Asian Journal of Pharmaceutical Research and Health Care

Open Access Open Access  Restricted Access Subscription Access

Evaluation of Non-adherence to Anti-tuberculosis Treatment at a DOTS Clinic in Malaysia


Affiliations
1 Department of Nursing, University Malaya Medical Centre, Kuala Lumpur, Malaysia
2 Program leader, BSc (Hons) Nursing (Post Reg,) MAHSA University, Saujana Putra Campus, Kuala Langat, Selangor, Malaysia
3 Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur – 57000, Malaysia
 

Adherence to tuberculosis treatment is vital to prevent and control the disease from further progression into multiple complications. However, due to many reasons the adherence level is very poor among the tuberculosis patients. This study was aimed to assess the knowledge and perception of tuberculosis patients on anti-tubercular therapy and determine the factors that involved in non-compliance to tuberculosis treatment. The study was carried out for a period of 4 months at the DOTS clinics, among the patients who availed anti-tuberculosis treatment for at-least 2 consecutive months. A structured, validated questionnaire was used to gather relevant information pertaining to the study objectives. Among the 171 respondents, most (39.8%) were between 21 to 39 years old, 55.6% were male, 81% with secondary level of education and 48% had diploma level of education. Majority of the respondents were Malay (40.9%), Chinese (23.4%), Indian (22.2%), and others (13.5%). The mean percentage score of respondents on knowledge, attitude, and perception on tuberculosis treatment were 58.9±19.3 and 44.2±9.4, respectively. There were no significant differences in the scores on knowledge, attitude, and perception on tuberculosis with respondents’ age, sex, education, ethnicity, marital and employment status. The knowledge, attitude, and perception towards TB treatment among the patients who regularly visit the DOTS clinics were moderate to good. However, there were many defaulters in the current TB therapy as many patients did not follow-up their treatment schedule and drop out in the early phase/month of the TB course due to lack of support from family and friends, and also the influence of social and community factors. These barriers need to be addressed in an emergency basis for the benefit of patient community.


Keywords

Adherence, Bacteria, DOTS clinic, Medication, Tuberculosis
User
Notifications
Font Size

  • World Health Organisation. Tuberculosis. WHO. Geneva, Switzerland. 2019. Available from: https://www.who.int/ news-room/fact-sheets/detail/tuberculosis (accessed 15 June 2020).

  • Caminero LJA. A tuberculosis guide for specialist physicians. International Union Against Tuberculosis and Lung Diseases, France, 2003, p. 24. Available from: https:// theunion.org/what-we--do/publications/technical/body/ PUB_TuberculosisGuideForSpecialistPhysicians_Part1_ ENG.pdf (accessed 20 June 2020).

  • Castelnuovo B. A review of compliance to anti tuberculosis treatment and risk factors for defaulting treatment in Sub Saharan Africa. Afr Health Sci. 2010; 10(4):320-4. PMCID: PMC3052808

  • Hirpa S, Medhin G, Girma B, et al. Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: a case control study. BMC Public Health. 2013; 13:782. https:// doi.org/10.1186/1471-2458-13-782 PMid:23981845 PMCid:PMC4015150

  • Aziah AM. Tuberculosis in Malaysia: combating the old nemesis. Med J Malaysia. 2004; 59(1):1-3. Available from: http://www.e-mjm.org/2004/v59n1/Tuberculosis_ in_Malaysia.pdfhttp://www.e-mjm.org/2004/v59n1/ Tuberculosis_in_Malaysia.pdf.

  • Awofeso N. Anti-tuberculosis medication side-effects constitute major factor for poor adherence to tuberculosis treatment. Bull World Health Organ. 2008; 86(3):B-D.

  • https://doi.org/10.2471/BLT.07.043802 PMid:18368191 PMCid:PMC2647396

  • Gugssa BC, Shimels T, Bilal AI. Factors contributing to non-adherence with treatment among TB patients in Sodo Woreda, Gurage Zone, Southern Ethiopia: A qualitative study. J Infect Public Health. 2017; 10(5):527-533. https:// doi.org/10.1016/j.jiph.2016.11.018 PMid:28189508

  • Elbireer S, Guwatudde D, Mudiope P, et al., Tuberculosis treatment default among HIV-TB co-infected patients in urban Uganda. Trop Med Int Health. 2011; 16(8):9817. https://doi.org/10.1111/j.1365-3156.2011.02800.x PMid:21585625

  • Goransson KE, von Rosen A. Patient experience of the triage encounter in a Swedish emergency department. Int Emerg Nurs. 2010; 18(1):36-40. https://doi.org/10.1016/j.ienj.2009.10.001 PMid:20129440

  • Birch S, Govender V, Fried J, et al., Does treatment collection and observation each day keep the patient away? An analysis of the determinants of adherence among patients with Tuberculosis in South Africa. Health Policy Plan. 2016; 31(4):454-61. https://doi.org/10.1093/heapol/czv084 PMid:26384375

  • Woith WM, Larson JL. Delay in seeking treatment and adherence to tuberculosis medications in Russia: a survey of patients from two clinics. Int J Nurs Stud. 2008; 45(8): 1163-74. https://doi.org/10.1016/j.ijnurstu.2007.07.014 PMid:1785480

  • Kessler RC, Andrews G, Colpe LJ, et al., Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002; 32(6):959-76. https://doi.org/10.1017/S0033291702006074 PMid:12214795

  • Vrijens B, De Geest S, Hughes DA, et al., A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012; 73(5):691-705. https://doi.org/10.1111/j.1365-2125.2012.04167.x PMid:22486599 PMCid:PMC3403197

  • Deshmukh RD, Dhande DJ, Sachdeva KS, et al., Social support a key factor for adherence to multidrug-resistant tuberculosis treatment. Indian J Tuberc. 2018; 65(1):41-47. https://doi.org/10.1016/j.ijtb.2017.05.003 PMid:29332647

  • Meda ZC, Lin YT, Sombie I, et al. Medication-adherence predictors among patients with tuberculosis or human immunodeficiency virus infection in Burkina Faso. J Microbiol Immunol Infect. 2014; 47(3):222-32.https://doi.org/10.1016/j.jmii.2013.05.001 PMid:23769812

  • Sagbakken M, Frich JC, Bjune G. Barriers and enablers in the management of tuberculosis treatment in Addis Ababa, Ethiopia: a qualitative study. BMC Public Health. 2008; 8:11.

  • https://doi.org/10.1186/1471-2458-8-11 PMid:18186946 PMCid:PMC2257959

  • Quinn GP, Jacobsen PB, Albrecht TL, et al., Real-time patient satisfaction survey and improvement process. Hosp Top. 2004; 82(3): 26--32. https://doi.org/10.3200/HTPS.82.3.26-32 PMid:15754859

  • Redding CA, Rossi JS, Rossi SR, et al. Health behavior models. Int Electr J Health Educ. 2000; 3:180-193. https://pdfs.semanticscholar.org/5913/74764a22b4a570906662948e3da0294c03a9.pdf

  • Mishra P, Hansen EH, Sabroe S, et al., Adherence is associated with the quality of professional-patient interaction in Directly Observed Treatment Short-course, DOTS. Patient Educ Couns. 2006; 63(1-2):29-37. https://doi.org/10.1016/j.pec.2005.08.006 PMid:16242297

  • Karuniawati H, Putra ON, Wikantyasning ER, Impact of pharmacist counseling and leaflet on the adherence of pulmonary tuberculosis patients in lungs hospital in Indonesia. Indian J Tuberc. 2019; 66(3):364-369. https:// doi.org/10.1016/j.ijtb.2019.02.015 PMid:31439181

  • Eva Maria G, Librada R, Victoria M, et al., Educational measure for promoting adherence to treatment for tuberculosis, Procedia - Social and BehavioralSciences. 2017; 237:705-9. https://doi.org/10.1016/j.sbspro.2017.02.047


Abstract Views: 295

PDF Views: 134




  • Evaluation of Non-adherence to Anti-tuberculosis Treatment at a DOTS Clinic in Malaysia

Abstract Views: 295  |  PDF Views: 134

Authors

Kumarasamy Sakuntala
Department of Nursing, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Manghanmal Ashah
Program leader, BSc (Hons) Nursing (Post Reg,) MAHSA University, Saujana Putra Campus, Kuala Langat, Selangor, Malaysia
Sivanandy Palanisamy
Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur – 57000, Malaysia
Karthikayini Krishnasamy
Department of Nursing, University Malaya Medical Centre, Kuala Lumpur, Malaysia

Abstract


Adherence to tuberculosis treatment is vital to prevent and control the disease from further progression into multiple complications. However, due to many reasons the adherence level is very poor among the tuberculosis patients. This study was aimed to assess the knowledge and perception of tuberculosis patients on anti-tubercular therapy and determine the factors that involved in non-compliance to tuberculosis treatment. The study was carried out for a period of 4 months at the DOTS clinics, among the patients who availed anti-tuberculosis treatment for at-least 2 consecutive months. A structured, validated questionnaire was used to gather relevant information pertaining to the study objectives. Among the 171 respondents, most (39.8%) were between 21 to 39 years old, 55.6% were male, 81% with secondary level of education and 48% had diploma level of education. Majority of the respondents were Malay (40.9%), Chinese (23.4%), Indian (22.2%), and others (13.5%). The mean percentage score of respondents on knowledge, attitude, and perception on tuberculosis treatment were 58.9±19.3 and 44.2±9.4, respectively. There were no significant differences in the scores on knowledge, attitude, and perception on tuberculosis with respondents’ age, sex, education, ethnicity, marital and employment status. The knowledge, attitude, and perception towards TB treatment among the patients who regularly visit the DOTS clinics were moderate to good. However, there were many defaulters in the current TB therapy as many patients did not follow-up their treatment schedule and drop out in the early phase/month of the TB course due to lack of support from family and friends, and also the influence of social and community factors. These barriers need to be addressed in an emergency basis for the benefit of patient community.


Keywords


Adherence, Bacteria, DOTS clinic, Medication, Tuberculosis

References





DOI: https://doi.org/10.18311/ajprhc%2F2021%2F26099