A study of compliance to DOTS among tuberculosis patients attending a district hospital, Uttar Pradesh

Side effects of Anti-Tuberculosis Drugs is a problem in the treatment of tuberculosis patients. In Barru Regency, the number of pulmonary TB patient visits in the outpatient and inpatient units in 2014–2016 was still high. Based on these data, it is deemed necessary to conduct research on the causes of cure rates in only 73% of the total users of pulmonary TB drugs, in terms of the side effects of anti-tuberculosis drugs, pulmonary disorders and gastric disorders. This study was conducted on Agustus, 2017 to January, 2018; using cross sectional approach. Subject of this study were 75 tuberculosis patients with BTA+ and side effects of Anti-Tuberculosis Drugs on the lungs and stomach, selected by total sampling. Data were obtained through interview, then analyzed by using path analysis. It is known that the pathways of influence were significant (T-value> 1.96) were knowledge on immune system, type of drug on immune system, knowledge on side effect of drug and type of drug on side effect of drug. Thus, the level of knowledge and types of drugs directly affect the immune system, as well as the side effects of drugs. Several factors that directly affect the side effects of anti-tuberculosis drugs are the level of knowledge and type of drug. Increased knowledge will reduce the side effects of the drug, because the patient makes an effort to neutralize the effect.

Bakcground: Leprosy continues to remain public health problem particularly in developing countries. Treatment is the most important aspect in leprosy control, however as the long duration of treatment compliance is critical point to success of therapy. Objective: Determine how big the problem of treatment compliance og leprosy patients in Kabupaten Blora and what factors influencing the compliance of those patients. A case control study was conducted in 22 health centers involving 126 leprosy patients. Patients who took irregularly Multi Drug Therappy (MDT) and heve been Released From Treatment (RFT) were considered as the case. Whereas those who regularly took MDT were considered as the control. Various variables observed from the patients, treatment and health providers were analysed using bivariate as well as multivariate statistical methods. Results: Showed that by using bivariate analysis dominant factors of irregular treatment of the patient to MDT in Kabupaten Blora were low social economy (odds ratio/OR:2,69), low knowledge on leprosy (OR:2,89), side effect of the drugs (OR:6,22), leprosy reaction (OR:3,43), disabilies (OR:4,2), no health education (OR: 13,12) and no home visit of provider (OR: 2,79). However, by multivariate log regression only 2 variables i.e. no health education and side effect of drugs were significantly influencing the irregularity to treatment. Nosignificant correlation between sex, education, detection methods, distance of health services, leprosy type, supervison and patient perception and the irregular treatment were found. Conclusion: That no health education and side effect of drugs are significant factors of irregularity to treatment in leprosy. Keywords: Leprosy-MDT-irregular treatment-health education-side effect of drugs

Objective To analyze the factors which influence the treatment compliance of hypertensive patients in health management. Methods Data of 6 325 hypertensive patients who received physical examination in our department were collected; 4 132 male cases and 2 193 female were included, their ages ranged from 28 to 84 years old; the average age was 61.2 ± 5.8 years. The patients of the health intervention group were randomly divided into 3 groups(group 1, group 2 and group 3). They were provided with regular health management(including weight management, catering management, sports management, medication management and monitoring of blood pressure), respectively, given different frequency of telephone follow-up(1 time per 2 months, 1 time per month, and 1 time per month), evaluating treatment compliance. All the results were analyzed and compared respectively according to the level of education, age and mental status. Data of 1 892 hypertensive patients who received outpatient services were enrolled as the control group. Among them, 4 132 were male and 2 193 were female, aged 28-84 years old, average(61.2 ± 5.8)years old. They received the traditional outpatient follow-up(outpatient service review and health education), their treatment compliance, timely correcting unhealthy lifestyle and medication method and self-testing blood pressure were evaluated. ANOVA and chi square test were used to analyze the treatment compliances and blood pressure control rates of the two groups. Result Compared with the control group, health intervention for hypertension patients could significantly improve the treatment compliance and blood pressure control rate(64.8% vs. 41.3%, 56.7% vs. 29.6%; χ2=2.827, 1.382; P=0.032, 0.007). Comparing the results of telephone follow-up frequency, the treatment compliance and blood pressure control rate of the 3 intervention groups were higher than those of the two other groups(77.3% vs. 65.4%, 51.7%, χ2=3.414, P= 0.041; 69.6% vs. 57.3%, 43.2%, χ2=2.763, P=0.028). The treatment compliance of patients with high education level was significantly higher than that of patients with low education level(68.7% vs. 59.1%, 46.4%, χ2=3.257 , P=0.037; 60.1% vs. 47.2%, 32.8%, χ2=1.234 , P=0.009). And the treatment compliance of patients with good mental state was significantly higher than that of patients with anxiety(Intervention group1 :64.3% vs. 55.1%,41.9%,31.0%, χ2=2.257, P=0.016; 59.4%vs.46.1% ,20.9% ,21.8% , χ2=3.34 5 P= 0.021; Intervention group2 :75.5% vs. 64.3%, 51.8% ,41.2%, χ2=2.932, P=0.030; 68.3% vs.57.1%, 39.2%, 32.1% , χ2=2.382, P=0.032; Intervention group3: 86.5% vs.73.2% , 62.6% , 52.4% , χ2=2.435, P=0.026; 75.2%vs. 68.0% , 51.7% , 43.3% , χ2=3.251, P=0.036). Conclusion More frequently follow-up can improve the treatment compliance and control rate of blood pressure in hypertensive patients; education, age and psychological condition are factors influencing treatment compliance in hypertensive patients. Key words: Primary hypertension; Health management; Treatment compliance; Affecting factor

BackgroundMultidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are global health problems. We sought to determine the characteristics, prevalence, and relative frequency of transmission of MDR and XDR TB in Shanghai, one of the largest cities in Asia.MethodsTB is diagnosed in district TB hospitals in Shanghai, China. Drug susceptibility testing for first-line drugs was performed for all culture positive TB cases, and tests for second-line drugs were performed for MDR cases. VNTR-7 and VNTR-16 were used to genotype the strains, and prior treatment history and treatment outcomes were determined for each patient.ResultsThere were 4,379 culture positive TB cases diagnosed with drug susceptibility test results available during March 2004 through November 2007. 247 (5.6%) were infected with a MDR strain of M. tuberculosis and 11 (6.3%) of the 175 MDR patients whose isolate was tested for susceptibility to second-line drugs, were XDR. More than half of the patients with MDR and XDR were newly diagnosed and had no prior history of TB treatment. Nearly 57% of the patients with MDR were successfully treated.DiscussionTransmission of MDR and XDR strains is a serious problem in Shanghai. While a history of prior anti-TB treatment indicates which individuals may have acquired MDR or XDR TB, it does not accurately predict which TB patients have disease caused by transmission of MDR and XDR strains. Therefore, universal drug susceptibility testing is recommended for new and retreatment TB cases.

Background: Inappropriate tuberculosis treatment is a major determinant of multidrug-resistant tuberculosis (MDR) TB, which is related to patient adherence to treatment. There are several factors that affect MDR-TB such as drug side effects, smoking and alcohol consumption. The aim is to estimate the magnitude of the effect of drug side effects on tuberculosis treatment adherence, based on the results of a number of similar primary studies. Subjects and Method: This study is a systematic review and meta-analysis research. Article search was carried out based on the eligibility criteria of the PICO model including: P= Tuberculosis patient; I= drug side effects, smoking and alcohol consumption; C= no drug side effects, no smoking and no alcohol consumption; O= Tuberculosis treatment adherence. Articles were collected from Google scholar, PubMed, Science Direct, and Springerlink. Keywords using “drug side effects” OR “tobacco smoking” OR “alcohol consumption” OR “tuberculosis” AND “medication adherence” AND “cross sectional” AND “adjusted odds ratio”. Inclusion criteria in this study included articles with a cross-sectional study design, the relationship size used was the adjusted Odds Ratio (aOR), articles published in the 2009 to 2022 range. Selected articles were tested for eligibility using CEBM and analyzed using the PRISMA diagram and the Review Manager 5.3 application. Results: 14 Cross-sectional studies were selected for the meta-analysis of 8 studies with 2,045 TB patients showed that drug side effects reduced TB treatment adherence by 0.26 times than no drug side effects (aOR= 0.26; 95% CI= 0.14 to 0.49; p< 0.001). 7 studies with 2,966 TB patients showed that alcohol consumption decreased TB treatment adherence by 0.61 times than not consuming alcohol (aOR= 0.61; 95% CI= 0.32 to 1.16; p= 0.130). Study 6 with 1,748 TB patients showed that smoking decreased TB treatment adherence by 0.86 times than non-smokers (aOR= 0.86; 95% CI= 0.17 to 4.37; p= 0.850). Conclusion: Side effects of drugs, alcohol, and smoking reduce treatment adherence in tuberculosis patients. Keywords: drug side effects, alcohol consumption, smoking, treatment adherence Correspondence: Aem Ismail. Master’s Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: aem.ismail80@gmail.com. Mobile: +6282133114822.

There is a large volume of published studies describing the adverse relationship between treatment non-adherence with tuberculosis treatment outcome. Non-adherence could result in increased risks of prolonged infectiousness, drug resistance, relapse cases and poor survival among tuberculosis patients. Nevertheless, few studies are to be found providing detailed on the reason of defaulting treatment among tuberculosis patients in Malaysia. Hence the goal of this paper is to find out the barriers and motivations factors that affect patients’ treatment compliance among our local tuberculosis patients. This is a qualitative study which included 12 in-depth interviews with tuberculosis non-compliance patients who were treated at Institute of Respiratory Medicine, Kuala Lumpur. All the conversations were recorded, transcribed and analysed by using thematic analysis. It was found that low knowledge, self-negative attitudes, traditional believes, negative perceptions towards health caregiver, drug side effects, stigma, financial problems, less family support and work commitments are the barriers that prevent the patients from religiously taking their anti-tuberculosis treatment. Meanwhile, factors that encourage them to continue their treatment were the believes of bad effects of the disease onto their lives and health, good relationship between patient and health caregiver and social support from people around them. In conclusion, non-adherence involved a dynamic influence of individual, socio-economic and treatment-related factors on the patients. The results presented here may facilitate improvement in the activities in promoting compliance among tuberculosis patients in the future which tailored to the patients’ specific needs. DOI : http://dx.doi.org/10.17576/JSKM-2017-1501-10

INTRODUCTION: World Health Organization recommends actually A 4-fixed dose combination (4-FDC) drug for TB treatment in order to prevent the emergence of drug resistance.However, some drug side effects may occur with FDC leading to drug changing; AIMS: We aim mainly to compare the safety and tolerability of 4 drug-fixed-dose combination regimen to the separate drug among patients with newly diagnosed TB. Secondly, we compare the completion to treatment in both regimens. METHODS: We retrospectively studied drug side effects and treatment compliance among new patients under the 2 types of regimens of TB treatment(FDC drug and separate standard drug)registered between 2008 and 2013. Every population includes 140 patients receiving daily 4 drugs(Rifampicin,Isoniazide,pyrazinamide,ethambutol)given as a FDC in the first and separately in the second. RESULTS: Drug side effects occurred more frequently with SSD(40,7%) than with of FDC regimen(31%) with statistical significance (95% CI = 3.97-29.06, p= 0.01).Gastrointestinal disorders (abdominal pain, diarrhea) are more frequent with the FDC drug(20% Vs 18,6%).Cytolysis is more frequent with SSD (16,4%) than with FDC drug(7,14%) with statistically significant difference.The time to onset of cytolysis differed between the 2 regimen. The rate of cytolysis is higher in patients under FDC (9%)who had severe cytolysis (10 times). No statistically significant difference was observed between the 2 regimen in treatment completion (p=0.79). CONCLUSION: The safety of the 4-FDC regimen was non-inferior to that of the separate drugs, but patient acceptability do not significantly improved with 4-FDC.

Pulmonary tuberculosis treatment causes various side effects including nausea and vomiting, itching, vision problems, and anemia. Drug side effects in the early stages are one of the causes of non-adherence to complete treatment. The purpose of this study was to analyze the effect of the side effects Tuberculosis treatment in the early stages on treatment compliance for tuberculosis patients. This study used a cross sectional design. Samples were taken as many as 71 respondents, the instruments used were side effects of early-stage tuberculosis treatment and compliance with tuberculosis treatment in tuberculosis patients from the Morisky Medication Adherence Scale (MMAS). The results of the study found 97.7% adherent and 2.3% non-adherent, 39.5% mild side effects and 60.5% severe side effects. Chi-square test showed that no significant difference between the side effects of TB treatment in the early stages of tuberculosis treatment compliance in patients p = 0.669 at significant level of 95% (α = 0.05). There was no effect between the side effects of Tuberculosis treatment in the early stages of treatment compliance for Tuberculosis patients. It was recommended that health workers continue to monitor the side effects of tuberculosis treatment and provide motivation to carry out treatment completely.
 
 Keywords: side effects; early stage; treatment; pulmonary tuberculosis; compliance

Objective To investigate the evaluation of disease perception, treatment compliance and community follow-up services of community schizophrenia patients, family members and personnel in Shantou City, and to provide a reference basis for improving the quality of management treatment. Methods With the method of stratified sampling qualitative research, a community sample of 17 198 patients with schizophrenia in seven districts or county in Shantou City were sampled from February to August 2019, with 2 towns being drawn from each district or county, and 10 patients, 10 family members and 3 personnel were selected in each town. The evaluation of disease perception, treatment compliance and community follow-up services were investigated and analyzed. Respondents were eventually included in 137 patients, 138 family members and 41 personnel.The interviewees were conducted with semi-structured interviews, the data were collected according to traditional methods, and the descriptive statistical analysis was carried out with SPSS 12.0. Results (1)34.3% of patients and 32.6% of the family members were not fully aware of the disease.22.6% of the patients and 23.2% of the family members had a sense of ill shame. (2)26.3% of patients did not comply with treatment, 29.9% of patients had not insight, 53.3% of patients and 24.6% of family members on the side effects of drugs and addiction understood improperly, and, 35.0% of patients and 13.0% of the family had a misunderstanding of illness and using drugs. (3)29.2% of patients and 31.2% of their families were tired of taking long-term medication, 24.8% of patients and 21.0% of their families felt socially isolated, and, 17.5% felt unsupported and 18.8% of their families admitted that they did not care enough about patients. (4)31.4% of patients did not actively receive follow-up services, 37.2% of patients and 20.3% of family members did not cooperate with follow-up doctors, and, 21.2% of patients and 10.1% of family members were not satisfied with follow-up services. (5)The personnel of psychiatric care could basically grasp the conditions of patients in the jurisdiction and carried out follow-up services on a regular basis (90.2%), master emergency disposal methods (92.7%), and have carried out training (97.6%). However, the psychiatric practice of the personnel were lower than (58.5%) and most lying part-time (78.0%), the average length of service was 5.7±1.4 years. The personnel satisfaction with the community follow-up service was higher (95.1%), but most of them thought that the psychiatric care was more difficult (36.6%), and were dissatisfied with the multi-functional staff to undertake a number of public services (31.7%). Conclusion The management treatment project of mental disorders services in Shantou City show initial results.The patients were satisfied with the community follow-up service, but the patients and their families still have low level of cognition, poor compliance, obvious negative emotions, and have concerns about drug treatment.It is necessary to strengthen the professionalization of personnel, to carry out early mental health education and rational emotional behavior training for patients and their families. Key words: Schizophrenia; Disease cognition; Therapeutic compliance; Community management; Qualitative research

One of the obstacles to the treatment of tuberculosis (TB) patients is the sideeffects of anti-tuberculosis drugs (ATDs) which cause patients to be reluctant to continue the medication. The elderly experience various physical and physiological changes in the bodysystem, including susceptibility to drug side effects, decreased knowledge and memory,resulting in non-compliance with taking the medication. This study aims to determine therelationship between ATDs side effects and compliance with taking medication for elderlypatients at the Tanjung Selor Health Center, Bulungan Regency, North Kalimantan Province.This study used a quantitative cross-sectional approach. The sample was taken by totalpopulation, namely elderly tuberculosis patients undergoing tuberculosis treatment as many as30 respondents. The research instrument was a questionnaire of drug side effects and ATDscompliance. Statistical test used Fisher's Exact. The results showed that most patients (76.7%)complained of OAT side effects and the rest without OAT side effects (23.3%). Treatmentcompliance was 20% compliant, and 80% were non-compliant. Fisher's Exact statistical testobtained p-value = 0.016 (< α = 0.05). It was concluded that there was a significant relationship between OAT side effects and treatment compliance in elderly patients with tuberculosis. Recommendations for health workers to give special attention to elderly patients with medication monitoring and compliance motivation. Future researchers should identify the involvement of family and health workers to monitor the side effects of anti-tuberculosis drugs.

Background: Tuberculosis was the first infectious disease declared by the WHO as a global health emergency. Men are more commonly affected than women. The case notifications were higher in males than in females most countries. The objective of the study was to assess socio-demographic determinants of tuberculosis patients attending directly observed treatment short course (DOTS) centre in Urban Ghaziabad.Methods: This was an observational cross-sectional study. The study was carried out in selected DOTS centres of district Ghaziabad. 850 study subjects age group more than 15 years were included. Multistage sampling was done. Numbers and percentage were used. SPSS version 13 was used for statistical analysis.Results: Majority 41.17% of tuberculosis (TB) patients belonged to 15-25 years age group. 30.58% patients were in 26-35 years age group followed by 23.52% in 36-45 years age group and least 4.70% were in >45 years age group. Majority 54.1% of TB patients were females that compared to 45.9% were males. Among tuberculosis patients majority 58.82% were married as compared to 40% were unmarried and least 1.18% were widow. 75.29% tuberculosis patients were Hindus as compared to 22.35 were Muslims and least 2.35% were Sikh/Christian. Among tuberculosis patients majority 44.71% were from nuclear family. 31.76% had joint family and least 23.53% had 3rd generation family.Conclusions: It was concluded that socio-demographic determinants were low. It was recommended to raise socioeconomic standard of population, give health education to improve personal habit and stop TB transmission.

Extensively Drug-Resistant Tuberculosis, China

Objective To investigate the treatment compliance and uric acid control rate in patients with primary gout. Methods One hundred primary gout patients with disease duration >6 months treated in our hospital from June 2015 to June 2016 were enrolled in the study. The treatment compliance and disease control rate were evaluated with revised Chinese Compliance Questionnaire-Rheumatology (CCQR). Results Eighty four valid questionnaires was recovered for analysis. Among 84 patients there were 46 cases of high compliance(54.8%)and 38 cases of poor compliance(45.2%). The CCQR score in high compliance group was significantly higher than that in poor compliance group (73.48±15.62 vs. 48.37±10.96, t=8.352, P 0.05). The duration of gout was shorter in high compliance group than that in low compliance group [(6.12±1.79)y vs. (13.24±4.56)y, P<0.001]. The uric acid control rate in high compliance group was higher than that in poor compliance group (76.1% vs. 36.8%, χ2=13.186, P=0.000 3); and the serum uric acid levels were(369.82±35.67)μmol/L and (497.46±63.49)μmol/L in two groups, respectively(t=11.606, P<0.001). Conclusion It is necessary to strengthen health education for gout patients to improve the treatment compliance and to achieve the high uric acid control rate. Key words: Gout; Patient compliance; Questionnaires

Objective To explore and analyze the application effect of health education series map in the health education of department of ophthalmology. Methods 200 patients with ocular diseases treated at our hospital from January to November, 2016 were randomly divided into an observation group (100 cases) and a control group (100 cases). The control group took routine health education guidance; in addition, the observation group took health education series map for training and guidance. The ophthalmology health education efficiency, satisfaction, health education popularization rate, doctor-patient communication efficiency, treatment compliance, and behavior change were compared between these two groups. Results The rate of awareness, satisfaction, health education popularization rate, doctor-patient communication efficiency, treatment compliance, and behavior change rate were 99.00%, 97.00%, 95.00%, 99.00%, 99.00%, and 87.00% in the observation group, respectively, which were higher than those in the control group, with statistical differences (allP<0.05). Conclusions The application of series map of health education in ophthalmic knowledge education process can improve the awareness of eye disease among patients and their families, increase rate of the popularity of health education, and help patients better understand the disease, so it is worth being clinically generalized. Key words: Health education series map; Department of ophthalmology; Health education; Effect

Objective To explore the influence of nursing intervention on treatment compliance in patients with pulmonary tuberculosis. Methods 90 patients were randomly assigned to receive routine anti-tuberculosis therapy alone (control group, 45 patients) or anti-tuberculosis therapy combined with nursing intervention including health education, reminding patients of taking medicines on time, psychological care, production of patient reminders, and emphasis on regular follow-up (study group, 45 patients). Survey on treatment compliance was conducted after completion of treatment. The rate of treatment compliance was compared between the two group. Results There was a significant difference in treatment compliance between the study group and the control group ( 93.3% vs. 73.33%). Conclusions Nursing intervention can increase the rate of treatment compliance and have patients recover more rapidly. Key words: Nursing intervention; Tuberculosis; Pulmonary; Compliance