Factors associated with default from treatment among tuberculosis patients in nairobi province, Kenya: A case control study

<p>Abstract</p> <p>Background</p> <p>Successful treatment of tuberculosis (TB) involves taking anti-tuberculosis drugs for at least six months. Poor adherence to treatment means patients remain infectious for longer, are more likely to relapse or succumb to tuberculosis and could result in treatment failure as well as foster emergence of drug resistant tuberculosis. Kenya is among countries with high tuberculosis burden globally. The purpose of this study was to determine the duration tuberculosis patients stay in treatment before defaulting and factors associated with default in Nairobi.</p> <p>Methods</p> <p>A Case-Control study; Cases were those who defaulted from treatment and Controls those who completed treatment course between January 2006 and March 2008. All (945) defaulters and 1033 randomly selected controls from among 5659 patients who completed treatment course in 30 high volume sites were enrolled. Secondary data was collected using a facility questionnaire. From among the enrolled, 120 cases and 154 controls were randomly selected and interviewed to obtain primary data not routinely collected. Data was analyzed using SPSS and Epi Info statistical software. Univariate and multivariate logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied.</p> <p>Results</p> <p>Of 945 defaulters, 22.7% (215) and 20.4% (193) abandoned treatment within first and second months (intensive phase) of treatment respectively. Among 120 defaulters interviewed, 16.7% (20) attributed their default to ignorance, 12.5% (15) to traveling away from treatment site, 11.7% (14) to feeling better and 10.8% (13) to side-effects. On multivariate analysis, inadequate knowledge on tuberculosis (OR 8.67; 95% CI 1.47-51.3), herbal medication use (OR 5.7; 95% CI 1.37-23.7), low income (OR 5.57, CI 1.07-30.0), alcohol abuse (OR 4.97; 95% CI 1.56-15.9), previous default (OR 2.33; 95% CI 1.16-4.68), co-infection with Human immune-deficient Virus (HIV) (OR 1.56; 95% CI 1.25-1.94) and male gender (OR 1.43; 95% CI 1.15-1.78) were independently associated with default.</p> <p>Conclusion</p> <p>The rate of defaulting was highest during initial two months, the intensive phase of treatment. Multiple factors were attributed by defaulting patients as cause for abandoning treatment whereas several were independently associated with default. Enhanced patient pre-treatment counseling and education about TB is recommended.</p

Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research

From a systematic review of qualitative research, Munro and coauthors found that a range of interacting factors can lead to patients deciding not to complete their course of tuberculosis treatment

When the trivial becomes meaningful: Reflections on a process evaluation of a home visitation programme in South Africa

This paper reflects on a process evaluation of a home visitation programme in South Africa. The programme, implemented in two low-income communities, focused on the reduction of risks to unintentional childhood injuries. The evaluation comprised a combination of qualitative and quantitative methods, including observations in conjunction with an evaluator's journal, diaries kept by the home visitors, interviews and focus group discussions. Short questionnaires were administered to programme staff and home visitors. Caregivers were visited to attain their assessment of visitors and the programme. These methods resulted in a detailed description of implementation processes, but more importantly gave insight into the experiences and perceptions of the social actors, i.e. programme staff, visitors and caregivers. It also offered possible explanations for the difference in the intervention effect between the two sites. Two major challenges to the evaluation were: (i) the power-imbalance between the evaluator and community participants (visitors and caregivers) and (ii) the language- and cultural barriers between evaluator and community participants. The evaluation demonstrated that process information can contribute towards explaining outcome results, but also that active participation from all social actors is a necessary condition if process evaluations are to result in programme improvement.

Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research

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. Nineteen electronic databases (1966–February 2005) were searched 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)’’. A meta-ethnographic approach was followed to synthesise findings across included studies. [PLoS Medicine, July 2007].Tuberculosis (TB), HIV/AIDS, adherence, meta-ethnographic approach, holistic, treatment, health care, qualitative studies, patients

Tropical Medicine, and DFID

study was received from the Medica

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

PubMe