This study attempted to investigate the level of patient satisfaction and adherence to TB treatment and associated factors among TB patients on intensive and continuation phase of treatment. The overall satisfaction rate with TB treatment service in this study is consistent with the study done India, where 91% of the patients in the study group expressed Satisfaction with the DOT services . However, in this study those who are not coming to health facilities because of less satisfaction with the services were not included.
The study also showed that patients on intensive phase of treatment had an increased satisfaction score as compared to those who were in continuation phase. The reason for this might be patient on intensive phase has frequent and ongoing interaction with health care provider more than patients on continuation phase. Similar finding was reported by earlier study done on out patient satisfaction, where frequency of visit to health facility significantly associated with patient satisfaction .
Perceived professional care, perceived time spent with health care provider, perceived accessibility, perceived technical competency, perceived convenience (cleanliness) and perceived consultation and relational empathy were independent predictors of patient satisfaction (P < 0.05). This indicates a good patient provider relationship has a positive outcome on patient satisfaction. This finding is supported by the Study done in Tanzania, where good patient-service provider relationship was an important reason for satisfaction on TB treatment service  and previous finding on out patient satisfaction in study from Ethiopia . In addition to this, perceived waiting time was significantly associated with patient satisfaction. This is consistent with study done in Eastern Ethiopia, where the level of satisfaction decreased with an increase in perceived length of waiting time .
The level of treatment adherence in this study is lower than the study conducted in South Africa where non adherence was reported to be 34% . However our finding is higher than the 5.4% reported from Nigeria . The reasons for poor adherence as reported by the respondents were absence of drug, the health facility being in far away from home, too hard to take many pills, fear of interaction with other medication, felt depression. Some of these reasons are similar to what was previously reported in earlier studies [25–27].
Patients’ treatment phase and waiting time in reception room were independent predictors of patient adherence to TB treatment. Patients on intensive phase, the respondents had good adherence to their TB treatment. This might be on intensive phase patients take their medication daily in the health institution and Patient might have good adherence during intensive phase, probably the illness is severe and fear of illness consequence make them not to miss pill. This is comparable with the study done in Hossana, Jimma and Arsi Zone of Ethiopia, where defaulting was highest during the continuation phase of treatment even if default not equal to poor adherence [16, 25, 26].
Our study demonstrated that perceived time spent with health care provider, perceived accessibility, perceived waiting time and perceived professional care had a positive association with patient adherence to TB treatment (P < 0.05). This is consistent with the studies conducted in South Africa and India [20, 23]. The key challenge of direct observation of treatment is to implement it well, maximizing convenience and respectful interaction with patients . Moreover, patient satisfaction was a significant association with adherence to TB treatment. An increased the overall patient satisfaction on TB treatment service has a positive effect on patient adherence to TB treatment. This is consistent with the study done in South Africa, where higher patient satisfaction with the service at the hospital was significantly associated with higher levels of adherence . Similarly, study done in India stated dissatisfaction with services provided was the predictors of default .