Factors Influencing Clients Adherence to Tuberculosis Treatment in Birim South

Abstract

Introduction: Tuberculosis (TB) is one major cause of illness and death worldwide especially in Asia and Africa. Globally, tuberculosis is one of the leading causes of death (WHO, 2017). However, TB is curable. The National TB Control Programme introduced the Directly Observed Treatment, Short Course (DOTS) to improve treatment success rates. Despite these efforts, the number of Multiple Drug Resistance Tuberculosis (MDR-TB) cases is increasing at a fast rate. Objective: The study assessed the factors influencing tuberculosis treatment adherence among TB clients in Birim South District and also determined the influence of individual, service related factors and community factors that influence adherence to anti-TB drugs.

Methods: A cross-sectional study design and quantitative approach was used to collect data. Pre coded Structured questionnaires were used to collect data which included a standardized and validated eight-item. Morisky Medication Adherence Scale (MMAS-8) adapted to measure adherence. All consecutive TB patients who visited each of the selected sub-district facilities of Achiase Health Centre and Akim Swedru Catholic Clinic were enrolled into the study, if found eligible, census approach was used for the study with sample size of 127. Data were entered into Excel and analyzed in STATA 15. Proportion of TB patient’s adherent was derived and data were assessed for association using Pearson’s Chi square test and simple logistic regression. Multiple logistic regression was done to adjust for confounders. Odds ratios of association between adherence and independent variables were recorded to determine factors that influence adherence to TB medication. Statistical significance was set at p-values ≤ 0.05. Results: The proportion of TB clients who adhered to TB treatment was 30%. After adjusting for other variables, the odds of adhering to TB treatment was 7.5 times as high among respondents who had some form of education as compared to those with no formal education (aOR = 7.52; 95% CI = 1.33 – 42.41; p = 0.022). However, after adjusting for all other variables, respondents who did not understand the instructions given had a 95% reduction in their odds of adhering to TB treatment as compared to those who understood the instructions given. Respondents who were provided with further source for clarification, their odds of adhering to TB treatment was significantly 6.9 times as high compared to those who were not provided with a source for further clarification after adjusting for all other variables (aOR = 6.99; 95% CI = 1.06 – 46.13; p = 0.043). However, after adjusting for other variables the odds of adhering to TB treatment was significantly 4.8 times as high among respondents who experienced no side effects as compared to those who experienced side effects (aOR = 4. Conclusion: From this study the proportion of TB patients who were adherent (medium to high adherence) to TB treatment were 30%. Health service factors such as unclear instructions given by pharmacist or physician was found to be a significant predictor of adherence to TB treatment. Also, for respondents who were not provided with further source for clarification, their odds of adhering to TB treatment was significantly higher compared to those who needed a source for further clarification after adjusting for all other variables. Side effects of TB treatment significantly predicts adherence.