Integration Challenges and Opportunity of Implementing Non-Communicable Disease Screening Intervention with Tuberculosis Patient Care: A Mixed Implementation Study

Figures & data

Figure 1 Cluster sampling schematic presentation of Hadiya Zone tuberculosis care center.

Table 1 Socio-Demographic Characteristics of Participants in Implementing NCD and Risk Factors Screening Intervention in Southern Ethiopia

Variable	Category	Frequency	Per cent
Sex (n=443)	Male	234	52.82%
	Female	209	47.18%
Educational status (n=443)	Not read or write	150	33.86%
	Primary school	170	38.37%
	Secondary school	69	15.58%
	College and above	54	12.19%
Occupation (n=443)	Governmental worker	37	8.35%
	Private government worker	52	11.74%
	Farmer	94	21.22%
	Student	122	27.54%
	Housewife	118	26.64%
	Self-employer	12	2.71%
	Other	8	1.81%
Residence (n=443)	Urban	203	45.82%
	Rural	214	48.31%
	Sub-city	26	5.87%
Marital status (n=443)	Single	151	34.09%
	Married	270	60.95%
	Divorced	7	1.58%
	Widowed	15	3.39%
Monthly income (n=443)	< 1000 Birr	236	53.27%
	1001–3000 Birr	132	29.80%
	> 3000 Birr	75	16.93%
Family size (n=443)	< 5 Family number	312	70.75%
	> 5 Family member	129	29.25%
Age in year (n=443)	20–34 Years	265	59.82%
	35–49 Years	100	22.57%
	>50 Years	78	17.61%
Religion (n=443)	Protestant	345	78.05%
	Orthodox	54	12.22%
	Muslim	40	9.05%
	Other	3	0.68%

Table 2 Distribution of in-Depth Interview Participants in the Implementation of Non-Communicable Disease and Risk Factor Screening Intervention in Hadiya Zone, Southern Ethiopia

Variables	Category	Frequency	Percent
Implementation site	Urban	4	57.14%
	Rural	3	42.86%
Implementation facility (n=7)	Hospital	4	57.14%
	Health centre	3	42.86%
Sex of stakeholder r(n=14)	Male	7	50%
	Female	7	50%
Age of stakeholder (n=14)	< 30 years	8	57.14%
	>30years	6	42.86%
Years of work experience (n=14)	< 3 years	4	28.57%
	>3 years	10	71.43%
Type of stakeholder (n=14)	Manager	1	7.14%
	Coordinator	3	21.43%
	Tb focal/implementer	10	71.43%
Age of patients (n=7)	20–34	2	28.57%
	35–49	3	42.86%
	>50	2	28.57%
Sex of patients (n=7)	Male	3	42.86%
	Female	4	57.14%
Educational status (n=7)	Not read or write	1	14.29%
	Primary education	3	42.86%
	Secondary education	2	28.57%
	College and above	1	14.29.%
Marital status (n=7)	Single	2	28.57%
	Married	4	57.14%
	Divorced	1	14.29%
Occupation (n=7)	Governmental	1	14.29%
	Private	1	14.29%
	Student	3	42.86%
	Housewife	2	28.57%
Tuberculosis category (n=7)	Pulmonary tuberculosis	3	42.86%
	Extra pulmonary tuberculosis	4	57.14%
Types of comorbid non-communicable disease (n=7)	Diabetes mellitus	2	28.57%
	Hypertension	4	57.14%
	Heart disease/stroke	1	14.29%
	More than one comorbidity	3	42.86%
Types of comorbid risk factors (n=7)	Tobacco smoker	1	14.29%
	Not smoker	6	85.71%
	Alcohol use	3	42.86%
	Not drink alcohol	4	57.14%

Figure 2 Classic flow chart diagram of the two stages of WHO step-wise NCDs and risk factors screening procedure from routine tuberculosis patients in Hadiya Zone, Southern Ethiopia.

Table 3 Description of Implementation Challenges Themes in Integration of NCD and Risk Factors Screening Intervention Among Routine Tuberculosis Patients

Main Theme	Sub-Themes	Codes
External factors	Service provision	Code 1: absence of medical equipment
		Code 2: absence of skill and knowledge training
		Code 3: Drugs and laboratory services not free
	Inter-organizational communication	Code 1: absence of feedback and referral system
		Code 2: lack of record and reporting system
	Consumer support organization	Code 1: lack of cooperative integration
		Code 2: shortage of supporting agencies
Internal factors	Intra-organizational communication system	Code 1: lack of linkage and referral system
		Code 2: shortage of skilled focal person
		Code 3: absence of early detection and management system
	Adopter character	Code 1: lack of trained health worker
		Code 2. Increased work load
		Code 3: Absence of awareness creation

Table 4 Distribution of Tuberculosis Patient’s Awareness Towards Non-Communicable Disease and Risk Factor in Hadiya Zone, Southern Ethiopia

Variable	Category	Frequency	Percent
Tuberculosis types	Pulmonary tuberculosis	290	65.46%
	Extra-pulmonary tuberculosis	153	34.54%
The meantime of health-seeking delay mean=50.67 days, std. 3.15)	< 50.67 days	314	70.88%
	> 50.67 days	129	29.12%
The meantime of treatment initiation delay (mean=16.38 days, std. 2.52)	< 16.38 days	389	87.81%
	> 16.38 days	54	12.19%
Having awareness of common non-communicable disease	Yes	279	62.98%
	No	164	37.02%
Knowledge of hypertension	Yes	277	62.53%
	No	166	37.47%
Awareness of diabetes mellitus	Yes	256	57.79%
	No	187	42.21%
Awareness of stroke	Yes	115	25.96%
	No	328	74.04%\
Knowledge of chronic obstructed pulmonary disease	Yes	116	26.19%
	No	327	73.81%
Awareness of cancer	Yes	179	40.41%
	No	264	59.59%
Awareness of non-communicable disease risk factors	Yes	245	55.30%
	No	198	44.70%
Smoking is a risk for non-communicable disease	Yes	217	48.98%
	No	226	51.02%
Alcohol use is a risk for non-communicable disease	Yes	228	51.47%
	No	215	48.53%
Obesity is a risk for non-communicable disease	Yes	207	46.73%
	No	236	53.27%
Physical inactivity is a risk for non-communicable disease	Yes	200	45.15%
	No	243	54.85%
Malnutrition is a risk for non-communicable disease	Yes	176	39.73%
	No	267	60.27%
Family is a risk for non-communicable disease	Yes	109	24.60%
	No	334	75.40%
Do you know tuberculosis and non-communicable disease comorbidity?	Yes	156	35.21%
	No	287	64.79%
Do you know tuberculosis and risk factors comorbidity?	Yes	195	44.02%
	No	248	55.98%
Can we prevent non-communicable disease?	Yes	303	68.40%
	No	140	31.60%
Can we treat non-communicable disease?	Yes	307	69.30%
	No	136	30.70%

Abbreviation: std, standard deviation.

Table 5 Description of Implementation Opportunity Themes in Integration of NCD and Risk Factors Screening Intervention Among Routine Tuberculosis Patients

Main Theme	Sub-Theme	Code
External factors	Community Health system	Code 1: Presence of health extension program
		Code 2: availability of NGOs
	Presence of Consumer support organization	Code 1: community health care insurance
		Code 2: association for diabetes mellitus
Internal factors	Availability of man power	Code 1: Assigned focal persons
		Code 2: trained stakeholder
	Readiness of organization	Code 1: availability of guidelines and information system
		Code 2: compatible tuberculosis program structure

Table 6 Prevalence of Risk Factors Among Routine Tuberculosis Patients, in Southern Ethiopia

Variable (n=443)	Category	Frequency	Per Cent	[95%, CI)
Age in year	20–34	265	59.82%	[0.552, 0.643]
	35–49	100	22.57%	[0.189 0.267]
	>50	78	17.61%	[0.143, 0.215]
Smoking	Yes	39	8.80%	[0.065, 0.118]
	No	404	91.20%	[0.882, 0.935]
Alcohol consumption	Yes	47	10.61%	[0.081, 0.139]
	No	396	89.39%	[0.861, 0.919]
Physical activity per day	<10 minutes	38	8.58%	[0.063, 0.116]
	> 10 minutes	405	91.42%	[0.884, 0.937]
Fruit consumption in a week	< 5 times	391	88.26%	[0.849, 0.910]
	>5 times	52	11.74%	[0.090, 0.151]
Vegetable consumption in a day	< 3 services	368	83.07%	[0.793, 0.863]
	> 3 services	75	16.93%	[0.137, 0.207]
BMI	< 23	330	74.49%	[0.702, 0.783]
	23–24.9	70	15.80%	[0.127, 0.195]
	> 25	43	9.71%	[0.073, 0.128]
Waist circumference in centimetres	<72 female/78male	298	67.27%	[0.627, 0.715]
	72–79 female/78-89male	126	28.44%	[0.244, 0.328]
	>80femal/90male	19	4.29%	[0.027, 0.066]
History of non-communicable disease in the family	Yes	44	9.93%	[0.075, 0.131]
	No	399	90.07%	[0.869, 0.925]

Abbreviation: CI, confidence interval.

Table 7 Prevalence of Common NCDs Among Routine Tuberculosis Patients, in Southern Ethiopia

Variable	Category	Frequency	Per Cent	[95%, CI]
Diabetes mellitus	Yes	25	5.64%	[0.038, 0.082]
	No	418	94.36%	[0.918, 0.962]
Hypertension	Yes	29	6.55%	[0.046, 0.093
	No	414	93.45%	[0.907 0.954]
Stroke	Yes	5	1.13%	[0.005, 0.027]
	No	438	98.87%	[0.973, 0.995]
Heart disease	Yes	6	1.35%	[0.006, 0.030]
	No	437	98.65%	[0.970, 0.994]
Cancer	Yes	4	0.90%	[0.003, 0.024]
	No	439	99.10%	[0.976, 0.997]
COPD	Yes	8	1.81%	[0.009, 0.036]
	No	435	98.19%	[0.964,0.991]
1st stage risk score	<8 score	393	88.71%	[0.854. 0.914]
	> 8 score	50	11.29%	[0.086, 0.146]
2nd stage risk score	< 12 score	430	97.07%	[0.950, 0.983]
	> 12 score	13	2.93%	[0.017, 0.050]
TB-NCD comorbidity status	Not comorbid	389	87.81%	[0.844, 0.906]
	One comorbid	32	7.22%	[0.051, 0.101]
	Multi-comorbidity	22	4.97%	[0.033, 0.074]

Abbreviation: CI, confidence interval.