Non-adherence to anti-TB drugs among TB/HIV co-infected patients in Mbarara Hospital Uganda: Prevalence and associated factors

Background: Non-adherence to treatment remains a major obstacle to efficient tuberculosis control in developing countries. The dual infection of Tuberculosis and HIV presents further adherence problems because of high pill burden and adverse effects. This poses a risk of increased multi-drug resistant TB. However, the prevalence of non-adherence and its associated factors have not been studied in these patients in Uganda.Objectives: To determine the prevalence and factors associated with non-adherence to anti-TB drugs among TB/HIV co-infected patients in Mbarara hospital.Methods: A cross-sectional study with qualitative and quantitative data collection methods was conducted among TB/HIV coinfected adults in Mbarara hospital from January to March 2008. Consecutive sampling was used to select 140 participants. Adherence was assessed over a 5-day period prior to the interview using patients self-reports. Data was collected using an interviewer administered questionnaire. Qualitative data was collected through key informant interviews using a topic guide and was analyzed manually. Quantitative data was analyzed using STATA version 8. Logistic regression was used to determine factors associated with nonadherence.Results: The prevalence of non-adherence was 25% (95% CI=17.8-32%). Being on continuous phase of the TB regimen was significantly associated with non-adherence (OR=6.24,

Prescribing practices for malaria in a rural Ugandan hospital: evaluation of a new malaria treatment policy

Background: Increasing resistance to first line antimalarial drugs led to a change in the antimalarial policy of Uganda in 2005. Successful implementation of this policy depends on changing prescribing patterns of health workers. Objectives: To describe prescribing patterns for malaria and associated factors in a rural Ugandan hospital following a change in antimalarial treatment policy from chloroquine plus sulphadoxine-pyrimethamine to artemisinin-based combination therapies. Methods: From the outpatients register, 715 prescriptions for malaria were reviewed. Data was collected on patient demographics, prescriber factors and prescription patterns. Prescriptions were considered to conform to the new antimalarial policy if artemether-lumefantrine was prescribed for uncomplicated malaria or quinine for treatment failure or complicated malaria. Results: The most frequently prescribed antimalarials for uncomplicated and complicated malaria were artemetherlumefantrine (n=564, 88.5%) and quinine (n=66, 84.6%) respectively. The proportion of prescriptions conforming to the new antimalarial treatment policy was 88.1% (n=630). Predictors of conformity were: duration in service of less than 6 years (OR=3.40. CI=1.24-9.33), prescriber’s profession (OR=97.51, CI=27.29-348.34) and diagnosis of uncomplicated malaria (OR=10.13, CI=3.37-30.42). Conclusions: Adequate training and provision of information relevant to the needs of different cadres of health workers is needed to promote effective uptake of new treatment policies.Key words: Malaria policy, prescribing practices, malaria treatmen