Factors associated with interruption of treatment among pulmonary tuberculosis patients in Plateau State, Nigeria, 2011

Abstract

IntroductionNigeria has one of the highest tuberculosis (TB) burdens in the world with estimated incidence of 133 per 100,000 populations. Multi-drug resistant TB (MDR-TB) is an emerging threat of the TB control in Nigeria caused mainly by incomplete treatment. This study explored factors that affect adherence to treatment among patients undergoing direct observation of TB treatment in Plateau state, Nigeria.MethodsBetween June and July 2011, we reviewed medical records and interviewed randomly selected pulmonary TB patients in their eighth month of treatment. Information on patients? clinical, socio-demographic and behavioral characteristics was collected using checklist and structured questionnaire for knowledge of treatment duration and reasons for interruption of treatment. We conducted focus group discussions with patients about barriers to treatment adherence. Data were analyzed with Epi Info software.ResultsOf 378 records reviewed, 229 (61%) patients were male; mean age 37.6 ±13.5 years and 71 (19%) interrupted their treatment. Interruption of treatment was associated with living > 5 km from TB treatment site (AOR: 11.3; CI 95%: 5.7-22.2), lack of knowledge of duration of treatment (AOR: 6.1; CI 95%: 2.8-13.2) and cigarette smoking (AOR: 3.4; CI 95%: 1.5- 8.0). Major reasons for the interruption were lack of transport fare (40%) and feeling well (25%). Focused group discussions revealed unfriendly attitudes of health care workers as barriers to adherence to treatment.ConclusionThis study revealed knowledge of the patients on the duration of treatment, distance and health workers attitude as the major determinants of adherent to TB treatment. Training for health care workers on patient education was conducted during routine supportive supervision.

Knowledge, attitude and perception of tuberculosis management among tuberculosis-infected patients in resource constraint setting: field experience from Oyo state, South-West, Nigeria

“…This finding is contrary to some studies conducted in northern Nigeria. 13,14 However, studies have shown that poor knowledge of TB could contribute to high burden of TB due to patients' poor health seeking behavior such as looking for inappropriate care. 15,16 Although many patients understand the need to seek care in approved health institutions, it has been shown that they do not fully assimilate the information they are receiving from the health care providers.…”

“…[10][11][12] Consistently, inadequate knowledge of TB treatment especially treatment duration has been associated with treatment interruption. 13 Suboptimal patients' compliance is a practical implication of poor TB knowledge. In real terms, when patients observe improvement in their health arising from the effective use of TB-medications within few weeks of treatment at the DOT centres, they stop taking medication.…”

Effects of directly observed treatment short-course education program on the knowledge, attitude and practice of community health extension workers in the management of tuberculosis in Sagamu local government, Ogun state, southwest Nigeria

“…This is possibly one major reason why TB control in the country has remained ineffective. 4,13,14 The relative lack of professional preparation in DOTS management of TB was probably an important factor why virtually all the participants (97.3%) considered the proposed training necessary.…”

Incidence of HIV and pulmonary tuberculosis co-infection among patients attending out-patient clinic in a Nigerian hospital

“…Patients, who show no clinical improvement following treatment, harbor multi-drug resistant strains which are capable of posing a threat to their immediate environment [19].…”