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International Digital Organization for Scientific Research ISSN: 2579-0781
IDOSR JOURNAL OF EXPERIMENTAL SCIENCES 9(2) 29-43, 2023.
https://doi.org/10.59298/IDOSR/JES/101.2.7002
Munyambabazi, Lilian
ABSTRACT
Tuberculosis (TB) is one of the biggest public health problem and now ranks alongside
Human Immunodeficiency Virus (HIV) as the world’s leading infectious cause of death.
Globally, patient compliance with anti-TB therapy estimated as low as 40% in developing
countries, remains the principle cause of treatment failure. The aim of this study was to
establish the factors contributing to treatment default by Tuberculosis patients at ART clinic
in Ishaka Adventist Hospital, Bushenyi District. A cross-sectional and descriptive study which
employed both qualitative and quantitative approach of data collection were used. The study
was conducted in ART clinic at Ishaka Adventist Hospital, Bushenyi District and it took a
period of four weeks. A purposive sampling technique was used to select the study
participants. Results showed that out of 38 study participants, majority 26 (68%) were of age
30 years and above. A large proportion 24 (63%) of the participants were unemployed
compared to the least 14 (37%) who were employed. Majority 21 (55%) travel at a distance of
10km and above to get TB treatment. Out of 38 participants, majority 26 (68%) did not
informed the family or friends when they were on TB treatment. Of 26 participants 16 (61.5%)
had fear of being isolated and 2 (7.7%) were other reason of no support. A large proportion
of participants rated the attitude of staff who attended to them at the health facility to be
unfriendly with 21 (55%) while very few 6 (16%) were rude. The ministry should ensure
availability of and access to resources for strengthening systems for delivery of quality
tuberculosis treatment, prevention and control.
Keywords: treatment, default, tuberculosis, ART, Uganda
INTRODUCTION
Tuberculosis (TB) is one of the biggest times higher than that in the general
public health problem and now ranks population [38]. Besides well-known risk
alongside Human Immunodeficiency Virus factors, the most vital unresolved
(HIV) as the world’s leading infectious challenge in TB control is the treatment
cause of death [1-19]. Tuberculosis is an completion and studies now found that
infectious disease caused by Treatment default and resistance to anti-
Mycobacterium tuberculosis [20]. The TB drugs emerged as a vital obstacle in
disease primarily affects lungs and causes the control of TB disease [39].
Pulmonary Tuberculosis (PTB) and also Globally, patient compliance with anti-TB
affect bones and joints, meninges, skin therapy had an estimate of as low as 40%
and other tissues of the body [21-37]. in developing countries which remains
According to World Health Organization the major principle cause of treatment
2013 report, people who have PTB can failure much as the World Health
infect others through droplets infection Organization recommended at least 90%
when they cough, sneeze or talk yet the cure rate of all diagnosed TB cases [40].
prevalence of this TB among close contact Despite the World Health Organization
of infectious patients can be about 2.5 expected recommendation on cure rate,
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Zumla and his colleagues found that the had a TB default rate of 11% with a
main barrier for achieving this desired TB treatment success rate of 70% among
treatment success rate is the high smear positive patients and clinically
treatment default rate of 10% in the 2008 diagnosed TB of 19% [44]. In 2010 to 2011,
to 11.9% in 2010 [41]. about 29% of TB patients registered at
As with most African countries especially Infectious Diseases Institute clinic
South Africa, the directly observed therapy defaulted from treatment (data
short-course (DOTS) strategy is the unpublished), for reasons not well known
mainstay of TB control. The Plan entails an particularly in Western region which had
ambitious drive to diagnose and bigger number of TB patients [45].
successfully treat at least 90% of all However, in Ishaka Adventist Hospital
noticed TB cases however, excessive verbal report showed that the growth of
default rates constrain the successful this assumption has been halted by
treatment of these patients [42]. From discovery of the phenomenon of treatment
2003 to 2011, patient default rates among default. Despite this mystified situation
new smear-positive TB cases remained this prompted investigation which focuses
higher than the less than 5% national to find out the factors contributing to
target, fluctuating between 6.1% and 11.2% treatment default by Tuberculosis patients
[43]. at ART clinic in Ishaka Adventist Hospital,
In East African countries, The World Health Bushenyi District.
Organization report showed that Uganda
METHODOLOGY
Study Design and Rationale Z2 p q
𝑛 = ( 2 ).
A cross-sectional and descriptive study 𝑑
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department in Ishaka Adventist Hospital, from available options while the open-
Bushenyi District were 42 in year 2017 ended questions to allow them express
(IAH GOPD, 2017). their own ideas in their own words.
𝑛 384 The use of the questionnaire was
𝑛𝑓 = ( 𝑛) ; 𝑛𝑓 = ( ); 𝑛𝑓 considered because it enabled the
1+ 384
𝑁 1+
42 researcher ensure privacy and
= 38 respondents confidentiality as the respondents were
Where; nf was sample size for N, filling them independently.
population of Patients diagnosed with Data Collection Procedures
Tuberculosis attending treatment at ART The self-administered questionnaires were
clinic and General Outpatient department used to conduct face to face interviews
in Ishaka Adventist Hospital, Bushenyi with one respondent at a time to ensure
District. privacy. Data collection took a period of
four weeks. Data would be collected in
Therefore, the sample size, n =38 morning from 9:00 am till mid-day. Each
respondents (Patients diagnosed with study respondent were requested to fill
Tuberculosis attending treatment at ART the questionnaire in English with the help
clinic and General Outpatient department of Researcher for those who did not
in Ishaka Adventist Hospital, Bushenyi understand English language. The
District). respondent would be thank for the
Sampling Procedure cooperation and participation in the study.
The researcher considered a purposive Data Analysis and Presentation
sampling technique to select the study The researcher would first tallied the
participants. This technique was chosen results manually then entered the
because of its suitability in studying information into the computer using using
situation where subjects with the required Microsoft excel/word 2013 and computer
characteristics happen to be in relatively software program Statistical Package for
small numbers. Social Sciences (SPSS version 16.0). The
Eligibility Criteria data analyzed were presented in the form
Inclusion Criteria of tables, pie charts, graphs and frequency
The study considered only Patients distribution tables which formed the basis
diagnosed with Tuberculosis attending for discussion and conclusion.
treatment at ART clinic and General Ethical Considerations
outpatient department in Ishaka Adventist Following the ethical approval of this
Hospital, Bushenyi District who could study, a letter of introduction was
consent voluntarily to take part in the obtained from Kampala International
study during the time of interview. University-Western Campus, School of
Exclusion Criteria Nursing sciences research committee. The
The study did not consider any Patients letter was taken to the administration of
diagnosed with Tuberculosis attending Ishaka Adventist Hospital and the in
treatment at ART clinic and General charge ART clinic for permission to carry
outpatient department in Ishaka Adventist out the study. The purpose of the study
Hospital, Bushenyi District who could not were explained to the respondents for
consent voluntarily to take part in the better understanding of the study. Verbal
study during the time of interview. and written consents were sought from
Research Instruments respondents by explaining and reading the
The questionnaire was made up of both purpose of study. Client’s rights, privacy
close and open-ended questions written in and confidentiality were respected and the
English. The close ended questions were information handle were confidential.
used to enable the respondents choose
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RESULTS
Table 1: Show demographic information of the study participants
Description Variables Frequency (n) Percentage / (%)
Age range Less than 30 years 12 32
30 years and above 26 68
Total 38 100
Sex Male 24 63
Female 14 37
Total 38 100
Tribe Banyankole 24 63
Bakiga 12 32
Others include Batooro 2 5
Total 38 100
Marital status Single 10 26
Married 14 37
Widow/widower 8 21
Others; separated, divorced 6 16
Total 38 100
Education level Never gone to school 16 42
Primary 17 45
Secondary 3 8
University 2 5
Total 38 100
Employment Unemployed 24 63
status Employed 14 37
Total 38 100
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KEY
45%
Less than 10km
55%
10km and above
21
Response
Yes 79
0 10 20 30 40 50 60 70 80 90 Series1
Frequency
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Table 3: Showing duration a person diagnosed with TB take his/her take treatment till
completion and reasons why less than 6 months
Description Variable Frequency (n) Percentage (%)
Duration a person Less than 6 months 16 42.1
diagnosed with TB take 6 months or more 4 10.5
his/her treatment till Till health worker stop you 18 47.4
completion
Total 38 100.0
80
63
60
Frequency
37
40
20 Series1
0
Yes No
Reponsese
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Table 4: Showing whether participant informed the family or friends when they were on
TB treatment and reasons why they did not
Description Response Frequency (n) Percentage (%)
Whether participant Yes 12 32
informed family or friends No 26 68
when on TB treatment Total 38 100
8%
18% Key
Yes
No
74% No response
Total 28 100.0
Source: field data
On the table 5 above results indicates that,
out of 28 participants who stop taking TB
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40
29
30 Series1
20
10
0
Day time Night time
Time of TB clinic opening
Figure 5 above, out of 38 participants a time for TB clinic to open during day time
large proportion 27 (71%) most convenient while few 11 (29%) prefer night time.
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or friends when they were on TB treatment hours or more. These findings correlate
while minority 12 (32%) informed the with Ronald et al. [39], result that 7 (16.7%)
family or friends. This finding did not of the respondents spend less than 1 hour
support Ndimande [47], who reported that for monthly refill of TB treatment and 13
compliance to TB treatment should be (31.0%) spend 3 hours and above.
improved by promoting TB treatment More than average of the study
literacy among those with the disease, participants with 26 (68%) said anti-TB
their families and communities, through drugs are always available at the clinic
empowering the healthcare provider with meanwhile only 12 (32%) said sometimes
knowledge of TB [47,48, 49, 50]. not available. Similarly the study was in
Out of 26 participants’ reason why line with Ronald and his colleagues that 9
participants did not inform their family or (21.4%) as uncaring despite 100% of the
friends when they were on TB treatment, interviewed respondents agreed that TB
16 (61.5%) said they had fear of being drugs were always available on their
isolated and 2 (7.7%) were other reason of scheduled visits [39]. A large proportion
no support. This disagreed with Elbireer et of participants rated the attitude of staff
al. [45], result that having a family member who attend to them at the health facility
to remind patient to take their medicine that they were unfriendly with 21 (55%)
and disclosure status to family members compared to very few 6 (16%) who said
about having TB during TB treatment were they were rude. The findings disagreed
not associated with defaulting. with Ronald et al. (2016), results found 12
Nevertheless, majority 28 (74%) did not (28.6%) of the respondents viewed health
complete TB treatment meanwhile care workers as friendly during
minority 3 (8%) completed TB treatment. In treatment, 7 (16.7%) as empathetic, 14
this finding failure to adhere to principles (33.3%) as rude. The results further
of TB control causes the development of disagreed with Kudakwashe [47]), who
almost all the Drug Resistance-TB (DR-TB), found out that more than 50% of those who
and poor or non-compliance to TB ranked the attitude as friendly to very
treatment is the main predisposing factor friendly were non-compliant.
for an individual to develop DR-TB. It Nevertheless, of 38 participants result
correlates to Lalloo [48], study results. The showed that a large proportion 20 (53%) of
results revealed that out of 28 participants the participant did not receive counseling
who stop taking TB treatment their reasons on anti-TB treatment from the health
why they stopped taking TB treatment workers while very few 8 (21%) said
were feeling well with 16 (57.1%) sometimes they receive counseling. The
meanwhile only 1 (3.6%) was taking results coincided with Ronald et al. (2016),
treatment. The finding was in line with the report indicated that 7 (16.7%) of the
results by Slama [46]. respondents were only counseled during
According to the study findings above, out first visit for treatment, 17 (40.5%) were
of 38 participants a large proportion 27 counseled on each visit, 13 (31%) were
(71%) revealed that most convenient time counseled once a while and 5 (11.9%) were
for TB clinic should open during day time never counseled. This could be the
while few 11 (29%) prefer night time. Many reasons why majority 28 (74%) of the study
patients may develop stigmatization participants said health worker do not give
amongst misinformed communities. chance to patients to ask about TB
According to the majority 22 (57.9%) spend treatment while minority 10 (26%) health
1-2 hours waiting for TB treatment from TB workers give chance to patients to ask.
clinic while minority 4 (10.5%) spend 3
CONCLUSION
Almost all the study participants had qualification, majority were age of 30 and
attained Primary education as their current above of whom most were male who were
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