Research Article - (2022) Volume 10, Issue 10
Prevalence and Factors Associated With Treatment Adherence among Tuberculosis Patients in Tiruvallur District, Tamil Nadu
Jaivant M, Rashmi Gour* and Stephen
*Correspondence: Dr. Rashmi Gour, Department of Community Medicine, Sree Balaji Medical College and Hospital, Tamil Nadu, Chennai, India, Email:
Abstract
The aim of this study is to assess the level of adherence to TB treatment and determine the factors contributing to nonadherence among patients with TB attending district TB centre and its sub centres in Tiruvallur district, Tamil Nadu. Thus we conclude that poor knowledge about the disease; treatment and adverse effects are the main problem that obstructs people from taking regular treatment.
Keywords
Adherence, Tuberculosis, Pulmonary
Introduction
Tuberculosis (TB) is among the top ten causes of global mortality. It is estimated that approximately one-third of the world’s population is infected with tuberculosis bacillus, and each year eight million people develop tuberculosis disease which annually kills 1.8 million worldwide many other interventions focus on educating patients with TB on knowledge regarding TB and its treatment so that they can take decisions with knowledge and helps in betterment of health care team to provide quality treatment without interruptions [1]. Online technologies like systems for reminder and tracking of patients with TB like reminder letters, phone calls, home visits, SMS services and electronic pill box are targeted on Patients with TB for improving adherence and undisturbed treatment completion [2]. Interventions like psychological counselling or social meetings for patients with TB are targeted which focuses on psychological aspects of patient and thus bettering the treatment adherence to TB treatment [3]. It is crucial to have a high focus on patients who have lost to follow up by the health care providers as it results in poor treatment outcome and also addressing the factors which leads to loss to follow up and improving the treatment adherence. Especially in resource limited setting [4]. Hence, this study was done to identify factors affecting the treatment adherence to TB treatment and methods to reduce disease burden in Tiruvallur district.
Materials and Methods
Study design
Hospital based cross sectional study.
Study population
The cross sectional study was done in TB cases attending district tuberculosis centre and TB units for treatment using pre tested and structured questionnaire by interview method during the study period.
Inclusion criteria
All adults aged above 18 years both male and female diagnosed as smear positive or smear negative or clinically diagnosed Pulmonary (PTB) and Extra Pulmonary (EPTB) and patients with TB who were residing in the district and registered for treatment and have been taking treatment for at least 2 months.
Exclusion criteria
Those who died after starting the treatment, those who are transferred out during the treatment, those who have not completed treatment for at least 2 months and those who refuse to give consent.
Methodology
A list of all the tuberculosis units in Tiruvallur district was obtained from the district TB centre in Tiruvallur enclosed in Annexure. Two tuberculosis Units were selected randomly from the 14 tuberculosis units and the entire smear positive, smear negative and clinically diagnosed patients with TB who got enrolled for treatment in these 2 TB Units between January 2019 to June 2019 were used as the sampling frame.
Results
Among the study population of 1800 patients with TB, 205 patients with TB who were registered we enrolled in the study (Table 1).
S.NO | Socio demographic characteristics | Number (N=205) | Percentage (%) | |
---|---|---|---|---|
1 | Gender | Male | 152 | 74.1 |
Female | 53 | 25.8 | ||
2 | Age | 18-40 | 46 | 22.4 |
41-65 | 138 | 67.3 | ||
>65 | 21 | 10.2 | ||
3 | Educational Status | illiterate | 8 | 3.9 |
School education | 140 | 68.2 | ||
College education | 50 | 24.3 | ||
PG/professional | 7 | 3.4 | ||
4 | Occupation | professional | 5 | 2.4 |
clerical | 31 | 15.1 | ||
skilled | 33 | 16.1 | ||
unskilled | 79 | 38.5 | ||
unemployed | 57 | 27.9 | ||
5 | Religion | Hindu | 121 | 59 |
Muslim | 57 | 27.8 | ||
Christian | 27 | 13.1 | ||
6 | Socio-Economic status | I | 5 | 2.4 |
II | 19 | 9.3 | ||
III | 28 | 13.7 | ||
IV | 74 | 36.1 | ||
V | 79 | 38.5 | ||
7 | Marital status | Unmarried | 33 | 16.1 |
Married | 162 | 79 | ||
Widowed/divorced | 10 | 4.9 | ||
8 | Type of family | joint | 63 | 30.7 |
nuclear | 142 | 69.3 |
Table 1: Socio demographic characteristics of the study population.
Table 2 shows the adverse effects of the Anti-tuberculosis treatment among the study participants. Out of 205 participants 43.9% reported adverse effects after receiving anti-TB treatment and rest 56% had a good compliance for Anti-TB treatment. About 93.3% complained of colored urine followed by GIT disturbance (80%), Peripheral neuropathy (25.5%), auditory effects/ vertigo (16.6%), skin problems (20%), visual problems/ Headache (14.4%) and Hepatitis (10%).
Adverse effect | Number(n=205) | Percentage |
---|---|---|
Yes | 90 | 43.9 |
No | 115 | 56 |
Type of Adverse effect | Number (n=90) | Percentage |
GIT disturbance | 72 | 80 |
Colored urine | 84 | 93.3 |
Hepatitis | 9 | 10 |
Peripheral neuropathy | 23 | 25.5 |
Visual problem/headache | 13 | 14.4 |
Auditory effects/vertigo | 15 | 16.6 |
Skin Problems | 18 | 20 |
Table 2: Adverse effect of anti-TB treatment among study population.
Table 3 shows significant association has been noted between prevalence of non-adherence to TB treatment and several socio demographic characters. Females are at a higher risk of being non adherent to TB treatment in comparison with males (OR-1.79, P-value 0.049). Nonadherence to TB treatment is more common in individuals more than 65 years and lowest in the age group of 18-40 years. This finding is statistically significant (P-value 0.0009). Non-adherence to TB treatment is more common among illiterates and lowest among professionals. This finding is statistically significant (P-value 0.0019).
Socio demographic Variable | Total frequency | Adherence | P value | Χ2 | OR | 95% CI | ||
---|---|---|---|---|---|---|---|---|
Yes (139) | NO (66) | |||||||
Gender | Female | 53 | 31 | 22 | 0.049 | 2.29 | 1.74 | 0.91-3.33 |
Male | 152 | 108 | 44 | |||||
Age | 18-40 | 46 | 36 | 10 | 0.0009 | 13.93 | - | - |
41-65 | 138 | 96 | 42 | |||||
>65 | 21 | 7 | 14 | |||||
Education | Illiterate | 8 | 2 | 6 | 0.0019 | 14.9 | - | - |
School Education | 140 | 89 | 51 | |||||
College education | 50 | 42 | 8 | |||||
Post graduate/Professional | 7 | 6 | 1 | |||||
Occupation | Professional | 5 | 4 | 1 | 0 | 109.1 | - | - |
Clerical | 31 | 16 | 15 | |||||
Skilled | 33 | 20 | 13 | |||||
Unskilled | 79 | 55 | 24 | |||||
Unemployed/Retired | 57 | 44 | 13 | 0.01 | 9.161 | - | - | |
Religion | Hindu | 121 | 92 | 29 | ||||
Muslim | 57 | 32 | 25 | |||||
Christian | 27 | 15 | 12 | |||||
Socioeconomic Status | I | 5 | 0 | 5 | 0.002 | 16.2 | - | - |
II | 19 | 15 | 4 | |||||
III | 28 | 22 | 6 | |||||
IV | 74 | 56 | 18 | |||||
V | 79 | 41 | 38 | |||||
Marital Status | Unmarried | 33 | 21 | 12 | 0.85 | 0.32 | - | - |
Married | 162 | 111 | 51 | |||||
Widowed/Divorced | 10 | 7 | 3 | |||||
Type of family | Joint | 63 | 41 | 22 | 0.28 | 0.3 | 1.19 | 0.63-2.23 |
Nuclear | 142 | 98 | 44 |
Table 3: Association of treatment adherence with socio demographic variables.
Table 4 shows significant association has been noted between prevalence of non-adherence to TB treatment and selected diagnostic and treatment attributes Tuberculosis are a t higher risk of being non-adherent to TB treatment in comparison with extra pulmonary Tuberculosis. This finding is statistically significant (OR-4.16, P-value 0.01). Those participants who are diagnosed at private sector are at higher risk of being non adherent to TB treatment in comparison with those who are diagnosed at government sector. This finding is statistically significant (OR-2.12, P-value 0.02). Those participants who had no family history of Tuberculosis are at higher risk of being non adherent to TB treatment in comparison with those who have family history of Tuberculosis. This finding is statistically significant (OR-7.90, P-value 0.000).
Variable | Total frequency | Adherence | P value | Χ2 | OR | 95% CI | ||
---|---|---|---|---|---|---|---|---|
Yes (139) | NO (66) | |||||||
Type of TB | Pulmonary | 179 | 116 | 63 | 0.01 | 5.82 | 4.16 | 1.20-14. 41 |
Extrapulmonary | 26 | 23 | 3 | |||||
Place of diagnosis | Private | 51 | 28 | 23 | 0.02 | 5.17 | 2.12 | 1.10-4.07 |
Government | 154 | 111 | 43 | |||||
Family history | No | 164 | 101 | 63 | 0 | 14.53 | 7.9 | 2.34-26. 67 |
Yes | 41 | 38 | 3 | |||||
Place of treatment | Higher Centers | 58 | 24 | 34 | 0 | 25.87 | 5.09 | 2.64-9.78 |
PHCs | 147 | 115 | 32 | |||||
Patient category | Category I | 164 | 102 | 62 | 0.0003 | 11.82 | 5.62 | 1.91-16. 53 |
Category II | 41 | 37 | 4 | |||||
No. of months of treatment completed | 2 months | 38 | 33 | 5 | 0 | 24.04 | - | - |
3 months | 51 | 43 | 8 | |||||
4 months | 72 | 38 | 34 | |||||
5 months | 36 | 19 | 17 | |||||
>6 months | 8 | 6 | 2 |
Table 4: Association of treatment adherence with selected diagnostic and treatment attributes.
Table 5 shows significant association between prevalence of non-adherence to TB treatment and adverse effects of anti-tubercular drugs Participants experiencing side effects related to treatment are at higher risk of being non adherent to TB treatment in comparison with those who do not develop side effects. This finding is statistically significant (OR-6.79, P-value 0.000). Those participants who develop colored urine are at higher risk of being non adherent to TB treatment in comparison with those who do not develop colored urine. This finding is statistically significant (OR-2.74, P-value 0.001). Those participants who develop tingling sensation of hands and legs are at higher risk of being non adherent to TB treatment in comparison with those who do not develop tingling sensation of hands and legs. This finding is statistically significant (OR-8.32, P-value 0.000).
Variable | Adherence | P value | Χ2 | OR | 95% CI | ||||
---|---|---|---|---|---|---|---|---|---|
Total frequency | Yes (139) | NO (66) | |||||||
Are you experiencing side effects related to treatment? | Yes | 90 | 44 | 46 | 0 | 40.26 | 6.79 | 3.63-12. 71 | |
No | 150 | 130 | 20 | ||||||
Adverse effects | |||||||||
GIT Disturbance | Yes | 72 | 28 | 44 | 0 | 42.5 | 7.92 | 4.10-15. 31 | |
No | 133 | 111 | 22 | ||||||
Colored urine | Yes | 84 | 46 | 38 | 0.001 | 10.1 | 2.74 | 1.50-5.01 | |
No | 121 | 93 | 28 | ||||||
Hepatitis | Yes | 9 | 7 | 2 | 0.72 | 0.08 | 0.58 | 0.119-2. 91 | |
No | 196 | 132 | 64 | ||||||
Peripheral Neuropathy | Yes | 23 | 6 | 17 | 0 | 20.57 | 8.32 | 3.10-22. 30 | |
No | 182 | 133 | 49 | ||||||
Visual problems/ headache | Yes | 13 | 9 | 4 | 0.9 | 0.012 | 0.93 | 0.27-3.14 | |
No | 192 | 130 | 62 | ||||||
Auditory effects/vertigo | Yes | 15 | 10 | 5 | 0.92 | 0.009 | 1.05 | 0.34-3.22 | |
No | 190 | 129 | 61 | ||||||
Skin Problems | Yes | 18 | 8 | 10 | 0.03 | 4.93 | 2.92 | ||
No | 187 | 131 | 56 | 1.09-7.79 |
Table 5: Association of Treatment adherence with adverse effects.
Discussion
The present study was conducted in Tiruvallur district TB centre includes 205 patients. As we look into the socio demographic characteristics of this study population 74.1% were males and 25.8% were females. In a similar study done by Mahala, et al. in Uttarakhand, 68% were males and rest were females [5]. We see that there is a predominance of males in both the studies assuming negligible sampling errors. Males seem to be more commonly affected by TB. This can be due to males facing inherently higher risk of contracting TB by virtue of their occupation, life style habits like smoking, alcoholism etc. In the present study, 87.3% had pulmonary TB and 12.6% had extra pulmonary TB. In a similar study done by Uria, et al. in Andhra Pradesh, 63.9% had Pulmonary TB and 9.1% had Extra Pulmonary TB [6]. In the present study there was significant association between treatment adherence with smoking, alcohol consumption and HIV/AIDS status of the participant. In a similar studies done by Gopi, et al. in Tamil Nadu, where there was significant association between treatment adherence with smoking and alcohol consumption [7]. In the present study there is significant association between treatment adherence with adverse effects GIT disturbance, peripheral neuropathy and skin problems. This finding is similar with those studies done by Kandel, et al. in Kerala [8]. In the present study there is significant association between treatment adherence with diagnostic attributes like type of TB, Place of diagnosis, family history, and place of treatment, patient category and number of months of treatment completed. This finding is similar to study done by jaggarajamma, et al. and Gopi, et al. in Tamil Nadu, Bagchi, et al. in Maharashtra [9]. This clearly shows that Patients diagnosed with Pulmonary TB in a private sector with no family history of Tuberculosis on CAT I has more possibilities of discontinuing their treatment by the end of Intensive phase. We need enhance more public private partnership. Also presence of family history of TB is seen to be associated with better adherence to TB treatment. This can be due to the fact that in the presence of family history of TB, the patients become more aware of the ill effects of the non-adherence to TB treatment.
Conclusion
In this study 67.8% of the study participants were adherent to treatment and 32.1% of the participants were non-adherent to TB treatment. From the results of this study it is concluded that a more extensive approach for simple access to drugs, an assured drug supply to each and every patient, valuable solutions regarding travel related issues, adoption of healthy lifestyle habits and emphasis on patient motivation to hospital visits for a procure therapy are essential for treatment completion among patients with TB in the study area. In order to raise the awareness to public regarding signs and symptoms, free availability of services and early undiagnosed TB consequences of the TB disease we recommend the strengthening of the educational campaigns conducted in regional TB program.
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Author Info
Jaivant M, Rashmi Gour* and Stephen
Department of Community Medicine, Sree Balaji Medical College and Hospital, Tamil Nadu, Chennai, IndiaCitation: Jaivant M, Rashmi Gour, Stephen, Prevalence and Factors Associated With Treatment Adherence among Tuberculosis Patients in Tiruvallur District, Tamil Nadu, J Res Med Dent Sci, 2022, 10 (10): 051-055.
Received: 29-Jul-2022, Manuscript No. JRMDS-22-53393; , Pre QC No. JRMDS-22-53393(PQ); Editor assigned: 01-Aug-2022, Pre QC No. JRMDS-22-53393(PQ); Reviewed: 16-Aug-2022, QC No. JRMDS-22-53393; Revised: 30-Sep-2022, Manuscript No. JRMDS-22-53393(R); Published: 10-Oct-2022