Assessment of Socio Demographic Characteristics on Uptake of Tuberculosis Screening by Community Members in Meru County, Kenya

The trend in tuberculosis in Kenya is worrying. TB is the fourth leading cause of death. In 2015 81,518 cases of TB were identified and treated. The Kenya prevalence survey of 2015-2016 found that estimated prevalence is 558/100,000 way above the WHO estimate of 233/100,000. The objective of the study was to determine the effect of socio- demographics characteristics on tuberculosis screening among community members in Tigania East of Meru County. The study design used was cross-sectional survey and targeted 440 household drawn from the five wards randomly and proportionately selected. Key informant interviews and focus group discussions were used to collect qualitative data. Qualitative data was analysed thematically. Quantitative data was analysed using descriptive statistics and inferential statistics using SPSS version 26. The study found out that there were statistically significant association between TB screening and religion (X 2 =13.103, df 3; p value=0.004,), monthly income (X 2 =14.970, df 6; p value=0.020. The study concluded that religion and monthly income of community members of Tigania East were associated with TB screening.

avoided though voluntary TB screening. This study therefore sought to assess the effect of socio demographic characteristics on uptake of TB screening in Tigania East.

Methodology
The study adopted cross-sectional research design using both quantitative and qualitative approaches. The crosssectional research design was appropriate because it explores and describes the relationship between variables in their natural setting without manipulating them. This study was limited to Tigania East of Meru County, Kenya. Tigania East which is an administrative sub-County of Meru is considered appropriate areas of study based on the high cases of tuberculosis reported by the Ministry of Health (2018). The study is conducted in Tigania East of Meru County.
The study population is about 60% of the population are of ages 18 years and above (KNBS). They were about 104,442 persons. These are both male and females. The study population of consisted of 174,121 persons. This is the estimated population of Tigania East by 2018 according to 2009 census projection (KNBS, 2009). The Sub County has five wards. It's in Tigania East Constituency. The respondents comprised of 398 households' members in Tigania East and 45 health workers from public health facilities in Tigania East. The unit of analysis was household members in Tigania East in Meru County while unit of observation was households in Tigania East in Meru County.The inclusion criteria was household members in Tigania East in Meru County who were willing to take part in the study were included. The study considered respondents aged more than 18 years to be appropriate. Respondents residing in the County for the past one year was considered appropriate in this study.
The exclusion criteria were households' members in Tigania East in Meru County unwilling to give consent to the study participation. The study did not consider respondents aged below 18 years. Respondents residing in the county for less than one year were not be included in this study.
The sample size of this study was 440 household respondents as shown in Table 3.1 Israel formula (2009) was used to determine the ideal sample size. Respondents of this study was household members. Israel (2009) formula was used in the form:

Journal of Biology, Agriculture and Healthcare
Where: n is the sample size, N is the target population size, e is the allowable error (0.05). n = 104,442 1+104,442 (0.05) 2 = 400 Household Members and added 10% to cater for drop-out and incomplete questionnaire for a total of 440 respondents Respondents of the study were selected using simple random sampling technique. This method of sampling involves giving a number to every member subject or member of accessible population, placing the numbers in a container and picking any number at random. The subjects corresponding to the numbers picked were included in the sample. The respondents were household members from Tigania East.
Questionnaires with open and closed questions were used to collect data from household members in Tigania East. Questionnaires were preferred due to their ability to capture respondent opinions in a structured manner and in written form for future reference. Further, they will enable the respondents to answer questions freely and frankly even on sensitive issues. In addition, they provide uniformity in answering questions allowing a great degree of comparison because the items are framed in the same format. Items of the questionnaire were measured using a Likert point scale where 4 represents strongly agree while 1 represents strongly disagree. Journal of Biology, Agriculture and Healthcare Focus groups discussions was held with community leaders in Tigania East. The group comprised of 5 to 8 informers and lasted for a minimum of 45 and a maximum of 1 hour. Information related to TB infections sought and evaluated in relation to that given by household Key health workers who are knowledgeable on tuberculosis were interviewed. These are County TB Coordinator, Sub County Clinical Officer, Sub County Laboratory Technologist, Sub County Public Health Officer, Sub County Public Health Nurse, Sub-county TB Coordinator Tigania East and Sub-county Medical Officer of Health in Tigania East.
Content validity which was employed by this study as a measure of the degree to which data collected using Journal of Biology, Agriculture and Healthcare www.iiste.org ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol.10, No.22, 2020 a particular instrument represents a specific domain or content of a particular concept. The researcher was selected pretest sample of 10% as recommended by Fisher (2010). Feedback from pretest sample was used to modify questions of the research instrument in order to measure what is expected to be measured. The study used Cronbach's alpha coefficient to test internal consistence of the instrument. Cronbach alpha value of 0.7 was used as the cutoff point as recommended by (Guest, 2018) to suggest reliability of the variables of the study. The overall value was 0.8 for the all the variables.
To analyze the data, the Statistical Package for Social Sciences, (SPSS version 24) software was used. The data collected in the research was sorted, edited, coded, keyed and classified on the basis of similarity and then tabulated. Descriptive statistics was used to analyze data and explain the findings. To permit quantitative analysis, data was converted into numerical codes representing attributes or measurement of variables. Descriptive statistics such as frequency distributions, percentages and frequency were used to summarize and relate variables which was attained from the study. The study adopted inferential statistics such as chi square.
Before data collection, the researcher sought permission from the Kenyatta University and National Commission for Science, Technology and Innovation. Approval from Meru County Health Deptarment was sought. Responsibility to the respondents was to include voluntary participation and informed consent prior to participation.
To ensure the participants was not prejudiced, simple language and statements was used to describe the aim of the research and its procedures. Responsibility to the profession was include accuracy in analysis, presentation and reporting of the study findings. Confidentiality and anonymity of the respondents was guaranteed. For objectivity purposes of scientific reaserch, stakeholders were informed and the objective of the research explained to ehnance willingness and high response rates from the respondents. Finally, respondents was assured about publication of final report.

3.Results
A total of 440 household questionnaires were distributed and 425 questionnaires were returned for a response rate of 96.5%. Table 2 summarizes socio-demographic characteristics of respondents. From the results 265(62.4%) were of the age 35-60 and 59(13.9%) were of the age 60 and above. The study found out 295(69%) were married monogamous and 16(4%) were Divorced, Majority of the respondents 234(55%) indicated that they had primary level education,22(5%) had university level of education ,22(5%) had diploma level of education.
The study found out that 181(43%) were farmer and 14(3%) others. The study finally found out that 281(66%) of the households earned less than 10,000 and 6(1.4%) had no monthly income Journal of Biology, Agriculture and Healthcare  Vol.10, No.22, 2020 52 The proportion of respondents who have been screened is presented in figure 1. Majority of the respondents 68% (n=288) stated that they have never been screened for TB while 32% (n= 137) stated that they have been tested for TB.

Figure 1 Uptake of Tuberculosis Screening
The result in Table 3 found out that the association between religion and TB screening was statistically significant at 5% level of significance (p value=0.004<0.05, X 2 =13.103, df 3), and the association of monthly income and TB screening was statistically significant at 5% level of significance (p value=0.020<0.05, X 2 =14.970, df 6). The rest of the socio demographic parameters that's; age, marital status and education level were not statistically significant.

4.Discussion
The study found out that the association between socio demographic characteristics (religion and monthly income) and TB screening was statistically significant. This implies that religion and monthly income of community members of Tigania East were associated with TB screening. Jewett et al., (2016) states that risk of exposure to TB in various social settings. Students can be more exposed to TB when volunteering, researching and travelling (Jewett et al., 2016). Medical students are at higher danger of exposure to TB and are required to do annual screening for TB.
In TB management gender plays an important role, as seen in various countries whereby men give better outcomes than women and the reverse in other countries (UNAIDS and Stop TB, 2016). Globally TB management focuses on early diagnosis and treatment of cases in high TB and HIV-endemic areas (WHO,2016). Nevertheless, low detection of TB and a rise of multi-drug-resistant strains have been a challenge (WHO,2016) A study conducted by Esmael Ali, Agonafir , Desale , Yaregal& Desta (2013) on assessment of patients' knowledge, attitude, and practice regarding pulmonary tuberculosis in eastern Amhara regional state, Ethiopia documented misconceptions ranging from 66.3% to 99.7% of the population on the aetiology (cause) of TB, 27.6% to 90.1% on the symptoms, 0.1% to 48.6% on the transmission and 33.4% to 92.9% on prevention methods (Amo-Adjei & Kumi-Kyereme,2013. Literacy status, socio-cultural differences, gender, and spatial variations have been reported to be factors affecting TB knowledge, attitude and practices (KAP) (Amo-Adjei , Kumi-Kyereme ;2013 ; Legesse, Ameni , Mamo , Medhin , Shawel , Bjune ,2010;Bati, Legesse , Medhin 2013)

Conclusion and recommendation
The study made the following conclusion; the association between socio demographic characteristics (religion and monthly income) and TB screening was statistically significant. This implies that the religion and monthly income of community members of Tigania East were associated with TB screening. The study recommend that Ministry of Health should introduce and implement Integrated Public health campaigns targeting all age groups, social class and literacy level in Meru community towards TB screening by health managers at lower administrative units