Noncompliance to DOTS: How it can be decreased

Abstract

Background: Tuberculosis is a communicable disease requiring prolonged treatment. The therapeutic regimens as recommended by WHO have been shown to be highly effective for both preventing and treating tuberculosis but poor adherence to medication is a major barrier to its global control. Aim: The aim was to elicit reasons of treatment default from a cohort of tuberculosis patients treated under Directly Observed Treatment Short course chemotherapy. Settings and design: This cross-sectional study was conducted in Agra city using the multistage simple random sampling. Materials and Methods: A total of 900 patients attending DOTS centres of the selected designated microscopy centers (DMCs) were included in the study from January 2007 onward. The information was obtained from treatment cards of patients and those who defaulted were further interviewed in community. Statistical analysis: Chi-square test was applied to observe the significance of association using the Epi Info software (version 6). Results: More default was observed among the age group of >45 years (22.8%), male (18.7%), business men (30.6%), and retired and unemployed patients. Other factors associated with higher default were pulmonary disease (18.2%), retreatment cases (30.6%) and category II patients (26.4%). Important reasons of default were side effects following medication (43.2%), improvement in symptoms (14.4%), and lack of time (13.5%). No relief in symptoms and lack of awareness were other important reasons. Conclusions: Noncompliance was found to be mainly due to side effects of medicines, lack of time, and unawareness. So educating the patient about various aspects of tuberculosis and some measures to decrease side effects are of utmost importance.

Keywords

• DOTS
• noncompliance
• RNTCP
• tuberculosis