Introduction: Ethiopia is the second largest refugees hosting country in Africa. Refugees are at increased risk of developing TB and of poor access to TB care and control services. However, there is limited evidence on whether the refugees’ TB related behavior is different from the surrounding communities in the country. This study, therefore, aims at assessing the knowledge, attitudes and practices (KAP) of the refugees towards TB, and their health seeking behaviors in comparison to the surrounding communities in Gambella Regional State, Ethiopia.

Methods: A community based comparative cross-sectional study was conducted in three refugee camps and their SCs in Gambella Regional State, Ethiopia from November, 2016 to May, 2017. The study participants were TB presumptive cases (cough for >2 weeks) and patients on anti-TB treatment who were 15 years of age and older. A total of 651 study participants were identified though screening of entire refugee camps and the SCs. A pretested structured questionnaire was used to collect data. Communities KAP differences between the two study population towards TB and their health seeking behaviors were computed using SPSS version 20.0.

Result: Of the 292 refugees and 359 SCs study participants, 188(64.4%) of the refugees and 216(60.2%) the SCs heard about TB. The SCs had higher overall (53.2%) TB knowledge compared to the refugees (31.9%) (P < 0.001). However, the refugees had better awareness than the SCs that HIV is a potential risk for TB (62.5% vs. 52.7%, (P=0.016). Only 40.4% of refugees and 21.3% of the SCs know that refugees are high risk group for TB (P< 0.001). The study participants belong to Nuer (AOR=0.23, 95% CI: 0.14-0.39) and Anuak (AOR=0.46, 95% CI: 0.25-0.87) ethnic groups had low level of knowledge.

Majority (x̅ score= 4.35) of the SCs study participants agree that TB is a public health problem in general, and a serious disease ( x̅ score= 4.14) in that specific community compared to the refugee (P <0.001). However, refugees more likely agree on feeling embarrassed ( x̅ score= 3.24 vs. 3.13 P <0.001), hiding from other people ( x̅ score= 3.16 vs. 3.02, P <0.001), and having higher stigma if they had TB ( x̅ score=3.25 vs. 3.24, P= 0.016) compared to the SCs, respectively. Moreover, appropriate health seeking behaviors were significantly higher among respondents who had information on TB transmissibility (AOR= 2.10, 95% CI: 1.33-3.32). But refugees and Nuer ethnic groups (AOR=0.52, 95%CI: 0.35-0.79) had significantly less odds of appropriate health seeking behaviors.

Conclusion: This study revealed low TB knowledge, poor health seeking behaviors, higher stigma, and negative attitude toward TB among refugees compared to the SCs. The national TB control program and other organizations working in refugees should design health communication strategies for refugee communities to address the gap and bring behavioral changes so as to ultimately improve TB control endeavors.

Keywords: Tuberculosis, KAP, Refugee, Surrounding Community, Ethiopia