Tuberculosis Awareness, Treatment Beliefs, and Early Care-Seeking Behaviors Among Households in Mogadishu, Somalia: A Community-Based Cross-Sectional Study

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Abstract
Background: Tuberculosis (TB) remains a major public health challenge in Somalia, where fragile health systems, delayed care-seeking, limited health literacy, and stigma may undermine TB prevention and treatment. This study assessed TB awareness, treatment-related beliefs, care-seeking intentions, and factors associated with belief in completing the full course of TB treatment among households in Mogadishu. Methods: A community-based cross-sectional study was conducted among 403 adult household respondents in Mogadishu, Somalia. Data were collected using a structured questionnaire covering sociodemographic characteristics, TB awareness, treatment-related perceptions, care-seeking intentions, and household preventive practices. Descriptive statistics were used to summarize participant responses. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with belief in completing the full course of TB treatment. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05. Results: Most respondents had heard of TB (85.4%), recognized coughing or sneezing as a mode of transmission (87.1%), and identified persistent cough as a symptom (86.4%). Overall, 83.1% believed in completing the full course of TB treatment, while only 48.6% correctly identified bacteria or germs as the cause of TB and 49.4% reported discomfort living with a person with TB. In the adjusted analysis, treatment completion belief was positively associated with having no formal education (AOR = 7.91, 95% CI: 2.27–27.54), recognizing persistent cough as a TB symptom (AOR = 15.03, 95% CI: 4.02–56.20), encouraging others to seek care at a health facility (AOR = 12.97, 95% CI: 3.65–46.12), and being comfortable living with a person with TB (AOR = 3.84, 95% CI: 1.38–10.64). Believing that TB is curable when diagnosed early showed an inverse adjusted association (AOR = 0.24, 95% CI: 0.06–0.87). Conclusions: Although TB awareness and treatment completion beliefs were generally high, important gaps in biomedical knowledge and stigma-related perceptions remained. Community-based TB education should strengthen the understanding of disease causation, symptom recognition, timely healthcare seeking, treatment completion, and supportive attitudes toward people affected by TB. The unexpected associations observed in the adjusted model warrant cautious interpretation and further investigation.

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