Determinants of undernutrition among adult Tuberculosis

patients attending public health facilities: unmatched case

control study

Methods and Material

4.1 Study area and study period
The study will be conducted in Dire Dawa city administration, which is located in the eastern
part of Ethiopia, which is 515 km away from Addis Ababa. Dire Dawa is one of the two
chartered cities in Ethiopia, the other being Addis Ababa. It is precisely located between 90
28.1” N and 90 49.1” N latitude and between 410 38.1” E and 420 19.1” E longitude. There
are two hospitals (Dilchora Referral Hospital and Sabian Primary Hospital) and fifteen health
centres (urban and rural) in Dire Dawa city administration the study will be conducted from
February to April, 2022.

4.2 Study design

Facility based unmatched Case control study will be conducted in public health facilities of
Dire Dawa administration.
4.3 Source and study population
4.3.1 Source population
The source populations will all TB patients who are in follow up in public health facilities of
Dire Dawa.

4.3.2 Study population

Study population will all selected adult TB patients who will be on follow-up in selected
public health facilities in Dire Dawa from February to April, 2022.

4.4 Inclusion and exclusion criteria

4.4.1 Inclusion criteria
Cases were undernourished adult Tuberculosis patients on follow up during the data
collection period. Controls were normal adult Tuberculosis patients on follow up during data
collection period.
All adult TB patients, who started anti-TB drugs and had a follow-up in Dire Dawa public
health facilities during the study period.
4.4.2 Exclusion criteria
All adult TB patients had severely mentally ill and critically ill patients who were unable to
communicate.

4.5 Sample size determination and sampling procedure

The sample size was calculated using Epi Info V.7 software. The study was designed to have
80% statistical power with a level of significance at 5% and a case to control ratio of 1:2.-The
calculated sample size is 99 for cases and 198 for controls using the double-population
proportion formula. Allowing for a non-response rate of 10%, the resulting sample size will
be 296 (99cases and 197 controls). The sample size was calculated for exposure status of
different variables: dietary counselling, HIV status and eating problem. We took the largest
sample among these exposure variables.

Table 1: Sample size calculation by double population proportion formula using epi info
version 7

Factors Percentage of exposure Percentage of OR Powe Sample Ref.

considered among cases exposure among r size
(undernourished TB controls(normal TB
patients) patients)

YES NO
HIV/AIDS 24 7.95 3.65 80 198 33
status

Eating 22.7 9 2.96 80 269 33

problem

Dietary 64.1 35.9 3.18 80 125 39

counselling
 4.6 Sampling procedure
Five health facilities selected out of seventeen (rural and urban health facilities)by lottery
method namely Dilchora referral hospital,Legehare health centre, Gende kore health centre,
Melekajebedu and Dechatu health centre were included in the study.

The calculated sample size (296) was proportionally allocated to these health facilities based
on TB patients load of each health facility. Finally based on the inclusion and exclusion
criteria, data was collected systematically by skipping every third TB patients until the
needed sample size was met.

TB-infected adults diagnosed with undernourished will recruited as cases, while those well-
nourished will recruited as controls in five public facilities.
 Dire Dawa town
Fifteen health centre and two public Hospitals (rural and urban)

Dilchora Legahare Melkajebedu Dechatu Genderkore

referral hospital health centre health centre health centre health centre

40
19 30
48 32

33 84 70
56 53

296

Figure 1: Schematic Presentation of Sampling technique