Assessment of the implementation of providers and patients adherence to Directly Observed Treatment Shortcourse (DOTS) strategy for Tuberculosis chemotherapy in Anambra State Nigeria.

Abstract

Background: The Directly Observed Treatment Shortcourse (DOTS) is a widely accepted strategy in the management of TB, however, Failure cases and Multi-drug resistant cases are also on the increase, hence the need to assess the adherence to the implementation of this veritable strategy from providers and patients views. Methodology: A comparative cross-sectional study involving 32 DOTS accredited facilities in rural and urban areas implementing DOTS strategy was utilized for this study. A total of 354 were randomly selected and assessed with the use of a questionnaire while a checklist was used to assess providers’ adherence. Data was analysed using SPSS version 21. Chi-square and Fisher`s exact test was used to test significance set at p<0.05. Results: The rural respondents spent less to get to the DOTS facility and this was statistically significant (p=0-02). The reasons for missing medications in rural compared to urban areas was also statistically significant (p=0.00). No health worker was noted to observe patients other than parents or siblings from the questionnaires and this was also statistically significant, (p=0.03). Overall patients adherence was 86.2% in rural compared to 87.6% in urban areas which was higher. None of the facilities in both subpopulations had health education checklist and one rural facility drug that passed expiration date was also seen. Conclusions: Overall adherence to DOTS implementation was high in both subpopulations, however, no health worker observed the patients. Direct observation of patients and follow-up is strongly recommended to prevent failure and resistant cases. Key words: Implementation; DOTS strategy; Providers adherence; Patients adherence; Anambra State.