Compliance in TB Chemotherapy: study of patients at George health center in Lusaka
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Tuberculosis has emerged as the most serious infectious disease in terms of morbidity and mortality in Sub-saharan Africa. The disease can be prevented from spreading and those who get infected can be cured if they are diagnosed and treatment is commenced early and taken for a sufficient length of time. To improve compliance and cure Direct Observed Therapy Short course (DOTS) chemotherapy has been introduced. But despite efforts to improve compliance as many as 35% patients on a 1995 Lusaka Tb cohort were reported as defaulters This study aimed at exploring reasons for this non adherence. OBJECTIVE: This study was carried out to determine reasons for lack of adherence to tuberculosis chemotherapy among patients attending George Health Centre in Lusaka. METHODOLOGY: General observation of the functioning of the TB clinic was done. All patients on DOTS missing for more than one day in the intensive and more than a week in the continuation phase from the daily morbidity records kept at the Health Centre during the period of february and november 1996 were eligible to participate and were followed to their homes. Those followed were administered with a semi-structured questionnaire and were invited to participate in a Focus Group Discussion (FGD). RESULTS: The incidence rate of TB in 1996 was 47 per 10000 population. 215 (33 %) of TB patients met definition of non adherent from the morbidity records, 21 (9.8 %) of these were true defaulters. 18% had died, 35.8% had shifted residence, 20% gave incorrect address, 10.7% were wrongly labelled as non adherents while 5.6% could not be reached. Among respondents there is a belief in two types of Tb known as the new and the old type. The new type is perceived as being AIDS related and is referred to as bone Tb. Survivors of treatment are viewed as having suffered from old Tb. Respondents felt DOTS was like a punishment because they were required to walk daily for treatment as a result some sent their children to collect drugs for them on a daily basis. Long waiting time is a problem and there is a general lack of counselling on duration and importance of compliance to regimen while the stage of disease impaired some patients from attending and there is stigma attached to AIDS and TB which prevents some patients from attending. The study also established that among women there is a belief not to engage in sexual intercourse while on treatment and are therefore scared of being divorced as a result some did not tell their spouses that they were on Tb treatment and some simply stopped once they felt better. High rental charges and being unemployed made some patient change residence frequently. Conclusion: Poor record keeping and high mortality rates contribute to high rate of defaulters being reported. DOTS is generally not being practised as prescribed. Establishment of Tb Health posts and extending operating hours at Health centres would decongest the patient load and improve service.
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