Social Determinants: Reinforcing and Enabling Factors as Predictors of Treatment-Adherence in Community-Based Drug Resistant Tuberculosis Patients in South-West, Nigeria

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DOI: 10.21522/TIJPH.2013.08.02.Art008

Authors : Oyepeju O Orekoya


Background: Medication Non-adherence in the treatment of patients with Tuberculosis (TB) is a major challenge in community-based clinical therapeutics. This has been attributed, in part, to duration and complexity of treatment regimens and toxic side-effects, which facilitates disease transmission with emerging resistance to anti-TB drugs. This study was undertaken to assess level of adherence to treatment and identify social determinants moderating medication-adherence guided by the PRECEDE framework among patients receiving treatment in South-west zone of Nigeria.

Method: This was a cross-sectional survey design conducted as a community-based study with 226 consenting patients receiving second-line drug treatment based on data obtained from all DR-TB OPD Health facilities within South-west, Nigeria. The study adopted total enumeration sampling technique. Data analysis was performed using IBM SPSS version 22. Univariate and multivariate Regression analysis was conducted to validate the association between the independent variables (Reinforcing and Enabling factors) and outcome variables (medication- adherence and appointment keeping behavior). The test of significance was set at 5% for all statistical procedures.

Results: Male participants in this study was 61.3%. Mean treatment-adherence prevalence was 84.75% (20.34±3.37 measured on 24-point scale). Social/Environmental factors correlated positively with treatment -adherence (r=0.165; p<0.01). Enabling factors with OR=1.44 (95% CI=1.08-1.92, p=0.013) predicted treatment-adherence more significantly than reinforcing factors for participants in this study.

Conclusion: Patients’ level of treatment-adherence was fair. Special attention should be given to enabling and reinforcing factors during patient education through social learning and structural support, which the study identified as inadequate, to optimize treatment-adherence in DR-TB patients.

Keywords: Reinforcing, Enabling, Drug resistance, Tuberculosis, Treatment-adherenc.


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