Abstract
BackgroundEvidence exists pointing out how non-adherence to treatment remains a major hurdle to efficient tuberculosis control in developing countries. Many tuberculosis (Tb) patients do not complete their six-month course of anti-tuberculosis medications and are not aware of the importance of sputum re-examinations, thereby putting themselves at risk of developing multidrug-resistant and extensively drug-resistant forms of tuberculosis and relapse. However, there is a dearth of publications about non-adherence towards anti-Tb medication in these settings. We assessed the prevalence of and associated factors for anti-Tb treatment non-adherence in public health care facilities of South Ethiopia.MethodsThis was a cross-sectional survey using both quantitative and qualitative methods. The quantitative study was conducted among 261 Tb patients from 17 health centers and one general hospital. The qualitative aspect included an in-depth interview of 14 key informants. For quantitative data, the analysis of descriptive statistics, bivariate and multiple logistic regression was carried out, while thematic framework analysis was applied for the qualitative data.ResultsThe prevalence of non-adherence towards anti-Tb treatment was 24.5%. Multiple logistic regression analysis demonstrated that poor knowledge towards tuberculosis and its treatment (AOR = 4.6, 95%CI: 1.4-15.6), cost of medication other than Tb (AOR = 4.7, 95%CI: 1.7-13.4), having of health information at every visit (AOR = 3, 95% CI: 1.1-8.4) and distance of DOTS center from individual home (AOR = 5.7, 95%CI: 1.9-16.8) showed statistically significant association with non-adherence towards anti- tuberculosis treatment. Qualitative study also revealed that distance, lack of awareness about importance of treatment completion and cost of transportation were the major barriers for adherence.ConclusionsA quarter of Tb patients interrupted their treatment due to knowledge, availability and accessibility of DOTS service. We recommend creating awareness about anti-Tb treatment, and decentralization of drug pick-ups to the lowest level of health institutions.
Highlights
Evidence exists pointing out how non-adherence to treatment remains a major hurdle to efficient tuberculosis control in developing countries
Two-third of patients were in the intensive phase of Tb treatment
Only 75.5% of participants were able to adhere to anti-Tb regimen, which was lower than the reported adherence rates in North East Ethiopia (77.5) [14] and Southwest Ethiopia (79.2%) [24]
Summary
Evidence exists pointing out how non-adherence to treatment remains a major hurdle to efficient tuberculosis control in developing countries. We assessed the prevalence of and associated factors for anti-Tb treatment non-adherence in public health care facilities of South Ethiopia. Evidence exists that tuberculosis (Tb) is a major public health problem throughout the world, with an estimated 9.6 million annual incident cases, of which 1.2 million (12%) were co-infected with HIV and 1.5 million died globally in 2014 [1]. In the treatment of patients with MDR-Tb, an intensive phase of at least 8 months and a total treatment duration of at least 24 months is recommended [5] This leads to non-adherence towards anti-Tb treatment. Coverage of DOTS service was still minimal and made little progress on treatment adherence in some resource- meager countries such as Ethiopia [6,7,8]
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