Abstract
Objective: To evaluate the association of the characteristics of the family system in adherence observed treatment short in patients with pulmonary tuberculosis in three cities of the south-southeast of Mexico. Material and methods: Cases of pulmonary tuberculosis were studied, who started treatment at first-level units. The follow-up was 6 months or until the patient lost his grip, emigrated to another city, died, or decided not to continue the study. Intrafamilial relationships were assessed, family functioning (FACES III) and social network (DUKE UNC-11); adherence was assessed with test-Greene Morinsky. We calculated incidence of non-adherence and relative risk factors studied. Variables with significant differences in the bivariate analysis were subjected to the proportional hazards model of Cox. Results: Two hundred and thirty four patients were included; the total track joined 36,937 days, with a median of 175 days. Patients with dysfunctional family have RR=8.95 (95% CI=4.51-17.76, p<0.001) compared with those with functional family, and patients with non-functional network showed RR=2.22 (95% CI=1.13-4.35, p 0.002) compared with those with functional social network. In the Cox regression model adjusted for education, statistical significance was maintained for family functionality. Family functioning influences the cohorts studied in treatment adherence
Highlights
Tuberculosis (Tb) is the leading cause of death worldwide and the number of new cases is increasing at an annual rate of 2%
The proportion of non-adherence recorded (14.5%) was similar to that found in studies conducted in Mexico, was higher than that found in Chile (11.4%), and lower than in New York (48%), South Africa (17%) and Ethiopia (20%) family dysfunction increased the risk of non-adherence to treatment with a relative risk (RR)=9.18, which is higher than that reported in another study in diabetic patients by Marin F-Reyes and colleagues (OR=6.9, 95% CI=2.3-21.1)
Valadez and colleagues [40] conducted a cross-sectional study in 121 type 2 diabetic families, which found that belonging to a nuclear family was associated with the uncontrolled diabetic patients (OR=4.61, 95% CI=1.52-14.41), 40 this association in this research it was not possible to corroborate because the nuclear family category had the lowest incidence rate (IR)
Summary
Tuberculosis (Tb) is the leading cause of death worldwide and the number of new cases is increasing at an annual rate of 2%. It is estimated that in 2008 there were 9.4 million new cases of TB, which killed 1.8 million people [3]. The magnitude of this problem is so great that in 1993 the World Health Organization (WHO) declared it as a global emergency [4]. The scheme is currently recommended to treat new cases of pulmonary TB includes four drugs (isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E)) for the first 2 months, followed by HR during the 4 following months [6,7] this scheme, known in Mexico as observed treatment short course (DOTS), has shown promising results in the fight against this disease [8,9]
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