The Non-Compliance To Tuberculosis Treatment Essay

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The Non-Compliance To Tuberculosis Treatment Essay

Tuberculosis is an air-borne infectious disease caused by bacteria of the genus Mycobacterium. Tuberculosis often called TB primarily affects the lungs causing what is referred to as pulmonary tuberculosis (PTB). It can also affect other parts of the body apart from the lungs leading to what is referred to as extra-pulmonary tuberculosis (EPTB). Extensive dissemination of the tubercle bacilli via the blood stream and lymphatic system leads to military tuberculosis. The World Health Organization declared Tuberculosis a global emergency in 1993 and it remains one of the world’s major causes of illness and death. TB is both preventable and curable. One third of the world’s population (two billion people) carry the TB bacteria. More than nine million of these become sick each year with active TB that can be spread to others. The Non-Compliance To Tuberculosis Treatment Essay

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Latent TB disease cannot be spread. TB disproportionately affects people in resource-poor settings, particularly in Africa and Asia. It poses a significant challenge to developing economies as it primarily affects people during their most productive years. More than 90% of new TB cases and deaths occur in developing countries. In Nigeria it is one of the diseases for routine notification to the Federal Ministry of Health via the Integrated Disease Surveillance and Response mechanism. Both diagnosis and treatment are free, the WHO, government and donor agencies finance the services. The global fund to fight Aids, Tuberculosis and malaria (GFATM) is an organ of the WHO that support TB control programs.

TB is one of the top ten leading causes of hospital admissions and one of the leading causes of morbidity and mortality in adults. TB is a disease associated with poverty and invariably occurs among the urban slum dwellers where there is often over-crowding. The fact that TB is a serious public health problem in Nigeria cannot be over emphasized. The Non-Compliance To Tuberculosis Treatment Essay

Before 2012, the exact burden of TB in Nigeria was not known, the WHO in 2007 estimated the incidence rate for all forms of TB at 311 per 100,000 population, incidence of smear positive pulmonary tuberculosis at 131 per 100,000 population, and prevalence at 546 per 100,000 population (WHO report, 2009). These figures place Nigeria 4th among the 22 high burden countries in the world and second in Africa. (Federal Ministry of Health, 2015)

However, WHO report for 2012 estimates show that Nigeria is still one of the 22 countries that contribute 80% of the global Tuberculosis burden, but the estimated incidence and prevalence of Tuberculosis for the country stands at 108/100,000 and 161/100,000 populations respectively. (WHO, 2012). The NTBLCP conducted a national TB prevalence survey in the country between March and November 2012. Estimated adult TB prevalence rates per 100,000 population based on findings from the national prevalence survey is 318 (95% CI, 225-412) smear positive and 524 (95% CI, 378-670) bacteriologically confirmed (smear positive and/or culture positive) cases. The Non-Compliance To Tuberculosis Treatment Essay

According to the survey report, the highest prevalence of TB cases appears among males and when disaggregated by age, individuals (both males and females) aged 35-54 years have the highest prevalence. Children < 15 years were not included in the survey. Quoting from the survey report, the prevalence of smear-positive TB among men is higher (484, 95% CI: 333-635) than in females (198, 95% CI: 108-289). A similar situation was found in the bacteriologically positive cases, with 751 (95% CI: 538-965) and 359 (95% CI:213-505) per 100,000 males and females respectively.

When survey report became available early 2014, the reported prevalence of 524 (95% CI, 378-670) cases per 100,000 population was found to be far higher than the earlier estimated prevalence for 2012 put at 161 per 100,000 population (WHO, 2013). With estimated population of 174 million in 2013, TB prevalence in absolute numbers was 570, 000 (includes HIV+TB) cases (430,000-730,000) and incidence was 590,000 (340,000-880,000) cases.

In 2013, the estimated incidence and prevalence of Tuberculosis for the country was 338/100,000 (194-506) and 326/100,000 (246-418) populations respectively. These estimates changed when the survey reports were published early 2014. Multi-drug resistance (MDR) According to WHO global TB report, there was an estimated 3.5% (95% C.I.: 2.2-4.7%) of new cases and 20.5% (95% C.I.: 13.6-27.5%) of previously treated cases with MDRTB worldwide in 2013. For Nigeria, the WHO estimated MDRTB prevalence of 3.1% and 10.1% among new and retreatment cases respectively in 2012 (WHO, 2010). The Non-Compliance To Tuberculosis Treatment Essay

Based on report of the first national drug resistant TB prevalence survey conducted in Nigeria by the FMoH/NTP between October 2009 and November 2010, there was a prevalence of 2.9% {weighted (95% CI: 2.1 – 4.0%)} among new smear positive TB cases and 14.3% (95% CI: 10.2 – 19.3%) among retreatment smear positive TB cases. The report of the survey was published late 2012.

Among all TB cases, the global average of isoniazid resistance without concurrent rifampicin resistance was 9.5% (95%CI: 8.0–11.0%) in 2013. In new and previously treated TB cases respectively, the global averages were 8.1% (95%CI: 6.5–9.7%) and 14% (95%CI: 11.6–16.3%) (WHO, 2010). In the Nigerian survey report, any resistance to Isoniazid (not considering concomitant resistance to Rifampicin or to any other drug) was found among all cases(generally) in 139 (9.6%; 95% CI: 8.1 – 11.3% of) respondents tested by Line Probe Assay. Stratified by treatment category there were a prevalence rate of 7.2% (95% CI: 6.0 – 8.8%) among new TB cases and 20.0% (95% CI: 15.2 – 25.6%) among retreatment TB cases (Federal Ministry of Health, 2013).

Any resistance to Rifampicin (not considering concomitant resistance to Isoniazid or to any other drug) was found in 115 (7.9%; 95% CI: 6.6 – 9.5%) among all cases (generally) tested by Line Probe Assay. Stratified by treatment category there were a prevalence rate of 4.4% (95% CI: 3.4 – 5.6%) among new TB cases and 24.9% (95% CI: 19.6 – 30.9%) among retreatment TB cases (Federal Ministry of Health, 2013). The Non-Compliance To Tuberculosis Treatment Essay

Statement of the Problem

The treatment of tuberculosis requires the use of multiple drug combinations to minimize the development of drug resistance. Multi-drug-resistant Mycobacterium tuberculosis (MDRTB) strains, defined as strains resistant to at least Rifampicin (RIF) and Isoniazid (INH), are emerging as major global public health problem. WHO estimated MDRTB rate of 3.1% among new cases and 10% among re-treatment cases in Nigeria as at 2011. (WHO Report, 2012). The emergence of HIV/AIDS has increased the incidence of TB worldwide and made both clinical management and laboratory diagnosis more complicated and difficult. Majority of victims are people of reproductive age bracket and this has devastating impact on the economy of Nigeria. Young men and women who ought to be contributing to the growth of the economy is instead a burden on the economy. The national DR-TB survey also confirms the known fact that TB disease is prevalent among the economically active age group. In that survey, these groups encompass about 70% of the respondents. The Non-Compliance To Tuberculosis Treatment Essay

1.3 Objectives of the Study

The main objective of this study is to assess the factors that influences non-compliance to tuberculosis treatment among patients suffering from tuberculosis. Specific objectives include;

i. To determine factors influencing non-compliance to tuberculosis treatment among patients suffering from tuberculosis.

ii. To determine impact of non-compliance to tuberculosis treatment on patients suffering from tuberculosis.

iii. To find out challenges facing the TB control in Usiomu, Eku, Delta state. The Non-Compliance To Tuberculosis Treatment Essay

1.4 Research Questions

1. What are the factors influencing non-compliance to tuberculosis treatment among patients suffering from tuberculosis?

2. Is there a significant impact of non-compliance to tuberculosis treatment on patients suffering from tuberculosis?

3. What are the challenges facing the TB Control Program in Usiomu, Eku, Delta state?

1.5 Research Hypotheses

Hypothesis I

H0: There are no significant factors influencing non-compliance to tuberculosis treatment among patients suffering from tuberculosis.

Hi: There are significant factors influencing non-compliance to tuberculosis treatment among patients suffering from tuberculosis.

Hypothesis II

H0: There is no significant impact of non-compliance to tuberculosis treatment on patients suffering from tuberculosis.

Hi: There a significant impact of non-compliance to tuberculosis treatment on patients suffering from tuberculosis.

1.6 Significance of the Study

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study. The Non-Compliance To Tuberculosis Treatment Essay

1.7 Scope of the Study

This study is on assessing the factors that influence non-compliance to TB among patients suffering from Tuberculosis in Usiomu Eku Delta State. The research study will cover the entire patients of General Hospitals Usiomu. All departments of the hospital will be sampled in the collection of data for the study. The study will cover a fair balance of male and female patients of the hospitals.

1.8 Limitations of the study

The demanding schedule of respondents made it very difficult getting the respondents to participate in the survey. As a result, retrieving copies of questionnaire in timely fashion was very challenging. Also, the researcher is a student and therefore has limited time as well as resources in covering extensive literature available in conducting this research. Information provided by the researcher may not hold true for all research under this study but is restricted to the selected respondents used as a study in this research especially in the locality where this study is being conducted. Finally, the researcher is restricted only to the evidence provided by the participants in the research and therefore cannot determine the reliability and accuracy of the information provided. Other limitations include; The Non-Compliance To Tuberculosis Treatment Essay

Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence.

Methods and Findings
We searched 19 electronic databases (1966–February 2005) for qualitative studies on patients’, caregivers’, or health care providers’ perceptions of adherence to preventive or curative TB treatment with the free text terms “Tuberculosis AND (adherence OR compliance OR concordance)”. We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare’s method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies. The Non-Compliance To Tuberculosis Treatment Essay

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Conclusions
Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients’ adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.

TB is one of the most spread diseases in the world. TB is an infectious disease, and second to HIV/AIDS it is the greatest killer worldwide due to a single infectious agent. In 2012, 8,9 million people had symptoms from TB and 1,3 million died from the disease. Over 95% of the people that succumb to the disease are from low- and middle-income countries in Asia and Africa. The reasons are the standard of living and the large spread of HIV/AIDS in these areas. However, thanks to the global efforts within the framework of the Millennium Development Goals (MDGs), TB death rate has dropped by 45% from 1990 to 2012. This is partly because of the implementation of the comprehensive “Stop TB Strategy” promoted by the World Health Organization (WHO). Directly Observed Treatment Short-course (DOTS) is the essential element that has presumably saved over 22 million lives. Because of this strategy, the world is on track to achieve the objective of reversing the spread of TB by 2015 [1, 2]. The Non-Compliance To Tuberculosis Treatment Essay

First-line anti-TB drugs have been used for a long time and resistance to the medicines is growing. Multidrug resistant TB (MDR-TB) is caused by bacteria that do not respond to first-line anti-TB drugs. There are medicines to treat MDR-TB but this second-line treatment is more complicated and has harder side-effects on the patient. The drugs have lower effect and are more expensive than the first-line treatment. The options of second-line treatment are limited and recommended medicines are not always available. The second-line treatment includes extensive chemotherapy up to two years which is more costly and can produce severe side-effect reactions in patients. In 2012 about 450,000 people in the world developed MDR-TB [1].

People with reduced immune systems like HIV/AIDS patients are more sensitive to the bacteria and suffer a 30% greater risk of developing an active TB, compared to people without HIV/AIDS. At least one-third of the people with HIV/AIDS also have the TB bacteria active or latent. In combination, the two diseases make the immune system weaken faster. Almost 25% of all deaths among HIV/AIDS-patients are due to TB. Sub-Saharan Africa accounts for largest population with HIV in the world; 1 in 20 adults is living with the disease. Thus, prevalence of HIV/AIDS is one of the largest contributing factors of the spread of TB in that region [1]. The Non-Compliance To Tuberculosis Treatment Essay

1.2. TB Treatment Approach: DOTS
Until 50 years ago, there were no medicines to cure TB. But today TB is a curable disease. The treatment of drug-sensitive TB consists of four antimicrobial drugs, information, supervision, and support to the patient by health workers or trained volunteers. Treatment adherence can be difficult without such supervision and support. The majority of TB cases can be cured when medicines are provided and taken properly [1]. The drugs are taken once a day and it is a strict treatment that is ongoing for at least 6 months, but if the patient’s sputum is still positive for active TB after 2 months the treatment is extended to 9 months. Inappropriate or incorrect use of antimicrobial drugs or premature treatment interruption can cause drug resistance and the chances of relapse are increased. Also the use of poor quality medicines can be a contributing factor to drug resistance. MDR-TB can be transmitted in the same ways as drug-sensitive TB [3]. DOT involves observing patients during their intake of medication. This is supposed to enhance treatment adherence among patients, to help them take their medicines regularly, and to successfully complete their treatment. This also prevents the development of MDR-TB. Depending on the local conditions, the supervision can vary from case to case. It may be undertaken at a health facility, in the workplace, in the community, or at home. The supervisors have to be approved by the patients and have to be trained and taught by health staff to be able to supervise [4]. The Non-Compliance To Tuberculosis Treatment Essay

Treatment adherence is essential not only from the perspective of the patient as an individual but also from the community level and preventive perspective. It is known that interrupted treatment is a major cause of relapse and multidrug resistant tuberculosis. It is important that the patients treatment adherence is as high as possible so that as many as possible can be cured and that the incidence of TB can be decreased [1]. For many reasons, adherence is not easy to achieve and National Tuberculosis Control Programs (NTPs) have a responsibility to ensure that the health systems are supportive of patients from diagnosis throughout the treatment. Due to their proximity with the patients in environments characterized by shortages of human health for health, nurses are critical health professionals playing an important role in supporting the patients in their treatment process. However, their experiences with respect to this task are rarely investigated. This study is therefore seeking answers to the following questions. What are the nurses’ experiences of treatment adherence among patients with TB? What is the main reason for interrupted TB treatment according to nurses? What do nurses do in supporting patients under TB treatment? What can and could nurses do to increase the adherence among patients with tuberculosis? The Non-Compliance To Tuberculosis Treatment Essay

2. Aim
The aim of the study was to identify nurses’ roles and experiences in relation to their work with supporting patients under tuberculosis treatment in Burundi.

3. Methods
3.1. Setting
Burundi is one of the smallest countries in Africa with a surface of about 27800, km2 [5]. The population was, in 2012, around 9.8 million people. During 2012 the TB prevalence in the country was 199 per 100 000, which means that about 19 500 people in Burundi suffered from TB (this includes patients with TB and TB/HIV). There were 6711 new cases of tuberculosis and 305 retreatment cases reported. The retreatment cases include relapses, treatment after failure, and treatment after default. New smear-positive and/or culture-positive cases had a success rate of 92% in 2012 and new smear-negative/extra pulmonary 84%, and among the retreatment cases the success rate was 85%. According to WHO, the treatment success rate among TB patients has been increasing since 2005. As to TB/HIV coinfection, 82% of all the patients with tuberculosis in 2012 also reported a known HIV status, which is a relatively high proportion [2]. The Non-Compliance To Tuberculosis Treatment Essay

In Burundi NTP is called The National Leprosy Tuberculosis Program (PNLT). PNLT is structured according to three levels of a health pyramid: peripheral level, intermediate level, and central level. There are a total of 606 health centres in Burundi; 165 of these are Centres for Screening and Treatment (CDTs), of which 138 are functional treatment centres. In addition to peripheral CDTs, there is one centre in Kibumbu which is the National Reference Centre for Multiresistant TB. All multiresistant TB cases confirmed or suspected at the peripheral levels are referred to this national reference centre. The Non-Compliance To Tuberculosis Treatment Essay

With regard to human resources, health workers of the CDTs are overseen by multidisciplinary supervision teams at District Health Offices (DHO), which coordinate the peripheral level. These teams are supervised by the intermediate level supported by the central level [6]. In 2009 there were a total of 7576 health workers in Burundi, 4241 nurses and midwives, 255 physicians, and 159 laboratory technicians [7]. The peripheral CDTs are staffed by nurses only, whereas the staff at the MDR centre in Kibumbu is made of a majority of nurses, including nutritionists and a few physicians.

3.2. Study Design
This is a qualitative study with a descriptive design. Descriptive qualitative studies are common in nursing and the goal of this type of research is to develop a rich understanding of a phenomenon [8]. Qualitative semistructured interviews have been used in this study and the purpose of these types of interviews is to get complex answers with a lot of information [9]. The Non-Compliance To Tuberculosis Treatment Essay

3.3. Sampling
A purposive sampling of nurses from two different centers of tuberculosis in Burundi was performed. One center was located in the city of Bujumbura and the other center was located in the country-side in Kibumbu. The center in Bujumbura treated patients with different types of tuberculosis except for patients with multidrug resistant tuberculosis; they were sent to the center in Kibumbu. The latter treated only patients with drug resistant tuberculosis. Contact was taken with the two centers to see if there were any nurses who were interested in participating in the study. In order to be selected, one needed to be qualified nurse (university graduate) and must have been working with TB treatment issues for at least one year, including the year prior to the interview.

A total of eight nurses were included, four nurses from each center. The participating nurses were between 33 and 52 years old; they had been working as nurses between six and 25 years and with tuberculosis between six and 22 years. Two participants were men and six were women. The Non-Compliance To Tuberculosis Treatment Essay

3.4. Data Collection Process
Data has been collected with qualitative semistructured interviews during a two-week period in January 2014. The purposes of qualitative interviews are to understand how the participants are thinking and feeling, what experiences they have, and how their world looks like [9]. The interviews were held in each of the two different TB treatment centers. A guide with questions was used, and the interviews were recorded. A guide of questions can be used to make sure that the authors do not forget any of the topics [9]. Each nurse was interviewed once for 15 to 40 minutes. No back translation of the interview guide was done as the questions were deemed easy to understand, generic, and rather straightforward. Instead, focus was put on the interpreter to ensure she perfectly understood the questions. The interpreter had previous experience of interpretation in qualitative research interviewing. The interviews were conducted in English, with interpretation from English to French. The first two authors were present during the interviews as well as an interpreter. The interpreter was a student from the partner university in Bujumbura. One author held the interview while the other took notes. To start the interview the nurses were asked to describe a typical treatment of TB. This was meant to make them feel comfortable and to feel that the authors were there to learn from them. In the end of the interviews, the author who had been taking notes was able to ask some complementing questions. The Non-Compliance To Tuberculosis Treatment Essay

The authors who conducted the interviews felt that saturation was reached during the seventh interview, which was conducted at the MDR centre in Kibumbu. It was realized that all the data was redundant and no new information was coming out. The 8th interview was conducted to see if any new insights could emerge, but this was not the case. It was then concluded that saturation had been reached.

3.5. Processing and Analysis of Data
The interviews were transcribed before they were analyzed using content analysis approach inspired by Burnard [10]. The purpose of performing a qualitative content analysis is to convert large masses of data into smaller segments and then to put those segments together into meaningful conceptual patterns [8]. The Non-Compliance To Tuberculosis Treatment Essay

Content analysis is suitable for semistructured or open-ended interviews but it is also suggested that the method can be used for more clearly structured interviews. To use this method the interviews have to be recorded and transcribed. The analysis consisted of 14 steps which were the base for the analysis in this study. Through these steps, themes and issues were identified and linked together under appropriate categories and subcategories [11]. To analyze the transcribed interviews the authors followed some of these steps and the interview transcript was broken down into relevant data. The authors read the transcribed data several times during this step and changed the coding to what was most appropriate. This is called open coding. The open coding still contained a lot of information. In the following step, the open coding that contained the same information was organized into broader subcategories which were then summarized together into categories. The authors performed these steps together and discussed what could be relevant names for the subcategories and categories; which codes should be put together into the same categories was also discussed. The interviews were read through repeatedly to make sure that the categories reflected the data [10]. The authors also discussed the collected data during the time of the analysis to get a relation between the small parts and the whole context. After this, another coauthor who did not participate in the interviews read through the material to ensure the validity. To put everything together, the subcategories and categories were marked with different colors, which made it easier to put the information with the same content into the corresponding unit. The categories were constantly checked against the aim of the study to make sure that they answered the purpose. The Non-Compliance To Tuberculosis Treatment Essay

3.6. Ethical Considerations
Ethical approval was given by the National Tuberculosis Control Program in Burundi which is under the Ministry of Health. The participation was voluntary and the nurses were able to choose the time and place for the interviews. The nurses were given verbal information about the study in their local language. The nurses also received information in writing regarding the purpose of the study, their ethical rights, and their participation. All information was handled with confidentiality and the participating nurses have been unidentified in the result. Each nurse has been given a number instead of their names and the numbers do not depend on the order of which the interviews were held. The nurses were told that they could stop their participation at any time without any consequences. The interviews were recorded but after they had been transcribed they were deleted. The nurses were given information about where the result was going to be published and how they would be able to reach it. The Non-Compliance To Tuberculosis Treatment Essay

1.0: Introduction
This chapter in detail discusses the study background; statement of the problem, study objectives, research
questions and justification of the study. The study’s purpose was to determine the factors associated to nonadherence to Tuberculosis treatment among Tuberculosis patients at individual, health care provider, facility
and community levels within Baringo County.
1.1: Background information of the study
Tuberculosis (TB) continues to be a major cause of high morbidity and mortality in Kenya. Kenya is among
the 22 countries contributing 80% of global TB burden. The country has improved from number 13th to 15th
among the 22 countries. The Kenya TB treatment defaulter rate is 15%. (GLOBAL TUBERCULOSIS
REPORT 2013, 2013).
Adherence to TB treatment is one of the factors that lead to increase in cure rate. This reduces mortality and
emergence of multi drug resistant tuberculosis (MDR) and lowers the high cost of treatment resulting. The Non-Compliance To Tuberculosis Treatment Essay
Tuberculosis does not discriminate on age, sex or education level. Previous research in different contexts has
shown that there exist many factors influencing non compliance. They range from individual patient, health
care provider, health care delivery patterns and socio-economic related factors influencing non adherence to
TB treatment (Munro SA, et al (2007).
Tuberculosis (TB) is a major contributor to the global burden of disease. Poor adherence to treatment is
common despite various interventions aimed at improving treatment completion. Currently, posed is a
challenge of non-adherence to treatment despite efforts with patient centred approach which allows homebased treatment supervised by a treatment supporter of their own choice, and health facility–based treatment
observed by a health professional.
Lack of a comprehensive and holistic understanding of local and community based barriers can be a hindrance
to achieving success in STOP TB interventions. New infections, TB drug resistance, high treatments costs
and mortalities have been associated with non-adherence. The aim of the study was to explore the issues
surrounding the Tuberculosis patients in order to determine the factors associated with their non-adherence at
various levels; this was done at individual (patient), health care provider, facility and community.
1.2: Statement of the Problem
In the management of Tuberculosis (TB), treatment adherence leads to successful cure rate. It’s expected that
if successful treatment of tuberculosis is to be achieved the patient must comply by taking anti-tuberculosis
drugs for at least six months. Non adherence to tuberculosis treatment leads to high increase in mortality,
Multi drug resistant tuberculosis (MDR) cases and high cost of TB treatment. These increase the Tuberculosis
burden to the nation, partners and community populations. Various Studies have been done to identify factors
influencing non adherence in other settings. Factors may differ depending on unique population settings and
its characteristics: cultural practices, lifestyle, and economic status among others. It’s unclear which factors
locally are associated to Tuberculosis patients’ non adherence in Baringo County community, Kenya. Baringo
County has Low Case notification rate, Low treatment success (<88%), high poverty prevalence (National
strategic Plan and Tuberculosis, Leprosy and Lung Health, 2015-2018). If no efforts are put to determine the
factors locally influencing non adherence, the STOP TB programs will continue using strategies that are
standardized, which might not yield effective results as per the context. Also the local and national
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Tuberculosis burden will be on the increase in terms of Multi-Drug Resistance (MDR), mortality and
treatment cost. The Non-Compliance To Tuberculosis Treatment Essay
1.3: Study Objectives
1.3.1: Broad objectives
The study aimed to determine the factors associated to non-adherence of medication among TB patients at
both urban and rural areas of Baringo County.
1.3.2: Specific objectives
1. Determine the patient factors which contribute to non adherence of TB treatment
2. Determine the health provider-patient relationships both at the TB clinic and at home
3. Determine the pattern of health care delivery influencing non adherence of TB treatment
4. Determine the socio-cultural factors influencing the non adherence to TB treatment
1.4: Research questions
1. What are the patient-related factors that contribute to non adherence to TB treatment?
2. What are patient-health workers factors in effecting TB treatment adherence issues?
3. What are the health care deliveries Patterns that influence non adherence of TB treatment?
4. What are the socio-cultural factors that influence non adherence to TB treatment?
1.5: Justification
Kenya is among the 22 countries that are contributing to 80% of global TB burden. Kenya is globally
recognized as a pathfinder for TB and leprosy control. Within Africa, Kenya was the first country to
achieve World Health Organization (WHO) targets for case detection and treatment success of new smearpositive pulmonary TB cases. Devolution presents opportunities for local prioritization and adaptation of TB
and leprosy control activities that are targeted and patient-centred (National strategic Plan and Tuberculosis,
Leprosy and Lung Health, 2015-2018). The non adherence among TB patients has contributed to high rate of
new cases, TB related mortality, Multi drug Resistant Tuberculosis (MDR) cases, and treatment costs.
The impact targets for National strategic Plan and Tuberculosis, Leprosy and Lung Health, 2015-2018 at the
end of 5 years are:
1. Reduce the incidence of TB by 5%, compared to 2014
i. Reduce the prevalence of MDR-TB among new patients by 15%
ii. Reduce the incidence of TB among PLHIV by 60%
2. Reduce mortality due to TB by 3%
3. Reduce the proportion of affected families who face catastrophic costs due to TB, Leprosy and lung
diseases The Non-Compliance To Tuberculosis Treatment Essay
4. Reduce by 50%, the proportion of cases with grade 2 disability due to leprosy
5. Reduce mortality due to chronic lung diseases e.g. COPD, asthma
Baringo County’s contribution is thwarted by the high default rate and current situation of Low Case
notification rate, Low treatment success (<88%) and High poverty prevalence. Non adherence to TB treatment
is among major hindrances to the achievement of the priorities for 2015-2018 period to ensure treatment
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success rate of at least 90% nationally among all drug-susceptible (DS) forms of TB centred (National
strategic Plan and Tuberculosis, Leprosy and Lung Health, 2015-2018).
The purpose of this study was to determine the various factors that are associated to defaulting of TB patient
during treatment comprising both urban and rural areas of Baringo County. The study has given
recommendations for possible future tuberculosis treatment and management interventions within Baringo and
other similar counties. This is within the Ministry of Health “A nation free from preventable diseases and ill
health through primary healthcare interventions at individual, household, community and primary healthcare
facility levels”

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CHAPTER TWO: LITERATURE REVIEW
2.0: Introduction
This chapter discusses the various reviewed studies in relation to tuberculosis treatment and the various factors
that are associated to defaulting in various contexts.
2.1: Literature Review
Kenya is among the 11 High Burden Countries (HBCs) that are not on track to reaching one or more of the
three targets for reductions in incidence, prevalence and mortality (GLOBAL TUBERCULOSIS REPORT The Non-Compliance To Tuberculosis Treatment Essay
2013 www.who.int/tb/data). Studies have been done at various contexts determining the factors influencing
non adherence of tuberculosis treatment. Mohamed et al. (2013) found that existence of human resource gaps
and TB staff inadequately prepared to deal with complex issues of TB patients influence the non adherence.
They concluded that reducing travelling and waiting times for TB patients may improve compliance rates.
Bagoes et al. (2009) also found that more patients take TB treatment according to prescription if they are
clearly informed and costs for treatment are reduced. They concluded that non adherence is a result of
developed negative image towards the health care staff, treatment, and quality of medication. Munro et al.,
2007 indicated in their study that ‘patients and providers’ personal character, abuse of substance, and religion
influence treatment adherence. Female patients adhered most despite cultural practice of seeking permission
for treatment from their spouses’.
Sathiakumar et al. (2010) reported that other non adherence issues besides smoking and travel-related
concerns, number of household members, tobacco chewing, and treatment period, relief of symptoms, alcohol
consumption and lack of adequate drugs. Also study indicates that 16% non‐compliance rate was due to
factors like place of residence, literacy, travelling time, waiting time, employment, living status, family
support, stigma, khat chewing and patients’ knowledge of TB.
Culqui (2012) found that patients’ compliance is associated with patient sex usually male, treatment
experience especially feeling malaise, or past history of previous non-compliance, use of recreational drugs,
dissatisfaction with the information received and presence of poverty. “This Tuberculosis is known to have a
strong association with poverty” (National strategic Plan and Tuberculosis, Leprosy and Lung Health, 2015-
2018). The Non-Compliance To Tuberculosis Treatment Essay
Muture et al indicated that most frequent reasons for default cited by patients who did not complete the
treatment course included ignorance about need for treatment compliance coupled with inadequate knowledge
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about TB and travelling outside treatment areas, consequently missing clinic appointment and running out of
drugs. Predictive factors for default were inadequate knowledge about TB, herbal medication use, low income,
alcohol abuse, previous default, HIV co-infection and the male sex.
CHAPTER THREE: METHODOLOGY
3.0: Introduction
This chapter discusses the research methodology including study area, population, design, sample size, sample
frame and sampling technique, Data collection tools and procedures for data collection, : Inclusion and
exclusion criteria, Proposal Ethical approval and Data handling and analysis
3.1: Study Area
The study was conducted in Baringo County, covering both urban and rural areas of the county. Baringo
County neighbours Nakuru, Keiyo, West Pokot, Kericho and Laikipia counties. It has attractive tourist Lakes
of Bogoria and Baringo. The community is majority of nomads. Interviews were done at four centres;
Kabarnet, Marigat, Mogotio, and Ravine.
3.2: Study Population
The study population was all enrolled tuberculosis patients in Baringo county health facilities. All registered
and traced TB drug interrupter patients within the six months prior to commencement date of the study were
interviewed. The Non-Compliance To Tuberculosis Treatment Essay
3.3: Study Design
The study utilized a retrospective cohort (drug interrupters) with a mixed method approach comprising both
interviews and focus group discussions. Interviews was done to all traced treatment interrupters and a focus
group discussion by the Sub county tuberculosis and leprosy coordinators and community health Volunteers.
3.4: Sample size
Treatment interrupter patients were accessed through convenience sampling method, this were Treatment
interrupter/defaulters within six months prior to commencement date of the study. One focus group discussion
was done comprising 1 County Tuberculosis and Leprosy Coordinator, 6 Sub County Tuberculosis and
Leprosy Coordinators and 6 Community Health Volunteers.
3.5: Sample frame and sampling technique
Traced treatment interrupters (defaulters) conveniently selected from hospital records in urban and rural health
facilities were interviewed. The treatment interrupters were reached through the assistance of Sub County
Tuberculosis and Leprosy Coordinators and 6 Community Health Volunteers. Interviews were conducted
using structured and semi-structured interview schedule. In addition Key informant focus group discussion
was done with community health volunteers, County Tuberculosis and Leprosy Coordinator and Sub county
Tuberculosis coordinators.
3.5: Data collection tools and procedures for data collection
Data was collected using developed observation checklists, interview schedule and questions for focus group
discussion questions. Respondents were traced treatment interrupters, health workers (SCTLCs) and
Community health volunteers. The Non-Compliance To Tuberculosis Treatment Essay
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3.6: Inclusion and exclusion criteria
All registered and traced treatment interrupters were recruited for study. Transfers in and out were not
considered.
3.7: Proposal Ethical approval
The study was submitted to Egerton University Research Ethics committee for ethical consideration and
approval. Incentives were given to respondents as compensation for waiting time and inconveniences caused
(Fare and lunch).
3.8: Data handling and analysis
All data captured was coded, entered and analysed using SPSS package version 20.
CHAPTER FOUR: RESULTS AND DISCUSSION
4.0: Introduction
This chapter discusses the study results as per the analysis of data captured from the treatment interrupters
(defaulters) who were traced within the last six months prior to commencement date of the study and
outcomes of informant focus group discussion.
4.1: Characteristics of study Sample
The study conducted interview to a total of 46 drug interrupters across Baringo County spread over its sub
counties (coverage sub counties of Kabarnet, Marigat, Mogotio and koibatek).
The interviewee’s (defaulters) mean age was 36 years with range 51 years (11 to 62). Among interviewee
(defaulters) were male 33(72%) and 13(28%) female. In addition were 13 members Key informant who
participated in focus group discussion (1 CTLC, 6 SCTLCs and 6 CHVs).
The interviewee’s marital status was; Single (35%), Married (54%) and separated (11%). Their education
levels were; none (9%), Primary (59%), Secondary (24%) and Tertiary (9%). The interviewee’s monthly
income levels were; less KSH 3500/(63%), 3500/= to 5000/=(17%), 5000/= to 10000/=(9%), 10000/= and
above(11%). The Non-Compliance To Tuberculosis Treatment Essay
4.2: What are the patient-related factors that contribute to non-adherence to TB treatment?
Treatment non adherence was both at treatment phases as; intensive (46%) and continuation (54%). Among
defaulters 24% smoke and 76% don’t smoke. But amongst the smoking patients 45% associate it with non
adherence while 55% don’t associate smoking with non adherence. Also among defaulters 41% drink, 59%
don’t drink. Among those who drink 58% associated their drinking habit with non-adherence.
Defaulters to access health facilities used various means of transport as; walking 26%, Vehicle 54% and
Motor Bike 20%. In relation to use of various means to access the clinics; 53% of patients who walk, 86% of
vehicles(matatu)users, while 55% of the motorbike users felt that financial challenges would hinder them from
attending the clinic.
Only 41% of defaulters associated symptoms relieve during treatment with non-adherence. Defaulter patients’
housing during treatments was; Own house (43%), Rental (33%), and with Parents (20%). Among the
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defaulter patients 82% understood that they were suffering from Tuberculosis disease, and 94% felt
Tuberculosis disease was curable. Only 33% of defaulter patients had a history of never complying with
previous medication of other disease during TB treatment. While taking the tuberculosis medication 56% of
defaulter patients experienced drug side effects. Among defaulter patients 76% had experienced other sickness
during tuberculosis treatment. The Non-Compliance To Tuberculosis Treatment Essay
Defaulter patients associated their occupation to non-adherence at 41%, while among the casuals workers
85% directly associated it with their non adherence.
Among the TB defaulters 52% associated their non-adherence to their forgetfulness or carelessness.
4.3: What are patient-health workers factors in effecting TB treatment adherence issues?
In seeking clarification for more detailed explanation on TB treatment 80% of TB non-adherents were
comfortable asking health provider’s questions. Still 52% associated their non-adherence with their
forgetfulness and carelessness. Among the TB defaulters 58% associated non adherence to the stressful events
experienced during treatment.
4.4: What are the health care deliveries Patterns that influence non adherence of TB treatment?
Support of defaulter during treatment was by; family (56%), Community health worker (2%), Health worker
(20%) and none (22%). Family support was experienced to all despite whom they lived with. Health workers
support was ranging 22% to 27%. TB defaulters lived with a distance of 46 %( less 10km), 22 %( 11km to
20km), 7 %( 21km to 30km) and 26 %( above 40km) away from the health facility. Most (59%) treatment
interruption was done among TB defaulters with primary level of education
4.5: What are the socio-cultural factors that influence non adherence to TB treatment?
The study found several socio economic factors ranging from: initiation ceremonies for example circumcision
exclusion, Believe that TB is witchcraft and inherited in some families, Believe in the effectiveness of
injection over oral drugs of 6-8 months, Migration practices due to nomadism, Practice cattle rustling
displaces population, Regional low economic status (poverty), Religious believe of prayers for healing
During treatment 76% of defaulters never experienced unstable living condition so it’s not directly
influencing defaulting. Also 61% of defaulters never associated their defaulting with immediate benefit of the
therapy. It seems there is social stigma associated with defaulting because 43% of defaulters believe so, while
56% of defaulters have some religious believe against western medication.
4.6: Summary of factors associated with TB non adherence
The study found several factors that were associated with patient non-adherence to TB treatment within
Baringo County. The study farther categorized the these factors into; patient related, health provider-patient
relationships, pattern of health care delivery and socio-cultural factors influencing the non-adherence to TB
treatment. Financial constraint: Insufficient fund

The Non-Compliance To Tuberculosis Treatment Essay

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