الفهرس 
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Abstract
eTuberculosis (TB) is a contagious disease which is caused by Mycobacterium tuberculosis that usually spreads through the air (Cobbett, 2014). Therefore, TB is an airborne disease. It is transmitted when an infected person talks, sneezes, coughs, or spits.
Even though tuberculosis (TB) is a treatable and preventable disease, it is continuing to play a significant role in global morbidity and mortality, affecting over 10 million people and causing 1.3 million deaths annually (WHO, 2018). Tuberculosis (TB), an infectious disease primarily affecting lung parenchyma, is most often caused by Mycobacterium tuberculosis. It may spread to almost any part of the body, including the meninges, kidney, bones, and lymph nodes. TB is strongly associated with poverty, malnutrition, overcrowding, substandard housing, and inadequate health care.
Refugees are vulnerable to TB in their countries of origin because their health status depends on the availability of and access to quality health systems, overall socioeconomic conditions as well as the occurrence of national emergencies such as famines and political conflicts. During migration, mobile populations are at risk for TB, particularly if travel occurs under precarious conditions including limited access to healthcare, incidents of violence or being kept in detention centers with poor nutrition and ventilation.
With the development of effective treatment strategies, the focus of TB management has shifted from the prevention of mortality to the avoidance of morbidity. As such, there is increased interest in the quality of life (QoL) experienced by individuals being treated for TB (Marra et al., 2014).
Community health nurses’ role is to enhance the public’s health and decrease the incidence of communicable diseases such as TB. They demonstrate the ability to use a shared vision, model excellence in public health nursing, overcome challenges through problem solving, enable action, and inspire others to act in the best interests of people and communities (Pirog et al., 2012).
Significance of the study:
Egypt hosts 273,152 refugees and asylum-seekers from 65 countries of origin. Most refugees and asylum-seekers are located in urban areas of Greater Cairo.
Refugees are considered a vulnerable population, several factors that adversely influence access to healthcare by refugees. Lack of knowledge about refugees’ rights, low socioeconomic status, language barriers and poor understanding of a host country’s healthcare system may influence their quality of life, as community health nurse role toward caring of specific population and prevention of communicable diseases as TB this study will conduct to assess quality of life among African refugees with tuberculosis in greater Cairo.
Aim of the study:
The aim of this study is to assess quality of life among African refugees with tuberculosis in greater Cairo through:
1. Assessing knowledge of African refugees with tuberculosis about the disease process.
2. Assessing Attitude of African refugees with tuberculosis toward prevention and control of the disease process.
3. Assessing practice of African refugees with tuberculosis toward care of themselves.
4. Assessing quality of life domains such as (Physical, psychological, social, emotional, and spiritual) among African refugees with tuberculosis.
Research Questions:
1. Is there a relation between quality of life of African refugees and their socio-demographic characteristics?
2. Is there a relation between quality of life of African refugees and their knowledge about TB?
3. Is there a relation between quality of life of African refugees and their attitude toward prevention of TB?
4. Is there a relation between quality of life of African refugees and their practice toward care of TB?
Research design:
A descriptive study design was used to conduct this study.
Research setting:
The study was conducted in two setting; at outpatient clinics of Abbassia Chest Diseases Hospital and Refuge Egypt TB clinics in Zamalek which is a non-governmental organization in Greater Cairo.
Subject of the study:
A purposive sample of (240) African refugees recently diagnosed with confirmed tuberculosis in last six month, their age between 18 to 45 years.
Tools of data collection
Tools of data collection:
Self-administered questionnaire form was developed by the investigator, based on reviewing related literatures and experts’ opinions, written in both English and Arabic languages to be easily understood by refugees. It included the following six parts:
Part 1: This part to assess the socio-demographic data of refugees including eleven closed ended questions such as gender, age, nationality, education level, marital status, monthly income, kind of accommodation, living with whom, room numbers, and home crowding index (Q1 to Q11).
Part 2: This part to assess the medical history of African Refugees which divided into two sections firstly to assess their medical history of Tuberculosis included 3 closed ended questions: such as onset of diagnosis with Tuberculosis, type of Tuberculosis, and follow up system. Secondly to assess the chronic diseases such as hypertension, diabetes, heart disease, liver diseases, kidney disease, musculoskeletal, neurological disorders, aids, and current complain such as persistent cough, coughing up blood, chest pain when breathing or coughing, loss of weight and appetite, lethargy, high fever, sweats especially at night, blood in the urine, and back. Finally, the medication administration (Q1 to Q 7).
Part 3: This part was dedicated to assessing the knowledge of African refugees about tuberculosis which included seven closed ended questions such as meaning of Tuberculosis, mode of transmission, cause, the high-risk groups of TB, preventive measures, methods of investigations, and complications of untreated TB. (Q1 to Q7).
Part 4: This part to assess the attitude of African refugees toward prevention of tuberculosis which included seven closed ended questions such as perceptions of stigma, social norms, impact on one’s life, perceived risk, preventive measures, advice others, and self-efficacy (Q1 to Q7).
Part 5: This part used to assess the practices of African refugees toward tuberculosis which include main 12 items of practices such as hand washing, disposal of waste products, cough etiquette, healthy nutrients, high proteins in meals, follow up, and medication compliance, stopping medication without doctor orders and keep home environmental sanitation (Q1 to Q12).
Results
The study result reveals that 52.5% of the studied refugees were male, while the female was 47.5. In addition, 53.8% were between the age of 18 – 25. Concerning their nationality, 43.8% were from Eritrea.
53.8% of them suffered from non-pulmonary tuberculosis. Also 16.3% had chronic disease which 5% out of them suffered from diabetes, heart disease, and neurological disorders.
The most complain of study sample of African refugees was lethargy for 84.6% of them, loss of weight and appetite for 82.5% and 79.2% respectively.
The results clarified that 45.4% of study sample of African refugees had poor knowledge about TB while, 34.2% of them had negative attitude and 77.1% of them had inadequate level of practices about prevention of TB.
The study findings proved that 46.2% of study sample of African Refugees suffered from low level of quality of life related to physical domain and 65% to psychological domain also 55.8% to social relationships and 52.1% to environmental domain. While 33.4% of them suffered from low total quality of life level.
Conclusion
In the light of the current study findings, it can be concluded that,
There was a statistically significant relation between quality of life and demographic data as educational level and type of tuberculosis; more than three quarters of high school patients felt better about their QoL than illiterate refugees. Furthermore, less than three quarters of patients with extra pulmonary tuberculosis had a higher quality of life level than those with pulmonary tuberculosis, additionally there was a significant relation between African refugees’ quality of life and their knowledge of tuberculosis; where less than half of the refugees with high knowledge have a low quality of life, more than two thirds of the patients with low knowledge have a moderate level of quality of life. While there is no significant correlation between quality of life and their attitude toward prevention of TB. Also, there is no significant relation between quality of life and practices.
Recommendations
Based on the current study finding the following recommendations were proposed:
• Educational programs to increase awareness, knowledge, practice, and attitude regarding TB are essential for preventing and managing the disease. These programs should be tailored to the specific needs of the target audience of refugees and delivered in a variety of formats, including booklets, brochures, radio and television broadcasts, and community-based campaigns.
• Developing standards/guidelines to intensify TB screening in clinics can help to increase TB case finding and initial treatment initiation. This is essential for preventing the spread of the disease.
• Conducting health awareness campaigns in communities to emphasize the effects of TB transmission and educating people on TB can help to reduce stigma and promote early care-seeking.
Further Research
• More research needs to be conducted to establish better ways of diagnosing and preventing TB and also ways to reduce the risk of mortality in TB patients.
• A further study is necessary to identify effects of educational program on knowledge and practices on quality of life for African refuges with TB.