Factors preventing completion of treatment among registered tuberculosis patients under directly observed therapy in Temeke municipality, Dar es salaam

Abstract

Background: Tuberculosis (TB) is an ancient infectious diseases caused by M. tuberculosis, M. bovis and M africanum. In recent years, there has been an increase in the number of TB cases due to the HIV epidemic. In Tanzania, Tuberculosis has been shown to be the third major cause of death after AIDS and Malaria. In 1999, Malaria led with 22%, followed by AIDS (17%), Tuberculosis (9%), Pneumonia (6.5%), and Anemia (5 %). Failure to complete the treatment regimen or defaulting from treatment has been one of the most challenging problems in tuberculosis treatment. Non completion of treatment is one of the contributing factors for MDR -TB and XDR _ TB development. Objectives: The study aimed to assess factors preventing completion of treatment among registered tuberculosis patients under directly observed therapy in Temeke Municipality. The specific objectives of the study were: To determine the socio demographic and economic characteristics preventing completion of anti TB treatment, to determine the underlying disease and treatment factors preventing completion of anti TB treatment among the registered TB patients, to determine the role of societal (stigma and social support) factors in relation to non completion of anti TB treatment and to assess knowledge on anti TB treatment and behavioral factors among registered TB patients Materials and Methods: An unmatched case control study design was conducted. A total of 292 (73 cases and 219 controls, ratio 1 :3) were studied. Record review of the patients was done using the TB register at the randomly selected TB clinics. Factors associated with non completion of anti TB treatment were assessed using a semi structured questionnaire. Data analysis was done using Epi info version 3.5.1 Results: Of the total population 292 (cases = 73 and controls = 219) were recruited. Among the cases, a total of 50 (68.5%) subjects had opted for community based DOT and 23 (31.5%) subjects opted for health facility based DOT, while for the controls, 163 (74.4%) subjects

opted for community based DOT and 56 (25.6%) subjects had opted for health facility based DOT.

Multivariate analysis showed factors associated with non completion of anti TB treatment to be distance of more than 5km from home to the health facility (Adjusted OR= 3.98, 95%CI= 1.82, 8.73), feeling stigmatized (Adjusted OR= 2.80, 95%CI= 1.45, 5.69), not knowing the duration for taking anti TB treatment (Adjusted OR= 2.99, 95%CI= 1.23, 7.32) and HIV infection (Adjusted OR= 2.22, 95%CI= 1.19,4.14)

Conclusion and recommendation: This study found that long distance, HIV infection, feeling stigmatized and unknown duration of treatment to be associated with non completion of anti TB treatment. Efforts must be directed towards enforcing the already existing policy and legislation towards stigma as well as including modules on stigma and discrimination to providers of all cadres within service provision.