Introduction: World Health Organization recommends screening of household contact as a key to improve detection of tuberculosis cases. Ethiopia’s current tuberculosis household contact investigation strategies rely on symptomatic contacts attending health facilities for investigation. This approach has not led to the detection of additional tuberculosis (TB) cases; alternative approaches have to be considered. The purpose of the research was to develop guidelines in endorsing the implementation of a community based household contact investigation program in Addis Ababa. Methods: A mixed method research using sequential exploratory design was conducted in Addis Ababa. In the first phase, qualitative data collection and analysis methods were used to formulate intervention approach and in the second phase, a quantitative random controlled trial was conducted, with the purpose of comparing the proposed intervention measures with routine household contact tuberculosis investigation. Frequencies and logistic regression analyses were used to determine the relative risk and associated factors. Thematic analysis was used for qualitative data analysis. Results: The in-depth interview and focus group discussion findings identified themes namely household contact investigation (HHCI) implementation, misconceptions on HHCI, challenges with HHCI Approaches, opportunities for HHCI provision, contributing factors associated with household involvement, strategies for effective HHCI service and partnerships with health bureau. In phase two, the study reported that the prevalence of TB was 7.1% among the intervention group compared to 1.9% in the control groups at the end of first year follow-up. Nine guidelines were developed to support the household contact investigation system. Conclusion: The passive case detection strategy of contact investigation did not find more cases, and tuberculosis patients and their family contacts were not satisfied with this method. However, the proposed community-based strategy shows that more TB cases can be detected by using existing medical staff. Therefore, an approach that makes the service more accessible is significant and the recommended community based TB household contact tracing approaches needs to be scaled up for its performance towards identified missed cases and enhance patient and their household contacts involvement. / Health Studies / D. Litt. et Phil. (Public Health)

Syftet med studien är att, utifrån en kritisk-saklig utredningsmetodik, granska hur familjerättssekreterare presenterar och bedömer barnets bästa och våld i nära relationer i 16 vårdnads-, boende- och umgängesutredningar. Utredningarna är gjorda av familjerätten i Örebro kommun. För att besvara studiens syfte och frågeställningar har den kvalitativa metoden dokumentgranskning använts i kombination med en semistrukturerad intervju. Studien visar att barn under nio år regelmässigt fråntas rätten att göra sin röst hörd samt att ett vuxet barnperspektiv genomsyrar utredningstexterna. Konsekvensen blir att barnets perspektiv osynliggörs och utelämnas. Språket har en avgörande betydelse för hur våldsproblematik hanteras, våldet tenderar att tonas ner eller ignoreras helt i bedömningen. Våld i nära relationer relateras inte till barnets mående, anknytning eller föräldraförmåga. Det är inte heller något som diskuteras eller tas hänsyn till i bedömningen. Den kritiskt-sakliga utredningsmetodiken har genom sina teoretiska begrepp varit ett grundläggande verktyg i studiens analys och diskussion. Detta har kombinerats med den lagstiftning som reglerar familjerättens uppdrag samt anknytningsteori och barnets bästa. Studien ämnar bidra till reflektion, inspiration och upplysning rörande barnets bästa och våld i nära relationer i vårdnads-, boende- och umgängesutredningar. Förhoppningsvis kan studien även bidra till att öka barnens inflytande i vårdnadstvister, stärka deras ställning och göra deras röster hörda. / The aim of the thesis is to examine, based on critical-factual investigation methodology, how family law secretary’s presents and assess “child’s best” and domestic violence in 16 custody-residence- and contact investigations. The investigations are made by family law in Örebro. To reach the aim of the study and the research questions the qualitative method document review was used in combination with a semi-structured interview. The results of the study showed that children younger than nine years routinely were denied the right to have their voices heard and also that an adult child’s perspective permeates the investigations. The consequence is that the child's perspective became ​​invisible or omitted. Language has an important part in how violence is handled, it tends to be grayed or ignored in the assessment. Domestic violence is not either related to the child’s wellbeing, attachment theory or parenting skills. That is also something that is not discussed or taken into consideration in the assessment. The critical-factual investigation methodology through its theoretical concepts has been a fundamental tool in the analysis and discussion. This has been combined with the law that regulates the family law assignment, attachment and “child´s best”. The study intends to contribute to a reflection, inspiration and enlightenment concerning “child´s best” and domestic violence in custody-, residence- and contact investigations. Hopefully, the study also helps to increase the children's interests in custody disputes, strengthen their position and to make the children´s voices heard.