Compliance to directly observed treatment short course chemotherapy (DOTS) among the pulmonary tuberculosis patients in Kathmandu District of Nepal.

Thesis Report.

ABSTRACT:

Introduction : Tuberculosis (TB) remains a world-wide public health problem despite of the fact that the causative organism was discovered more than 100 years ago, 90 years of vaccination status and 60 years of chemotherapy. Compliance to TB treatment has been shown to reduce mortality, relapse and treatment failure. The greatest concern for poor compliance to TB treatment is emergence of drug resistance, which requires longer and more complex regimens with poor outcomes. The objective of this study is to study the various aspects of compliance to directly observed treatment short course chemotherapy (DOTS) for the treatment of tuberculosis in Kathmandu District.

Methods: A cross sectional study was carried out using structured interview schedule. The study has been carried out in 18 DOTS clinic of Kathmandu District. PTB patients who registered for DOTS therapy in those DOTS clinics during the period of April 2017 to October 2017 were included in the study.

Results: Majority of the study respondents (80%) was in the age group of 15 - 35 years, which is also the productive age group. The present study shows that 92% of study respondents were compliant to the DOTS chemotherapy. The traditional risk factors for non compliance like socio-demographic factors, smoking and alcohol consumption, long travelling time, were not major hurdles for treatment compliance. The study also revealed that the compliance of DOTS was significantly higher among those who have good knowledge about various aspects of disease. Less waiting time at clinics and good knowledge of TB and its treatment were independently associated with compliance on multivariate analysis (AOR 7.85, 95%CI 1.48-41.38, P = 0.01).

Conclusions: Less waiting time at DOTS clinic and good knowledge on TB was strongly associated with improved compliance. Service accessibility along with communication skills training to the providers can increase compliance rate. In Kathmandu District, the compliance to DOTS chemotherapy was good compared to other studies. Compliance throughout the treatment needs emphasis.

Key words: Tuberculosis, Compliance, Directly Observed Therapy Short course Therapy