The Non-Compliance To Tuberculosis Treatment Among Patients Suffering Tuberculosis
1.1 Background Of Study
Tuberculosis is a problem of global importance among communicable diseases. It is second leading disease causing death worldwide killing nearly 2 million people each year in Nigeria. Non-compliance of patients on tuberculosis treatment in an irregular and unreliable way has greatly caused risk of treatment failure, relapse and the development of drug-resistance tuberculosis strains. There are varieties of reasons why patients fail to take their medications.
The center for disease control (2008) states the following:
- The patients compliant is that medicines must be taken with empty stomach to facilitate absorption. This can be difficult for patients to follow especially waking up an hour earlier than usual everyday just to take medicine on empty stomach.
- Another complains is the size of tablet
- Side-effect of the drugs can lead to patients not complying to their treatment.
- Issues on denial, stigmatization, emotional distress, cultural and life-style factors make patients not to take their treatment.
- Poverty, transportation, religion and attitude of health workers contribute to non-compliance of patients on tuberculosis treatment.
Non-compliance of patient on tuberculosis treatment is a serious problem for national tuberculosis control programs (2007) states that this case tends to have higher morbidity and mortality rate when compared to those who are not cured. They remain infectious for prolonged period of time, hence affected patient continues to transmit the disease in the community.
World Health Organization (2009) has estimated that 2 billion people have latent tuberculosis disease which has killed 1.7 million people in Nigeria. In Nigeria, 81% patients are non-compliant to treatment for more than one month before presenting at chest clinics. The patients visit traditional healers and have low level of knowledge about the disease or due to high cost of treatment, transportation and poverty. World health organization (2013)reported worldwide that some countries like South Africa, Kenya, Nigeria, Malaysia, Ghana, China, United States of America and Canada were implementing the directly- observed treatment short-course strategy by the end of 2013. World health organization 2015) currently recommends a case detection rate of 70% and a treatment success rate of 85% for all tuberculosis cases. It is believed that achieving these targets will lead to a reduction in tuberculosis prevalence, incidence, transmission and drug-resistance to tuberculosis treatment.
This study was conducted to determine the non-compliance of tuberculosis in Imo State University Teaching Hospital, Orlu L.G.A.
1.2 Statement Of Problem
Despite the global effort to reduce the incidence of tuberculosis worldwide through mass media, there is still non-compliance to treatment which may be due to the bulkiness of the drugs and taking the drugs on empty stomach. Noticing the incidence of tuberculosis on orthodox and other clinics motivates the researcher to carry out a research to determine the reasons for non-compliance of patients to tuberculosis treatment.
1.3 Objective Of Study
The objectives of this study include:
- To ascertain the knowledge of people about tuberculosis, its causes and its effects.
- To find the cause of patients not complying to their treatment.
- To identify the knowledge of patients based on the importance of complying to treatment.
- To identify strategies for improvement of patients’ acceptance of care and treatment of tuberculosis.
1.4 Significance Of Study
To The Client:
- The study will help the individual to have the knowledge on health investigation and screening in order to indicate the early signs and symptoms
- It will also help the patient to know the importance of treatment given to them.
To the family
- It will help the family members to have the knowledge on the cause & prevention of tuberculosis.
To the community
- This will educate people on the importance of good personal and environmental hygiene and also avoid over-crowding.
To the country
- It will reduce mortality and morbidity rate in the county.
To the health worker
- It will help the health care provider to have adequate knowledge on the management and treatment of the patient.
1.5 Research Question
- What are the knowledge levels of people about tuberculoses disease, its cause and its effects?
- What are the causes of patients not complying to their treatment?
- What are the people’s knowledge about the importance of complying to their treatment?
- What are the strategies for improvement of patients’ acceptance of care and treatment of tuberculosis?
1.6 Scope Of Study
This study is focused on patients suffering tuberculosis in Imo State University Teaching Hospital, Orlu, L.G.A.
1.7 Operational Definition Of Terms
A communicable disease that is caused by mycobacterium tuberculosis.
Finding or searching for more information.
People that harbor infections caused by micro- organisms.
The presence and growth of a micro-organism that produce tissue –damage
This is the presence of a disease which affects a large number of populations in a definite territory.
5.0 Discussion Of Findings
This chapter is on the discussion of the findings, nursing implication, summary conclusions, limitations recommendations and suggestion for further studies the study assessed non-compliance to tuberculosis in Imo state university teaching hospital, Orlu, Imo state
Research Question One:
What are the knowledge levels of people about tuberculosis disease, its causes and effects?
From the study finding, 6o% of the respondents are aware of what tuberculosis disease is its causes and effects while 40% do not have an idea about the disease 75% think tuberculosis is an infectious disease, 7.5% think it is a spiritual attack, 12.5% think it is heredity disease while 5% believe it is a congenital disease. 17.5% think the disease is caused by plasmodium, 12.5% think it is caused by virus, 22.55 believe it is causes by mycobacterium tuberculosis. as for mode of transmission , touching of an infected person, 25% believe it can be transmitted by playing with an infected person, 37.5% think it can be contacted thorough inhalation of droplets from cough or sneeze of an infected person while 20% believe it can be contacted through the use of personal items belonging to an infected person
Research Question Two:
What are the causes of patients not complying to their tuberculosis treatment?
From the analysis data, the cause of non-compliance of patient to treatment could be seen in this manner 30% of the respondents adhere to treatment regimen while 70% do not adhere. As for the cause of non-compliance, 15% were not adhering to treatment due to the big size of tablets, 17.5% was due to less awareness that adherence to the therapy is very important for complete cure, 12.5% was as a result of side-effects of the drugs while 55% was due to the use of complementary and alternative medicine (natural). This is in line with centers for disease control and presentation (2008) which stated the reasons patients fail to take their medications as the above mentioned reasons.
Research Question Three:
What are the peoples knowledge about the importance of complying to their treatment?
From the analyzed data, 25% (10) of the respondents think adherence to treatment is important while 75% I don’t think so. As well, 25% of the respondents think TB can damage body organs if not properly treated while 75% do not think so.
Research Question Four:
What are the strategies for improvement of patient’s acceptance of care and treatment of tuberculosis?
Based on the findings, 35(87.5%) of the respondents believe tuberculosis patients should receive instructions about the use and importance of the anti-Tb drugs from drugs providers while 12.5% do not think so. As well, 80% of the respondents think TB patients should receive comprehensive information about tuberculosis at the time of diagnosis through health education while 20% do not think so. 87.5% of respondents think showing patient those who are convalescing from the disease would help to improve compliance to treatment while 12.5% do not think so.
From the result of the study, it was shown that a large population of the respondent are aware of what tuberculosis is but they lack the thorough knowledge which affects their compliance to treatment. Therefore, the nurse and other health care workers should use the harmful effects of not complying t o treatment and as well as the use and importance of the anti- TB drugs, giving comprehensive information about tuberculosis at the time of diagnosis and showing TB patients whose who are convalescing from the disease.
Limitation Of Study
The following problems were encountered during the course of stud:
- Time interval to carry out this study was short.
- Lack of adequate literature for review, analysis and discussion
- Level of literacy of respondents was very poor making explanation of the topic and items in the questioner a difficult one.
- The researcher is a novice in research and this aided to the set back encountered.
This study was no the non-compliance to TB treatment among TB patients in Imo state university teaching hospital, Orlu L.G.A . A descriptive survey design method was used for the study. 40 questionnaires were formulated, distributed and data collected. The total populating constituted 40 patients. Table, and percentages, it was noticed that majority of the respondents understood what tuberculosis disease is but do not have in-depth knowledge about the importance of complying to treatment and dangers of non-compliance.
Based on the findings of the study, the researcher concluded that majority of the respondents had same knowledge about the respondents do not adhered to treatment due to certain personal reasons. However, all would definitely improve a great deal if more effort is put to properly educate and explain to patients on the need for strict adherence to treatment.
In view of research findings, the following recommendations are made:
- There is need for hospitalization for actual diseases, specific treatment other than regimen.
- There should be implementation of a tuberculosis control program in general hospitals and provide supervised treatment at least for patients with parameters considered predictive for non-compliance.
- If the result of this study are confirmed by other studies of patients treated by general hospitals legislators responsible for public health policies should give priority to providing special treatment for tuberculosis patients (particularly in urban centers ), establishing out –patient and hospital –based tuberculosis control programs
5.4 Suggestion For Further Studies
The researcher suggested that a similar study should be carried out in other hospitals so that generalization would be made.
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