Iweama Cylia Nkechi, Agbaje Olaoluwa Samson, Umoke Prince Christian Ifeanachor, Igbokwe Chima Charles, Ozoemena Eyuche Lawretta, Omaka-Amari Nnenna Lois, Idache Benjamin Mudi
Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nigeria.
Department of Human Kinetics and Health Education, Faculty of Education, Ebonyi State University, Abakaliki, Nigeria.
SAGE Open Med. 2021 Jan 30;9:2050312121989497. doi: 10.1177/2050312121989497. eCollection 2021.
Tuberculosis is a public health problem in Nigeria. One of the most effective ways of controlling tuberculosis is the directly observed treatment short-course. However, some factors influence tuberculosis patients' treatment nonadherence via directly observed treatment short-course. The study objective was to assess medication nonadherence and associated factors among tuberculosis patients in north-west Nigeria.
A cross-sectional study enrolled tuberculosis patients using directly observed treatment short-course in public health facilities in Kano and Kaduna States from January 2015 to June 2016. The sample selection was conducted via a multistage sampling procedure. Data were collected using tuberculosis patients' demographic and clinical characteristics forms, well-validated structured instruments, and medical records. SPSS version 20 was used for data analysis. Logistic and multivariable logistic regression analyses to determine factors of medication nonadherence ( < 0.05).
Complete responses from 390 patients out of the 460 patients recruited for the study were used for data analyses. The mean age was 51.5 (standard deviation = ±13.8) years. The mean tuberculosis medication adherence questionnaire score was 4.35 ± 1.12. The prevalence of nonadherence to tuberculosis medication was 30.5%. Multivariable logistic regression analysis showed that having a monthly income between #100,000 and #199, 000 (adjusted odds ratio = 0.01; 95% confidence interval: 0.00-0.13), being widowed (adjusted odds ratio = 26.74, 95% confidence interval: 2.92-232.9), being married (adjusted odds ratio = 120.49, 95% confidence interval: 5.38-271.1), having a distance <5 km to directly observed treatment short-course center from home (adjusted odds ratio = 0.06, 95% confidence interval: 0.00-0.01), having a tuberculosis/HIV co-infection (adjusted odds ratio = 0.01, 95% confidence interval: 0.12-0.35), use of antiretroviral treatment and cotrimoxazole prophylaxis therapy medications (adjusted odds ratio = 24.9, 95% confidence interval: 19.6-304.3) were associated with tuberculosis medication nonadherence.
Tuberculosis medication nonadherence was high among the patients. Thus, patient-specific adherence education, attenuation of potential factors for tuberculosis medication nonadherence, and continual resource support for tuberculosis patients are needed to improve treatment outcomes.
结核病是尼日利亚的一个公共卫生问题。控制结核病最有效的方法之一是直接观察短程治疗。然而，一些因素会通过直接观察短程治疗影响结核病患者的治疗依从性。本研究的目的是评估尼日利亚西北部结核病患者的药物治疗不依从情况及相关因素。
一项横断面研究纳入了2015年1月至2016年6月在卡诺州和卡杜纳州公共卫生机构接受直接观察短程治疗的结核病患者。样本选择通过多阶段抽样程序进行。使用结核病患者的人口统计学和临床特征表格、经过充分验证的结构化工具以及医疗记录收集数据。采用SPSS 20版进行数据分析。进行逻辑回归和多变量逻辑回归分析以确定药物治疗不依从的因素（P<0.05）。
研究招募的460名患者中有390名患者的完整回复用于数据分析。平均年龄为51.5岁（标准差=±13.8）。结核病药物依从性问卷的平均得分是4.35±1.12。结核病药物治疗不依从的患病率为30.5%。多变量逻辑回归分析表明，月收入在100,000至199,000奈拉之间（调整后的优势比=0.01；95%置信区间：0.00-0.13）、丧偶（调整后的优势比=26.74，95%置信区间：2.92-232.9）、已婚（调整后的优势比=120.49，95%置信区间：5.38-271.1）、从家到直接观察短程治疗中心的距离<5公里（调整后的优势比=0.06，95%置信区间：0.00-0.01）、患有结核病/艾滋病合并感染（调整后的优势比=0.01，95%置信区间：0.12-0.35）、使用抗逆转录病毒治疗和复方新诺明预防性治疗药物（调整后的优势比=24.9，95%置信区间：19.6-304.3）与结核病药物治疗不依从有关。
患者中结核病药物治疗不依从的情况很严重。因此，需要针对患者进行依从性教育，减少结核病药物治疗不依从的潜在因素，并持续为结核病患者提供资源支持，以改善治疗效果。
