Tuberculosis Treatment Non-compliance Rate and Associated Factors at Public and Private Tuberculosis Follow up Clinics in Northeast Ethiopia: A Comparative Cross Sectional Study

Melsew Getinet Tsegaw^1, and Yimer Seid Yimer²

¹Department of Public Health, Saint Lideta College of Health Sciences, Addis Ababa, Ethiopia

²Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia

Cite this paper:
Melsew Getinet Tsegaw and Yimer Seid Yimer. Tuberculosis Treatment Non-compliance Rate and Associated Factors at Public and Private Tuberculosis Follow up Clinics in Northeast Ethiopia: A Comparative Cross Sectional Study. American Journal of Epidemiology and Infectious Disease. 2018; 6(1):24-29. doi: 10.12691/ajeid-6-1-5

Abstract

Background: Non-Compliance to tuberculosis treatment is an important barrier for tuberculosis control programs because incomplete treatment may result in prolonged infectiousness, drug resistance, relapse, and death. Objective: This study was aimed at assessing treatment non-compliance rate and associated factors among registered tuberculosis patients at public and private directly observed therapy short course centers in Northeast Ethiopia. Methods: The study population was all individuals aged ≥18 years. Study subjects were selected using simple random sampling methods using patient’s registration number as a sampling frame. Data was collected using standardized, well-structured and pre-tested questionnaire. Both bivariate and multivariate logistic regression techniques were applied to analyze the data using statistical package for social science version 21. Results: High rate of treatment non-compliance was found in both patients managed in private (32.2%) and public (27.6%) tuberculosis clinics. Forgetfulness, use of addictive substance and unavailability of drugs remained significant predictors of non-compliance both in public and private tuberculosis clinics. Herbal medication use was significantly associated with treatment non-compliance only among patients attending public tuberculosis clinics, AOR (95% CI) = 5.646(2.12, 15.05). Unlike patients at public tuberculosis clinics, monthly income, knowledge about tuberculosis, closure of tuberculosis clinics and health education showed significant association with non-compliance at private tuberculosis clinics. Conclusions: Forgetfulness, use of addictive substance and unavailability of drug were found to be the three most important factors, leading to treatment noncompliance both in public and private clinics. Integrating health education and counseling services with assigned particular personnel in all facilities and provision of alarming machines to all patients is recommended.

Keywords:
noncompliance public private Mix-DOTS treatment interruption

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	World Health Organization (WHO). Global tuberculosis control: WHO report; Geneva, Switzerland. 2011.
[2]	United States Agency for International Development (USAID). Integrating TB/HIV Services in Private Clinics in Ethiopia. Private Sector Program-Ethiopia (PSP-E). 2008.
[3]	Amhara National Regional State Health Bureau: TB data analysis. Bahidar, Ethiopia. 2010.
[4]	Federal Ministry of Health Ethiopia (FMOH). Tuberculosis, Leprosy and TB/HIV Prevention and Control Program Manual. 2008, 4th edition.
[5]	Issa DW. Drug resistance patterns of tuberculosis among re-treatment cases in St. Peter’s TB specialized hospital, Addis Ababa. Addis Abeba University. 2003.
[6]	Namukwaya E, Nakwagala F, Mulekya F, Mayanja-Kizza H, Mugerwa R. Predictors of treatment failure among pulmonary tuberculosis patients in Mulago hospital, Uganda. African Health Sciences. 2011, 11(S1): S105-S111.
[7]	Morsy A, Zaher H, Hassan M, Shouman A. Predictors of treatment failure among TB patients under DOTS strategy in Egypt. Eastern Mediterranean Health Journal. 2003, 9(4): 689-701.
[8]	Picon P, Bassanesi S, Caramori M, et al. Risk factors for recurrence of tuberculosis. J Bras Pneumol. 2007, 33(5): 572-578.
[9]	Shargie E, Lindtjørn B. Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in southern Ethiopia. PLoS Med. 2007, 4(2): 280-287.
[10]	Tekle B, Mariam D, Ali A. Defaulting from DOTS and its determinants in three districts of Arisi zone Ethiopia. INT J TUBERC LUNG DIS. 2002, 6(7): 573-579.
[11]	Abula T, Worku A. Patient non compliance with drug regimens for chronic disease in North West Ethiopia. Ethiop J Health Dev. 2001, 15(3): 185-192.
[12]	Jaggarajamma K, Sudha G, Chandrasekaran V, et al. Reasons for non-compliance among patients treated under revised national tuberculosis control programme (RNTCP). Tiruvallur district, South India. Indian J Tuberc. 2007, 54: 130-135.
[13]	Yao S, Huang W, Hof S, et al. Treatment adherence among sputum smear positive pulmonary tuberculosis patients in mountainous areas in China. BMC Health Services Research. 2011, 11(341).
[14]	Janakan M, Seneviratne R. Factors Contributing to Medication Noncompliance of Newly Diagnosed Smear-Positive Pulmonary Tuberculosis Patients in the District of Colombo, Sri Lanka. Asia Pac J Public Health. 2008, 20(3): 214-223.
[15]	Xu W, Lu W, Zhou Y, et al. Adherence to anti-tuberculosis treatment among pulmonary tuberculosis patients: a qualitative and quantitative study. BMC Health Services Research. 2009, 9(169).
[16]	Zhao L, Xie X, Shen Y. Research Analysis on Medication Adherences of Tuberculosis Patients. China Pharmacy. 2005, 16(13).
[17]	Auer C, Lagahid J, Tanner M, Weiss M. Diagnosis and management of tuberculosis by private practitioners in Manila, Philippines. ELSEVIER Health Policy. 2006, 172-181.
[18]	Montagu D, Anglemyer A, Tiwari M, et al. Private versus public strategies for health service provision for improving health outcomes in resource-limited settings. Global Health Sciences, University of California, San Francisco. 2011.
[19]	Gupta S, Behera D. Reasons for interruption of anti-tubercular treatment as reported by patients with tuberculosis admitted in a tertiary care institute. Indian J tuberc. 2011, 58: 11-17.
[20]	Chengsorn N, Bloss E, Anekvorapong R, et al. Tuberculosis services and treatment outcomes in private and public health care facilities in Thailand. INT J TUBERC LUNG DIS 2009, 13(7): 888-894.
[21]	Gidado M, Ejembi C. Tuberculosis case management and treatment outcome: assessment of the effectiveness of public – private mix of tuberculosis programme in Kaduna state, Nigeria. Annals of African Medicine. 2009, 8(1): 25-39.
[22]	Chatterjee P, Banerjee B, Dutt D, et al. A comparative evaluation of factors and reasons for defaulting in tuberculosis treatment in the states of west Bengal, Jharkhand and Arunachal Pradesh. IND TUB. 2003, 50: 17-22.
[23]	Muture B, Keraka M, Kimuu P, et al. Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: A case control study. BMC Public Health. 2011, 11: 696.
[24]	Vijay S, Balasangameswara J, Agannatha P, Saroja V, Kumar P. Defaults among tuberculosis patients treated under DOTS in Bangalore city: a search for solution. IND TUB. 2003, 50(185).
[25]	Boyle S, Power J, Imbrahim M. Factors affecting patient compliance with anti-tuberculosis chemotherapy using the directly observed treatment, Short Course Strategy (DOTS). Int JnTuberc Lung Dis. 20006, 6(4): 307-312.
[26]	Bam T, Gunneberg C, Chamroonsawasdi K, et al. Factors affecting patient adherence to DOTS in urban Kathmandu, Nepal. INT J TUBERC LUNG DIS 2006, 10(3): 270-276.
[27]	Finlay A, Lancaster J, Holtz T, et al. Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, a case-control study. BMC Public Health. 2012, 12(56).
[28]	Vijay S, Kumar P, Chauhan L, et al. Risk Factors Associated with Default among New Smear Positive TB Patients Treated Under DOTS in India. PLoS ONE. 2010, 5(4).
[29]	Pandit N, Choudhary S. A Study of Treatment Compliance in Directly Observed Therapy for Tuberculosis. Indian Journal of Community Medicine. 2006, 31(4).
[30]	Kassaw K. Assessment of adherence among registered TB patients to directly observed short course and its determinant factors in N/Wollo. UoG. 2009.