Dinámica familiar y adherencia al tratamiento en pacientes pediátricos con tuberculosis

Abstract

Introduccion No existen estudios que evaluen la dinamica familiar en poblacion pediatrica con tuberculosis. Tampoco se ha medido la adherencia al tratamiento, a pesar de que la no adherencia es un problema de salud publica especialmente en enfermedades cronicas infecciosas. Objetivo Evaluar la dinamica familiar y la adherencia al tratamiento de pacientes pediatricos con tuberculosis pulmonar y extrapulmonar de un servicio de infectologia en Mexico. Material y metodos Estudio transversal descriptivo en el que participaron, de mayo a julio de 2015, 17 pacientes de 8 a 15 anos con tuberculosis. Se aplicaron tres instrumentos en espanol: la dinamica familiar se midio con el cuestionario APGAR familiar adaptado para ninos de 8 anos en adelante y la adherencia al tratamiento con la prueba de Haynes-Sackett y la prueba de Morisky-Green-Levine. Resultados La tuberculosis extrapulmonar supero con el 76.4% de los casos a la tuberculosis pulmonar (23.5%); la forma clinica de tuberculosis mas frecuente fue la ganglionar. La funcionalidad familiar (94.1%) predomino sobre la disfuncion moderada (5.8%) y la disfuncion grave (0%). La alta adherencia al tratamiento antituberculoso rebaso con el 58.8% a la moderada (29.4%) y a la baja (11.7%). La tasa de abandono del tratamiento apenas fue del 5.8%. Conclusiones Los hallazgos sugieren que se debe evaluar la dinamica familiar dentro de los controles medicos del tratamiento antifimico, tanto en el primer nivel de atencion como en el hospital. Esta disposicion ayudaria a promover una adherencia alta al tratamiento. Background There are no studies evaluating family dynamics in pediatric population with tuberculosis. Neither treatment adherence has been measured, even though patient non-adherence is a public health problem, especially in chronic infectious diseases. Objective To assess family dynamics and treatment adherence in pediatric patients with pulmonary and extrapulmonary tuberculosis from an Infectious Diseases Service in Mexico. Material and methods Descriptive cross-sectional study, conducted from May to July 2015, with 17 patients aged eight to fifteen years -old with tuberculosis. Three instruments in Spanish were applied: family dynamics was measured with the Family APGAR questionnaire, adapted for children aged eight years-old and above; treatment adherence was measured with the Haynes-Sackett and the Morisky-Green-Levine tests. Results In 76.4% of cases, extrapulmonary tuberculosis was higher than pulmonary tuberculosis (23.5%); the most common clinical form was ganglion tuberculosis. Family functionality (94.1%) dominated over moderate dysfunction (5.8%) and severe dysfunction (0%). High adherence to antituberculosis treatment was 58.8% more prominent than the moderate one (29.4%) and the low one (11.7%). The rate of patient abandonment was only 5.8%. Conclusions Findings suggest incorporating the evaluation of family dynamics within the medical controls of the antituberculosis treatment, both in the first level of care and in the hospital. This provision may help to promote high treatment adherence.