How long is the first line treatment of pulmonary tuberculosis?
a. 2 months
b. 6 months
c. 9 months
d. 12 months
3. Does tuberculosis treatment in children have a longer length?
a. Yes
b. No
4. How many drugs are used in the first line treatment of tuberculosis?
a. 1
b. 2
c. 3
d. 4
5. Do you know what direct observed treatment during the initial phase of treatment is?
a. Yes
b. No
If yes, explain briefly:__________________________________________
___________________________________________________________
6. What is multi-drug resistant tuberculosis?
a. Tuberculosis that is resistant to Isoniazid and Rifampicin
b. Tuberculosis that is resistant to any one tuberculosis medication
c. Tuberculosis that is resistant to all tuberculosis medications
d. Tuberculosis that is resistant to Pyrazinamide and Ethambutol
7. In which group of people is multi-drug resistant tuberculosis most likely to occur?
a. In people with HIV
b. In people who have been exposed to other tuberculosis patients
c. In people who have been treated for tuberculosis before
d. In people who have never had tuberculosis before
8. When should the first follow up sputum sample be carried out following the
commencement of treatment of a confirmed case of tuberculosis?
a. 1 month after the commencement of treatment
b. 2 month after the commencement of treatment
c. 3 month after the commencement of treatment
d. 7 month after the commencement of treatment
9. What is the major element to assess tuberculosis treatment cure?
a. Skin test
b. Chest X-ray
c. Sputum
d. All of the above
10. What are the consequences of incomplete treatment?
a. Development of resistant tuberculosis
b. Failure to fully cure the disease
c. Further transmission of the disease
d. All of the above
11. Is there a vaccine for TB?

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 a. Yes
b. No
If yes, name it:__________________________________________
___________________________________________________________
12. When is the best time for BCG vaccination?
a. At birth
b. At 2 months
c. At 6 months
d. Other. Specify __________________________________

Attitudes
Please mark which most applies regarding your attitude to the statement. If the statement
does not apply to you do not tick a box.

1. Finding every new case of tuberculosis is essential for control of the disease
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
2. Community engagement is essential for the control of the disease
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
3. There is a substantial increase in treatment completion rates if direct observed
treatment is used
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
4. There is a stigma associated with tuberculosis in Mozambique
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree

Briefly explain: ____________________________________________________________

____________________________________________________________

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 5. The way you interact with tuberculosis patients/regard tuberculosis contributes any
possible stigma there is
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree

Briefly explain: _____________________________________________________________

_____________________________________________________________

6. Tuberculosis as a disease has more stigma associated with it than HIV

a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
7. Money spent on educating the Mozambican general population is better than money
spent on direct observed treatment
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
8. In Mozambique, the general population is aware of the tuberculosis services that are
available
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
9. Public awareness regarding tuberculosis as a health problem in Mozambique is
adequate
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree

Briefly explain: ______________________________________

____________________________________________________________

10. Multi-drug resistant tuberculosis is a problem in Mozambique

a. Strongly agree

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 b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
11. Traditional or alternative medicine assists in wellbeing of tuberculosis patients
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
12. First line therapies for tuberculosis are accepted by patients
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
13. In Mozambique, there are many barriers to tuberculosis treatment
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree

Briefly explain: _______________________________________________

____________________________________________________________

14. The majority of staff in your health centre have adequate training regarding
tuberculosis
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
15. The laboratory service that your health centre uses is adequate for the diagnosis of
tuberculosis
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
16. In your health centre, there is a sufficient number of people required to treat the
tuberculosis patients seen
a. Strongly agree

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 b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
17. Making people with suspected/confirmed pulmonary tuberculosis wear masks in the
hospital is acceptable
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
18. Teaching tuberculosis patients cough hygiene is not important
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
19. Infection control is an important means to prevent contracting tuberculosis
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
20. I have been seriously concerned I have had tuberculosis
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
21. I should know whether I’ve got or had tuberculosis
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
22. If I contracted tuberculosis, I would be allowed to continue working in my current
capacity
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree
23. My employer would maintain confidentiality if I were to contract tuberculosis
a. Strongly agree
b. Agree

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 c. Neutral
d. Disagree
e. Strongly Disagree
24. I should know my own HIV status
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly Disagree

Briefly explain: _______________________________________________

____________________________________________________________

Practices
1. A patient comes in with a persistent cough of 16 days duration, the cough is dry and
the patient is not short of breath. The patient is experiencing night sweats, fatigue and
lives with his brother that has been feeling the same way for the past four weeks.
a. What is the most likely differential diagnosis and what one diagnostic test
would you do to exclude your most likely differential diagnosis?
i. Tuberculosis
ii. Sputum sample, immediately
b. What drug(s) would you use and for how long would you use them in the
initial phase of tuberculosis treatment?
i. Pyrazinamide, Isoniazid, Rifampicin and Ethambutol
ii. 2 months
c. What drug(s) would you use and for how long would you use them in the
continuation phase of tuberculosis treatment?
i. Isoniazid and Rifampicin
ii. 4 months
2. What would you do if you have a patient that grows a positive sputum sample
following four months of treatment?
a. Start new first line treatment
b. Continue since last intake
c. I do not know
3. What should you do if your patient has yellowish skin after three weeks of treatment?
a. Consider this as a potential side effect of drug therapy
b. Stop treatment
c. Evaluate level of liver enzymes if possible
d. All of the above are correct

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