Tropical Diseases Research Centre, Biomedical Sciences Department, P, O, Box 71769, Ndola, Zambia.
BMC Public Health. 2010 Dec 7;10:756. doi: 10.1186/1471-2458-10-756.
Zambia continues to grapple with a high tuberculosis (TB) burden despite a long running Directly Observed Treatment Short course programme. Understanding issues that affect patient adherence to treatment programme is an important component in implementation of a successful TB control programme. We set out to investigate pulmonary TB patient's attitudes to seek health care, assess the care received from government health care centres based on TB patients' reports, and to seek associations with patient adherence to TB treatment programme.
This was a cross-sectional study of 105 respondents who had been registered as pulmonary TB patients (new and retreatment cases) in Ndola District between January 2006 and July 2007. We administered a structured questionnaire, bearing questions to obtain individual data on socio-demographics, health seeking behaviour, knowledge on TB, reported adherence to TB treatment, and health centre care received during treatment to consenting respondents.
We identified that respondents delayed to seek treatment (68%) even when knowledge of TB symptoms was high (78%) or when they suspected that they had TB (73%). Respondent adherence to taking medication was high (77%) but low adherence to submitting follow-up sputum (47%) was observed in this group. Similarly, caregivers educate their patients more often on the treatment of the disease (98%) and drug taking (100%), than on submitting sputum during treatment (53%) and its importance (54%). Respondent adherence to treatment was significantly associated with respondent's knowledge about the disease and its treatment (p < 0.0001), and with caregiver's adherence to treatment guidelines (p = 0.0027).
There is a need to emphasise the importance of submitting follow-up sputum during patient education and counselling in order to enhance patient adherence and ultimately treatment outcome.
尽管赞比亚长期实施直接观察治疗短程方案，但仍面临着沉重的结核病（TB）负担。了解影响患者对治疗方案依从性的问题是实施成功结核病控制规划的重要组成部分。我们着手调查肺结核患者寻求医疗保健的态度，评估政府保健中心根据肺结核患者报告提供的护理，并寻求与患者对结核病治疗方案的依从性相关的因素。
这是一项横断面研究，对象为 2006 年 1 月至 2007 年 7 月期间在恩多拉区登记为肺结核患者（新发病例和复发病例）的 105 名受访者。我们采用了一种结构化问卷，提出了有关个人社会人口统计学、卫生寻求行为、结核病知识、报告的结核病治疗依从性以及治疗期间在保健中心接受的护理等问题，以获取同意的受访者的信息。
我们发现，受访者即使对结核病症状的了解程度很高（78%），或者怀疑自己患有结核病（73%），也会延迟寻求治疗（68%）。该组受访者对服药的依从性很高（77%），但对提交随访痰液的依从性较低（47%）。同样，照顾者更经常教育患者治疗疾病（98%）和服药（100%），而不是在治疗期间提交痰液（53%）及其重要性（54%）。受访者对治疗的依从性与他们对疾病及其治疗的了解程度显著相关（p<0.0001），并且与照顾者对治疗指南的依从性相关（p=0.0027）。
在对患者进行教育和咨询时，有必要强调提交随访痰液的重要性，以提高患者的依从性，最终改善治疗结果。
