Wares D F, Singh S, Acharya A K, Dangi R
TB/Leprosy Control Programme, The Britain-Nepal Medical Trust, Biratnagar.
Int J Tuberc Lung Dis. 2003 Apr;7(4):327-35.
Tarai districts, eastern Nepal.
To identify potential methods of increasing adherence to tuberculosis (TB) treatment by determining factors that patients felt influenced adherence.
New pulmonary TB patients registered from July to November 1998 with an outcome of non-adherence to treatment (NA) were identified from District TB Registers, traced and interviewed using a semi-structured questionnaire. An equivalent number of adherent (A) patients were interviewed.
Of 81 NA patients traced, 30 were interviewed, 16 had been incorrectly classified, age was incorrectly recorded in four, 13 had migrated and 18 were not found. The groups were similar in demographics, type and knowledge of TB. More A patients knew their diagnosis (P = 0.07) and reported haemoptysis as an initial symptom (P = 0.03). NA patients had longer travel to a health facility (P < 0.001), and fewer had been informed by health care workers (HCW) about the consequences of not completing treatment. The most common reasons given for stopping treatment were side-effects, HCWs' mistakes or behaviour, and health service failure. Desire for cure and knowledge that TB was curable were most the important reasons for completing treatment.
Non-adherence seemed related to treatment delivery failures. The health system needs strengthening in Nepal. Intensified HCW training and supervision, better health education for patients and families, more flexibility for treatment supervisors, adequate supplies for treatment centres and decentralisation of treatment delivery to the lowest health service level practicable are urgently needed.
尼泊尔东部的特莱地区。
通过确定患者认为影响依从性的因素，找出提高结核病治疗依从性的潜在方法。
从地区结核病登记册中识别出1998年7月至11月登记的新肺结核患者，其治疗结局为不依从治疗（NA），进行追踪并使用半结构化问卷进行访谈。对同等数量的依从（A）患者进行访谈。
在追踪的81例NA患者中，30例接受了访谈，16例分类错误，4例年龄记录错误，13例已迁移，18例未找到。两组在人口统计学、结核病类型和知识方面相似。更多的A组患者知道自己的诊断（P = 0.07），并报告咯血为初始症状（P = 0.03）。NA组患者前往医疗机构的路程更长（P < 0.001），且较少有医护人员告知其不完成治疗的后果。停止治疗最常见的原因是副作用、医护人员的失误或行为以及卫生服务失败。渴望治愈以及知道结核病可治愈是完成治疗的最重要原因。
不依从似乎与治疗提供失败有关。尼泊尔的卫生系统需要加强。迫切需要加强医护人员培训和监督，为患者及其家属提供更好的健康教育，治疗监督员更具灵活性，治疗中心有足够的物资供应，并将治疗服务下放到可行的最低卫生服务水平。
