Biological and Social Economic Determinants of Adherence and Cure of Tuberculosis Treatment: Path Analysis Evidence from Yogyakarta

Abstract

Background: Tuberculosis (TB) was an infectious disease which was still a health problem worldwide, including in Indonesia, which only had a population of around 261 million. The purpose of this study was to analyze biological and social economic determinants of adherence and cure of TB treatment. Subjects and Method:This was an analytic observational study with a case control design. The study was conducted in Bantul, Yogyakarta, from April to May 2019. A sample of 225 TB patients was selected by random sampling. The dependent variable was adherence and cure of TB treatment. The independent variables were age, gender, education, family income, nutritional status, healthy behavior, complication, family support, drug taking supervisor, drug taking adherence, environment, and smoking. The data were collected by questionnaire and analyzed by path analysis. Results: Adherence and cure of TB treatment was directly increased with good nutritional status (b= 076; 95% CI= 0.03 to 1.49; p= 0.042), drug taking adherence (b= 3.67; 95% CI= 1.47 to 5.92; p= 0.001), drug taking supervisor (b= 3.64; 95% CI= 1.26 to 6.02; p= 0.003), strong family support (b= 2.03; 95% CI= -3.85 to -0.21; p= 0.029), and healthy physical environment (b= 4.05; 95% CI= -0.09 to 8.20; p= 0.056). Adherence and cure of TB treatment was directly decreased with age ≥65 years old (b= -0.54; 95% CI= -1.85 to 0.75; p= 0.411), female gender (b= -0.05; 95% CI= -0.86 to 0.76; p= 0.900), unhealthy behavior (b= -3.20; 95% CI= -5.02 to -1.36; p= 0.001), smoking (b= -1.50; 95% CI= -2.56 to -0.43; p= 0.006), complication (b= -1.41; 95% CI= -2.60 to -0.23; p= 0.019). It was indirectly affected by nutritional status, education, family income, and healthy environment. Conclusions: Adherence and cure of TB treatment is directly increased with good nutritional status, drug taking adherence, drug taking supervisor, strong family support, and healthy physical environment. Adherence and cure of TB treatment is directly decreased with age ≥65 years old, female gender, unhealthy behavior, smoking, complication. It is indirectly affected by nutritional status, education, family income, and healthy environment.

A comparative analysis of the profile and treatment outcomes of tuberculosis patients managed at the community and primary health care facilities in Botswana

“…People who have strong family support though not significant, showed increased likelihood of treatment cure. This was in line with research conducted in Indonesia [19] , [20] , [21] which showed that strong family support can increase TB patients' compliance, hence raising cure rates. This could be explained that, family members frequently provide patients with psychological support, which lowers the likelihood of poor medication adherence resulting in improved TB treatment outcomes and program improvement [9] .…”

Factors Associated with the Level of Non-Adherence to Take Antituberculosis drugs

“…The result of the study conducted by the author showed different results from the study conducted by Fitriani et al [13] and Furlan [14] which state that age was associated with adherence to take antituberculosis drugs. The difference may occur because of the age range of the study subjects in the study conducted by the author was more concentrated in adulthood, so that the number of study subjects with extreme age ranges (elderly age range) that has the potential to be non-adherent to take antituberculosis drugs was very small.…”

Literature Review : Evaluasi Peer Group Support dan Family Support Terhadap Kepatuhan Pengobatan Pada Pasien Tuberkulosis Paru

“…(2019). Indonesia (13) . Secara tidak langsung dipengaruhi oleh status gizi, pendidikan, pendapatan keluarga, dan lingkungan yang sehat (13) .…”

“…Indonesia (13) . Secara tidak langsung dipengaruhi oleh status gizi, pendidikan, pendapatan keluarga, dan lingkungan yang sehat (13) . Bhatt Tingkat keberhasilan pengobatan ditemukan secara signifikan lebih tinggi pada kelompok yang didukung (65% vs 46,03%; p = 0,0349).…”

“…(11) Hal ini juga dibahas dalam penelitian Fitriani (2019), bahwa responden yang mendapat dukungan keluarga yang tinggi memiliki proporsi tinggi dalam patuh minum obat, tetapi ada pula beberapa responden yang mendapat dukungan kelurga tinggi tetapi tidak patuh, ini dikarenakan responden sudah malas dan bosan sehingga anjuran kelurga kurang ditaati. (13) http://2trik.jurnalelektronik.com/index.php/2trik Dari pembahasan diatas, dapat diketahui bahwa peer group support dan family support sangat baik dan dianjurkan untuk diimplementasikan sebagai intervensi tambahan dalam membantu proses pengobatan pada pasien TB paru. Salah satu dari kedua dukungan diatas bisa diberikan kepada pasien TB paru untuk meningkatkan kepatuhan dalam pengobatan, atau lebih baik lagi apabila kedua dukungan tersebut diberikan kepada pasien, sehingga dapat lebih meningkatkan kepatuhan pasien dalam pengobatan tuberkulosis paru.…”