| Objective Tuberculosis (TB) is today considered the most important resurgent disease worldwide. It has the highest morbidity and mortality rate compared to any other single pathogen. Anti-tuberculosis chemotherapy should be administered to the greatest possible number of patients in order to cure them, and thereby interrupt the chain of transmission of TB within the population. The most serious problem hindering TB treatment and control is noncompliance of patients. Adherence to treatment requires the active participation of the patient in self-management of treatment and cooperation between the patient and the health care provider. The reasons for poor compliance are multifaceted and complex, but include the characteristics of the individual patient and social and economic factors such as communication between the patient and health care providers, duration and number of medications needed, side effects, cost of treatment, competing demands on time, contradictory norms or expectations of families and cultural groups, and the poor quality of the TB control infrastructure.The present study was conducted to determine the rate of compliance to anti-tuberculosis drugs among TB patients in Shangdong Province and to study some epidemic factors associated with it.Subjects and methods All patients prescribed anti-tuberculosis therapy from January, 2004 to January, 2005 were identified from records kept in Shandong Provincial Tuberculosis Hospital. Addresses of these patients were obtained from their records. The research team visited these patients at home during March and April 2005;a predesigned questionnaire was completed using a patient self-report method. The questionnaire was composed of the following sections: a) demographic characteristics of the patient, e.g. age, sex, work and education;b) symptoms and diagnosis of tuberculosis and knowledge of the course of tuberculosis, modes of transmission, and its complications;and c) adherence, where the patient was asked about drugs taken, how taken, number of tablets (dose), regularity, side effects and improvement in symptoms of TB, attitude to treatment. The patients were considered noncompliant if they did not take the medication as prescribed by the treating physician. Analysis was carried out using SAS6.12 statistical software. Crude odds ratio was computed to test the bivariate association for binary variables. Multivariate logistic regression was performed to obtain the adjusted estimates of the effect on compliance of allvariables found significantly associated in bivariate analysis. Results The number of newly diagnosed TB cases recorded during the study period was 205, including 122 males(59.5%) and 83 females(40.5%),with mean age37±15.5 yrs( range 11-87 yrs). About two-thirds of males (64.5%) and females (66.7%) complied with their anti-tuberculosis regimens, giving an overall compliance rate of 65.1%. Noncompliance cases include the following types:?Cases of forgetting to take medications, which occupied 26.3% of all noncompliance cases.?Absent from taking medications for at least two weeks 45 (22.0%) patients had such experience. ?To change the dosage and/or types of drugs 6(2.9%) patients change the dosage and/or types of anti-tuberculosis medications during the treatment period.The relationship of some factors presumbly thought having impact on the noncompliance was analyzed using standard logistic regression analysis, and it was found that: 0 The agressiveness of attitude to taking medications was negatively related with noncompliance rate (standard partial regression coefficient-0.43 p< 0.01),while the agressiveness of attitude was sianificantly related with the supportive degree of family friend and surrounding personels mainly including colleagues (0.30 p < 0.01),the closeness of association of patients and consultant doctors (-0.16 p < 0.05).Patients who were initially diagnosed with tuberculosis were more aggressive to medical treatment than the others (0.37 p< 0.05).?The degree of fear that taking anti-tuberculosis medications might negatively interfere with social relationship with people was positively related with noncompliance rate (0.26 p < 0.01).Such fear was significantly related with the negativity of patients about tuberculosis, which was further positively influenced (0.55 p < 0.01) by complications (0.23 p< 0.05) and negatively by the relationship of patients and doctors(-0.18 p < 0.1).Conclusions This study showed that compliance with anti-tuberculosis chemotherapy poses specific problems because of the epidemiological and socioeconomic context in which it occurs. Noncompliance with anti-tuberculosis therapy was significantly associated with the attitude of patients about TB and taking medicine, and fear that taking medication could lead the declining of social relation ship of patients with other people. To increase the compliance rate among TB patients, more information about TB must be given to them at the time of diagnosis through health education sessions;these should be appropriate to the educational level and cultural believes of the patient. More detailed instructions about the importance and effectiveness of drug treatment of TB must also be provided by the health care personnel. |
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