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Socio-Economic Factors Influencing Adherence to TB Treatment in Nepal

This study analyzes the relationship between socio-economic status and patient adherence to anti-TB treatment under the DOTS program in Nepal's Kaski district. Factors such as gender, age, income, and living conditions were considered. The research highlights the challenges faced by low socio-economic groups in adhering to treatment despite free medication, emphasizing the need to address indirect costs and deeper societal norms. Recommendations include further research on local community values and healthcare provider attitudes to enhance TB control programs in developing countries.

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Socio-Economic Factors Influencing Adherence to TB Treatment in Nepal

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  1. Background 1 § About 1/3 of world population infected with Tuberculosis (TB) §25% of all avoidable deaths in developing countries due to TB §In Nepal, 45% of the population is infected with TB; of whom 60% in productive age group §44,000 people develop active TB annually with 20,000 having infectious pulmonary form

  2. Background 2 §Directly Observed Treatment Short-course (DOTS) started in Nepal in 1996 and was implemented throughout the country by April 2001 §However, still in 2001/2002, 6,000-8,000 people died from TB §Under DOTS, 8 months treatment schedule is followed and anti-TB drugs are given free of charge §Non-adherence is a principal cause of treatment failure.

  3. Objective To analyse the association between socio-economic position and patients’ adherence to anti-TB treatment under DOTS

  4. Setting: §Study conducted in Kaski, a western hilly district in Nepal §TB treatment under DOTS offered by the Regional TB Center (RTC), 2 Primary Health Centers (PHCs), 8 Health Posts (HPs), 3 Sub-health Posts (SHPs), etc Population: §All sputum positive patients, whether they completed their treatment (adherents) or not (non-adherents) §From mid-July 1999 to mid-July 2001, totally 50 non-adherent and 309 adherent patients were registered Methods 1

  5. Design: §Case-control study §Cases: patients who did not complete treatment §Controls: patients who completed treatment Data collection method: §Face-to-face questionnaire based interviews Socio-economic variables: §Gender, age, marital status, literacy, occupation, living area, caste, income, living conditions, travel cost to the TBtreatment facility, and affordability of treatment Methods 2

  6. Methods 3 Analyses: §Relationship of all socio-economic risk factors with non-adherence (outcome) performed by cross-tabulation § Significance of risk (OR) of becoming non- adherent were calculated by Chi-square and Chi- square trend tests §Means calculated by independent sample t-tests § Bivariate and multivariate analyses performed to identify factors associated with non-adherence

  7. Table 1: Background characteristics of respondents

  8. Table 2: Risk of nonadherence to anti-TB treatment by socioeconomic position estimated from multivariate logistic regression analysis (N=129)

  9. Table 2: Risk of nonadherence to anti-TB treatment by socioeconomic position estimated from multivariate logistic regression analysis (N=129) (contd)

  10. Conclusions & recommendations 1 §Even in DOTS and with free drugs, low socio- economic position is an important risk factor for nonadherence , especially lack of cash in hand §Raises pertinent issues ”Are DOTS and free distribution of anti-TB drugs enough to make patient adherent towards their treatment?” §Considerations of indirect costs in addition to direct costs are important in National TB control pogrammes in poor countries

  11. Conclusions & recommendations 2 § Research on other aspects needed to get fuller understanding of the lack of success of the DOTS strategy, for example n Norms and values in local community n Health care providers’ attitudes, values and behaviour n Meaning of treatment from patients’ own perspective

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