Woimo Tadele Teshome, Yimer Wondwossen Kassahun, Bati Temesgen, Gesesew Hailay Abrha
Department of Infectious diseases, Dawro District Health Office, Dawro, Ethiopia.
US Department of Human and Health Services, Biostatistics and Bioinformatics Branch (BBB), NICHD, New York, USA.
BMC Public Health. 2017 Mar 20;17(1):269. doi: 10.1186/s12889-017-4188-9.
Evidence exists pointing out how non-adherence to treatment remains a major hurdle to efficient tuberculosis control in developing countries. Many tuberculosis (Tb) patients do not complete their six-month course of anti-tuberculosis medications and are not aware of the importance of sputum re-examinations, thereby putting themselves at risk of developing multidrug-resistant and extensively drug-resistant forms of tuberculosis and relapse. However, there is a dearth of publications about non-adherence towards anti-Tb medication in these settings. We assessed the prevalence of and associated factors for anti-Tb treatment non-adherence in public health care facilities of South Ethiopia.
This was a cross-sectional survey using both quantitative and qualitative methods. The quantitative study was conducted among 261 Tb patients from 17 health centers and one general hospital. The qualitative aspect included an in-depth interview of 14 key informants. For quantitative data, the analysis of descriptive statistics, bivariate and multiple logistic regression was carried out, while thematic framework analysis was applied for the qualitative data.
The prevalence of non-adherence towards anti-Tb treatment was 24.5%. Multiple logistic regression analysis demonstrated that poor knowledge towards tuberculosis and its treatment (AOR = 4.6, 95%CI: 1.4-15.6), cost of medication other than Tb (AOR = 4.7, 95%CI: 1.7-13.4), having of health information at every visit (AOR = 3, 95% CI: 1.1-8.4) and distance of DOTS center from individual home (AOR = 5.7, 95%CI: 1.9-16.8) showed statistically significant association with non-adherence towards anti- tuberculosis treatment. Qualitative study also revealed that distance, lack of awareness about importance of treatment completion and cost of transportation were the major barriers for adherence.
A quarter of Tb patients interrupted their treatment due to knowledge, availability and accessibility of DOTS service. We recommend creating awareness about anti-Tb treatment, and decentralization of drug pick-ups to the lowest level of health institutions.
有证据表明，在发展中国家，不坚持治疗仍然是有效控制结核病的主要障碍。许多结核病患者没有完成为期六个月的抗结核药物疗程，也没有意识到痰复查的重要性，从而使自己面临发展为耐多药和广泛耐药结核病以及复发的风险。然而，在这些地区，关于不坚持抗结核药物治疗的出版物却很少。我们评估了埃塞俄比亚南部公共卫生保健机构中抗结核治疗不坚持的患病率及其相关因素。
这是一项采用定量和定性方法的横断面调查。定量研究在来自17个卫生中心和一家综合医院的261名结核病患者中进行。定性方面包括对14名关键信息提供者的深入访谈。对于定量数据，进行了描述性统计分析、双变量和多因素逻辑回归分析，而对定性数据则应用了主题框架分析。
抗结核治疗不坚持的患病率为24.5%。多因素逻辑回归分析表明，对结核病及其治疗的了解不足（比值比[AOR]=4.6，95%置信区间[CI]：1.4 - 15.6）、结核病以外药物的费用（AOR = 4.7，95%CI：1.7 - 13.4）、每次就诊时都能获得健康信息（AOR = 3，95%CI：1.1 - 8.4）以及直接观察短程治疗（DOTS）中心与个人家庭的距离（AOR = 5.7，95%CI：1.9 - 16.8）与抗结核治疗不坚持在统计学上有显著关联。定性研究还表明，距离、对完成治疗重要性的认识不足以及交通费用是坚持治疗的主要障碍。
四分之一的结核病患者由于对DOTS服务的了解、可及性和可用性而中断治疗。我们建议提高对抗结核治疗的认识，并将药物领取点下放到最低级别的卫生机构。
