FACTORS INFLUENCING ADHERANCE TO TUBERCULOSIS TREATMENT

AMONG PATIENTS ATTENDING TB CLINIC IN PORT REITZ SUB-COUNTY

HOSPITAL, MOMBASA COUNTY

VERAH GESARE NYAENYA

D/UPHRIFT/20011/241

A RESEARCH DISSERTATION SUBMITED TO THE DEPARTMENT OF HEALTH

RECORDS KENYA MEDICAL TRAINING COLLEGE MSAMBWENI CAMPUS IN

PARTIAL FULFILMENT OF THE REQUIREMENT OF THE AWARD OF DIPLOMA

IN HEALTH RECORDS INFORMATION TECHNOLOGY

FEBRUARY, 2022.
 DECLARATION
This dissertation is my original work and has not been presented for a diploma in any other

institution.

Signature……………………………………. Date………………………………………………

VERAH GESARE NYAENYA

D/UPHRIFT/20011/241

i
 SUPERVISOR’S APPROVAL

The following undersigned certify that they have read and recommended the department of health

records and information for the acceptance of dissertation entitled; factors influencing adherence

to tb treatment among patients attending t clinic in port reitz sub county hospital, Mombasa county.

Internal supervisor

Signature…………………Date …………………

Ms. Okiru Beverlyne BSc HRIM

Department of Health Records and Information Management. KMTC Msambweni

External supervisor

Signature……………………Date ……………………

Mr. Omuya Dominic BSc BIT

Department of Business. KCB Bank

ii
 DEDICATION

My sincere gratitude to the God for His gift of life, knowledge, power and guidance throughout

this study, special thanks to my loving father Innocent Nyaenya and mother Conceptor Kemunto,

and my siblings for your encouragements and reminder that all is possible in God and your

financial support that made this research dissertation successful.

iii
 ACKNOWLEDGEMENT

First and foremost, I thank God for giving me strength to pursue this study. I also wish to extend

my sincere gratitude to my research tutor Mr. Muriki Kenneth for taking me through research

theory tutorials, my internal supervisors Ms. Okiru Beverlyne for Her continued efforts, guidance

and advice that has made the success dissertation and to my external supervisor Mr. Dominic

Omuya for His encouragement, and support in the course of my study.

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 TABLE OF CONTENTS

DECLARATION ............................................................................................................................. i
SUPERVISOR’S APPROVAL ...................................................................................................... ii
DEDICATION ............................................................................................................................... iii
ACKNOWLEDGEMENT ............................................................................................................. iv
TABLE OF CONTENTS ................................................................................................................ v
LIST OF TABLES ....................................................................................................................... viii
LIST OF FIGURES ....................................................................................................................... ix
DEFINITION OF TERMS ............................................................................................................ xi
ABSTRACT .................................................................................................................................. xii
CHAPTER ONE: INTRODUCTION ............................................................................................. 1
1.1 Background of the Study ................................................................................................................................. 1
1.2 Problem statement ......................................................................................................................................... 3
1.3 Justification of the study ................................................................................................................................. 4
1.4 Research Questions ........................................................................................................................................ 4
1.5 Objectives of the study ................................................................................................................................... 5
1.5.1 Broad objective ........................................................................................................................................ 5
1.5.2. Specific Objectives .................................................................................................................................. 5
1.6 Scope of the study .......................................................................................................................................... 5
CHAPTER TWO: LITERATURE REVIEW ................................................................................. 7
2.1 Awareness of tuberculosis .............................................................................................................................. 7
2.1.1 knowledge ............................................................................................................................................... 7
2.1.2 Level of Education. ................................................................................................................................... 8
2.1.3 Source of information .............................................................................................................................. 9
2.2 Follow up care system..................................................................................................................................... 9
2.2.1 Distance ................................................................................................................................................... 9
2.2.2 Guidance and counseling ....................................................................................................................... 10
2.3 Doctor-patient relationship ........................................................................................................................... 11
2.3.1 Waiting Time .......................................................................................................................................... 11
2.3.2 Attitude.................................................................................................................................................. 12
CHAPTER THREE: RESEARCH METHODOLOGY ............................................................... 13
3.1 Study Design ................................................................................................................................................. 13
3.2 Study area ..................................................................................................................................................... 13
3.3. Target Population ........................................................................................................................................ 13
3.3.1 Inclusion criteria..................................................................................................................................... 13

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 3.3.2 Exclusion criteria .................................................................................................................................... 13
3.4 Variables ....................................................................................................................................................... 14
3.4.1 Dependent variables .............................................................................................................................. 14
3.4.2 Independent variables............................................................................................................................ 14
3.5 Sampling technique ...................................................................................................................................... 14
3.6 Sample Size ................................................................................................................................................... 14
3.7 Data Collection Instruments .......................................................................................................................... 15
3.8 Data collection process ................................................................................................................................. 15
3.9 Pretesting ..................................................................................................................................................... 15
3.10 validity ........................................................................................................................................................ 16
3.11 Reliability .................................................................................................................................................... 16
3.12 Data Analysis .............................................................................................................................................. 16
3.13 Ethical consideration ................................................................................................................................... 16
CHAPTER FOUR: FINDINGS, ANALYSIS AND PRESENTATION ...................................... 17
4.0 Demographic characteristics of patients ....................................................................................................... 17
4.1 Awareness .................................................................................................................................................... 18
4.1.1 Respondent’s response on level of education ........................................................................................ 18
4.1.2 Knowledge about TB .............................................................................................................................. 19
4.1.3 Source of information ............................................................................................................................ 20
4.2 Follow-up care system .................................................................................................................................. 20
4.2.1 Respondent’s response on distance ....................................................................................................... 20
4.2.2 Counselling and Guidance ...................................................................................................................... 22
4.3 Doctor-patient Relationship .......................................................................................................................... 22
4.3.1 staff’s Attitude ....................................................................................................................................... 22
4.3.2 Waiting Time .......................................................................................................................................... 23
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION .................... 24
5.1 Discussion ..................................................................................................................................................... 24
5.1.1 Awareness about tuberculosis treatment ............................................................................................... 24
5.1.2 Follow up care system ............................................................................................................................ 25
5.1.3 Doctor patient relationship .................................................................................................................... 25
5.2 Conclusion .................................................................................................................................................... 26
5.3 Recommendation ......................................................................................................................................... 27
5.4 Further research ........................................................................................................................................... 27
REFERENCES ............................................................................................................................. 28
INTERVIEW SCHEDULE .......................................................................................................... 31
APENDIX I: REASERCH PERMIT ............................................................................................ 36
APPENDIX II: WORK PLAN ..................................................................................................... 37

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APPENDIX III: BUDGET ........................................................................................................... 39
APPENDIX IV: MAP ................................................................................................................... 40

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 LIST OF TABLES

Table 4.1 Respondents demographic information.................................................................................................... 17

Table 4.2 Respondent’s knowledge on tuberculosis ................................................................................................ 19

Table 4.3 Respondents response on hospital distance .............................................................................................. 20

Table 4.4 Respondents response on doctors’ encouragement .................................................................................. 21

Table 4.5 Respondents response on medical providers ............................................................................................ 22

Table 4.6 Respondents response on waiting time .................................................................................................... 23

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 LIST OF FIGURES

Figure 4.1 Respondents education level .................................................................................................................. 18

Figure 4.3 Source of information about TB ............................................................................................................. 20

Figure 4.4 Respondents response on hospital distance cost ..................................................................................... 21

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ABBREVIATIONS

TB -Tuberculosis

WHO -World Health Organization

MTB - Mycobacterium Tuberculosis

PCT - Patient Centered Treatment

MOH -Ministry of Health

DOTs -Directly Observed Treatment

GOK -Government of Kenya

CPGH -Coast Provincial General Hospital

MDR-TB -Multi drug resistance tuberculosis

DPR -Doctor-patient relationship

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 DEFINITION OF TERMS

Adherence -The quality or process of sticking fast to TB treatment.

Awareness -Is the concern about or well-informed interest of patients towards

TB treatment.

Follow up system -It’s a further action taken after treatment or procedure is finished

Doctor-patient relationship -Its formed when a doctor attends to a patient medical need.

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 ABSTRACT

Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis (MTB), which

is transmitted through the air or by ingesting infected milk or meat. Adherence is the quality or
process of sticking fast to TB treatment, Currently, Tuberculosis has become a resurgent public
Health problem in developing countries and is the leading cause of death from any single infectious
agent. Tuberculosis (TB) is the cause of 1.8 million deaths annually, 99% of the deaths occurs in
the developing countries and among the poorest people of these countries. Treatment adherence is
a key factor for treatment success and when non adhered to, it is associated with adverse outcomes.
To determine how Awareness, follow up System and doctor-patient relationship influence
adherence of TB treatment amongst patients in Port Reitz Sub County Hospital. The study used
descriptive cross-sectional study design and simple random sampling technique was used in the
selection of the respondents. The data was collected using interview guide. The research was
pretested at Kinango Sub County hospital. 10% of the sample size was administered with the
interview schedule under supervision to stimulate formal data collection on small scale to identify
practical challenges with the regard to data collection instruments. The data collected from the
interview schedule was analyzed using Microsoft excel and presented in forms of tables and charts.
The study findings showed patients had knowledge about TB, were guided and counselled,
majority acquired information from healthcare providers and that staffs had poor attitude towards
TB patients. The study concluded that Awareness, doctors-patient relationship and follow up care
influence adherence of TB treatment. The researcher recommends that patient waiting time should
be improved and not keeping patient for long as well as efforts to change healthcare attitudes
towards patients.

xii
 CHAPTER ONE: INTRODUCTION

1.1 Background of the Study

Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis (MTB), which

is transmitted through the air or by ingesting infected milk or meat (Bovine TB) and it is both

preventable and curable (WHO, 2014). Adherence to treatment is described as the extent to which

the patients follow instructions on how the medication prescribed is to be undertaken (Osterberg

& Blaschke, 2015) People who have pulmonary tuberculosis (TB disease in the lungs) can infect

others through droplet infection when they cough, sneeze or talk (WHO, 2014). The disease is

contagious and caused by a number of airborne microorganisms including; M. Africanum, M.

Tuberculosis, and M. bovis, which are spread when infected persons cough, sneeze or speak and

susceptible persons inhale the infected air, (karumba, 2015). TB/HIV list and MDR-TB (WHO,

2013). It’s however easily preventable (BCG at birth) and treatable if medication is taken as

prescribed.

Tuberculosis is highly ranked in all the lists of countries having high per capita burden of TB,

combination of correct dosage, sufficient time and adequate drugs (Tang, Zhao, Wang &Yin,

2015). According to (WHO, 2014) there were at least 2.5 million individuals in Africa who fell ill

as a result of TB in 2016 alone which accounts for at least a quarter of the new cases in the world.

Additionally, 417,000 people in Africa died due to TB which accounts for 25% of all TB deaths

occurring in the African region. The biggest number of new TB cases occurs in Asia estimated to

be at 61 percent, followed by Africa in countries like Nigeria and South Africa with 26 percent,

making 87 percent of new TB Cases that occur amongst 30 TB endemic countries, (WHO, 2013).

1
In Chennai city of India, the prevalence of pulmonary tuberculosis is estimated to be high and

concentrated in some areas of the city, with men having higher rates than women in all ages and

those above the age of 55 have a prevalence > 1%. (Dhanaraj B et al, 2015).

In Africa, the incidence rate for tuberculosis is noted to be high mostly in the African WHO regions

with 290/100,000 per year. It appears that 9 percent of all new tuberculosis cases among adults

(aged15-49years) are attributed to HIV infection, but the proportion is much greater in the African

WHO region accounting for 3 percent and some industrialized countries, notably the US having

26 percent. The prevalence rate for co-infection equals or exceeds 5 percent with South Africa

having 2 million co infected adults. (Elizabeth L. Corbeth et al, 2015).

In Sub Saharan Africa, there are a varying proportion of patients whose defaulting rate increased

from 11.3 percent to 26.9 percent, which is attributed to distance from the hospital, experiencing

side effects, having no family support, inadequate knowledge about tuberculosis treatment, and

use of public transport, (Castel nuovo. B et al, 2014).

In East Africa, the distribution of adherence to TB treatment varies from country to country for

instance, in Tanzania, the level of adherence to anti TB treatment is estimated to be at 95 percent

among TB patients who opted for the home-based treatment under the PCT (Patient Centered

Treatment) approach (Mkopi et al, 2014). In Rwanda however, reported poor adherence to anti-

TB treatment as it was estimated to be at 10%. This was a reflection of many TB patients taking

less than 90% of the TB treatment. Poor adherence to anti TB treatment is an important

independent determinant of mortality among the TB patients (Kayigamba et al, 2015).

2
Kenya uses a standard six months treatment for TB as guided by WHO but treatment adherence

remains a major challenge to the effectiveness of treatment (WHO, 2013). Factors associated with

non-adherence can be categorized into Health- Care- System related or Individual (social

Economic or Behavioral) related (Ali & Prins, 2016). Other factors found to impact on adherence

were inadequate of knowledge about TB, smoking, distance travelled to collect medicine and

patient feeling well after few months of treatment (Kastien et al, 2016).

TB cases notified in Mombasa were 1067 with 600 occur in Port Reitz Sub County Hospital

(WHO, 2014). Out of the patients attending tuberculosis treatment in Port Reitz Sub County

Hospital, 35% of the patients default from treatment. However, this provides a perfect ground for

conducting research on factors influencing to TB treatment among patients attending Port Reitz

Sub County Hospital.

1.2 Problem statement

Treatment is availed free of charge to all TB patients and the disease being highly treatable, the

world should be TB free by 2030, among other epidemics (WHO, 2014). The national Strategic

Plan on TB in Kenya aims to reduce TB incidence by 5%, reducing mortality by 3%, and raising

treatment success to 95%, from 2014 figures, by 2018 (WHO, 2014). Adherence to TB treatment

continues to be one of the major obstacles that TB control programmed worldwide have to deal

with, especially in developing countries (Tessema, Muche, Bekele,Reissig, Emmrich &Sack,

2015). Defaulting can result in acquired drug resistance, which requires a prolonged period of

treatment with more expensive medicines than treatment for drug-susceptible TB (Caminero,

2014). A report issued in 2019 showed that the patients who attended TB treatment in Port Reitz

Sub County Hospital, 35% of TB patients defaulted (WHO, 2013) this report and statistics provide

3
a perfect ground for conducting a research on factor influencing adherence to TB treatment among

patients attending Port Reitz Sub County Hospital.

1.3 Justification of the study

Treatment adherence is a key factor for treatment success and non-adherence is associated with

adverse outcome like highly mortality. The findings of the study will act as a source of empirical

data and reference point for other scholars interested in the field, particularly those who will be

interested in furthering knowledge on the factors influencing adherence to tuberculosis treatment

among patients attending Port Reitz Sub County Hospital in Kenya. Furthermore, the results from

this study will be used to update and equip the health workers of Port Reitz Sub County Hospital

, with knowledge about factors influencing adherence to TB treatment among TB patients in order

to increase the level of adherence to TB treatment and also reduce on the number of patients lost

to follow and those who default the TB treatment, resulting in improving the general outcomes of

TB patients. The information will also offer useful information to the Ministry of Health.

1.4 Research Questions

What is the level of awareness of patient on tuberculosis treatment attending Port Reitz Sub

County Hospital?

What is the follow up care that supports patients adhering to tuberculosis treatment among

patients attending Port Reitz Sub County Hospital?

What is the doctor-patient relationship that influencing adherence to tuberculosis treatment

among patients attending Port Reitz Sub County Hospital?

4
1.5 Objectives of the study

1.5.1 Broad objective

The main objective of this study is to determine the factors that influence adherence to tuberculosis

treatment among Coast Provincial General hospital.

1.5.2. Specific Objectives

To assess the extent of knowledge of patient on tuberculosis treatment among patients

attending Port Reitz Sub County Hospital.

To examine the follow up care that supports patients adhering to tuberculosis treatment among

patients attending Port Reitz Sub County Hospital

To determine the doctor-patient relationship that influencing adherence to tuberculosis

treatment among patients attending Port Reitz Sub County Hospital

1.6 Scope of the study

The scope of the study is to determine the factors that influence adherence to tuberculosis treatment

among patients in Port Reitz Sub County Hospital. The study targeted a total population of 51 TB

patients who attends TB clinic in Port Reitz Sub County Hospital. The research was carried out

during the month of November and it took a period of 1 month.

5
Conceptual Framework

Independent variables Dependent variable

Knowledge
Awareness
education
source of information

Adherence to TB
Follow up Care treatment
Distance
Guidance and
counselling

Doctor-patient relationship
Waiting time
Attitude

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 CHAPTER TWO: LITERATURE REVIEW
INTRODUCTION

This chapter presented the literature review that was relevant to the factors that influence adherence

to tuberculosis treatment among patients in Port Reitz Sub County Hospital. It also looked at the

theories informing the study. The literature review is from other related studies that have been

carried out in Kenya and elsewhere in the world. It also has some related studies on specific

objectives of the study.

2.1 Awareness of tuberculosis

2.1.1 knowledge

Tuberculosis awareness is an effort to raise awareness of tuberculosis and reduce the disease

burden by educating people about its signs and symptoms, prevention measures and treatment

option. Most studies reviewed which directly explore the knowledge of patients towards TB are

drawn from developing countries where there is a high incidence of TB. Despite the international

attention of TB and DOTS, awareness of TB is not well established in Africa. There are still many

superstitions and cultural beliefs surrounding TB which hamper its prevention, diagnosis and

treatment (Nthaita, 2014). In a study done in Asmara Eritrea it was found that most of patients had

no knowledge about TB causation, transmission and length of treatment duration, most of patient’s

common reason for discontinuation is that they “felt cured” and did not know the standard

treatment duration should be at least 6 months (Frezghi H.G. et al, 2018). In comparison to a study

in Plateau state Nigeria, it was found that only 43.4% of patients were knowledgeable on actions

to take when missed their drugs or clinic (Luka Mangveep Ibrahim et al, 2014).

It has been reported that TB infected patients seek assistance for treatment when the disease is

well advanced and that this delay is the result of factors, such as a lack of knowledge, lack of

7
awareness of the significance of the symptoms (Bayouni et al, 2016). The fact that the disease is

transmitted by bacteria is important information not understood by many patients, and health care

providers often fail to give patients any in-depth explanation of disease causation (Bayouni et al,

2016). Patients believed that TB is a result of breaking cultural rules that demand abstinence from

sex after the death of a family member or after a woman has a spontaneous abortion. They believed

that only traditional healers could cure TB. Lack of knowledge (Edginto et al, 2014) about TB can

limit people’s ability to prevent its spread and seek treatment. People’s knowledge, attitudes, and

perceptions with respect to health in general and specific illness, such as TB, influences their

behavior (PEtrovici et al, 2015). People’s awareness and attitudes with respect to health in general

and specific illnesses, such as TB, influence their behavior (PEtrovici et al, 2015).

2.1.2 Level of Education.

Level of education affects the extent of adherence to tuberculosis treatment. Patient’s level of

education has been strongly associated with adherence to treatment of tuberculosis with studies

from Eretria proving that patients who receive health information or education from health

facilities were more adherents than those who didn’t receive education (kebede et al, 2016).

According to a study carried out in Ilorin teaching hospital in Nigeria, it was stated that there was

statistically significant association level of education and treatment adherence among the TB

patients with adherence being higher among the illiterate people. In this study it was discovered

that patients who had no formal education were most likely to miss drugs accounting for 19.4

percent out of the 280 respondents than those with formal education (Bellos et al, 2014). In another

study that was carried out in the same hospital about adherence to TB therapy which included 544

TB patients and it was observed that, the greatest number of patients that missed drugs were those

8
with no formal education accounting for 19 percent. The study also noted out that patients with

tertiary education were less likely to miss their drugs accounting for 4.3 percent as compared to

those with no formal education with a percentage of 19.4 percent (Anyaike et al, 2013).

2.1.3 Source of information

Availability of the source information about tuberculosis has influenced the adherence to

tuberculosis treatment. Healthcare providers are still patients preferred, most trusted information

source (Nthaita, 2014). Nonetheless, many patients use the internet as a source of information in

addition to their provider (Feather et al, 2016). One of the distinctive characteristics of the internet

is that it contains information that is often unverified, inaccurate, biased, or misleading and

difficult to comprehend (Langille et al, 2013).According to (Wallen et al, 2013) studies done in

Ethiopia, patients source of information included books, other patients attending TB clinics and

Mass media leaving out health care professionals who should be key informant to patient on

treatment adherence to TB.

2.2 Follow up care system

Follow up care is the act of making contact with a patient or a caregiver at later, specified date to

check on the patient’s progress since the last appointment. The distance and the counselling

influence the adherence to TB treatment.

2.2.1 Distance

In a study carried out in Argentina, it was observed that cost of transport and access to the health

care center greatly affected adherence to TB treatment among the TB patients whereby the risk for

defaulting from treatment increases as a result of economic barriers in accessing health care

facility. Most of the patients who had difficulties in accessing and meeting the transportation costs

9
were at a higher risk of non-adherence than those who never encountered such problem (Herrero

et al, 2015).

Also, other studies carried out in different parts of Argentina indicated that distance to the health

care facility and attitude of the health care workers influence the level of adherence to TB treatment

among the patients. A research study carried out in Ethiopia districts concerning the quality of

tuberculosis care and its association with treatment adherence indicated that out of the 44 health

facilities, 44 percent (18) health centers, the TB care providers were untrained and in 13 out of the

44 health facilities, daily outpatient care was not being given. The unavailability of daily TB care

at the health facility contributed to patients missing treatment, the health workers were usually

under supervised by the district TB control experts and some of them were unable to deal with the

patients minor illnesses as a result of these, TB patients were fond of missing their treatment and

out of 237 patients, 43 percent interrupted their treatment for more than 15 days and 30 percent

had at least one dose of drugs unused (Mesfin, 2012).

In a study in Nepal inconvenient opening times for TB clinics situated far from patients‟ homes

accounted for defaulting in 28% of non-compliant TB patients (Bam et al, 2015). Both studies

recommended flexible clinic opening times to accommodate patients staying at a distance, so as to

improve compliance to treatment

2.2.2 Guidance and counseling

A study from Peshawar showed good treatment outcome in TB patients who received counseling.

Counseling is significantly beneficial in improving patient knowledge and behavior in all aspect:

disease, treatment and prevention. The counsellor gives information to families of affected to act

10
as agent of change, remove stigma, common misconception and promote treatment adherence,

completion and disease prevention (PEtrovici et al, 2015).

2.3 Doctor-patient relationship

Several studies have tried to look at the relationship of the doctor and patient to their health status,

seen as important to gain a better understanding of the causes associated with adverse health

outcomes, identifying patients at risk of such adverse outcomes and subsequently developing

appropriate interventions (Berkman, 2014).

A study carried out in Thailand aimed at determining the patient factors predicting successful

treatment. Out of 1,241 patients studied, 81% with good doctor-patient relationship and knowledge

of tuberculosis were successfully treated, the argument being that these factors are associated with

better compliance to TB treatment and subsequently treatment success (Bam et al, 2015) . Several

other studies have demonstrated doctor-patient relationship of TB patients as significant predictors

of treatment compliance (Winkvist et al, 2018). Meanwhile, a Malaysian study demonstrated that,

among other factors, non-compliance was associated with poor doctor-patient relationship

(O"Boyle et al , 2013). The patient waiting time and attitude affected the doctor relationship.

2.3.1 Waiting Time

According to (Berkman, 2014),waiting time can be defined as objective evaluation of the quality

of services received against the individual expectations. In a study by (Kenagy et al, 2014),patients

spent considerable amount of time in TB clinics waiting to be seen by doctors/clinicians, due to

this delays in services there is increasing effect of waiting time one of them being non adherence

to treatment. In Ethiopia, most of TB patients in attending clinics complained about time taken to

serve them verse time taken waiting to be served has a concern, they had to wait for more than 30

11
minutes before they were seen and due to this most of them fall in trap of defaulting treatment

because they felt like they did get enough time to interact with doctors rather than having long

waiting time hence unforeseen cost implications for those who use hired means of transports and

time wasting felt among the employed (Mesfin, 2012).

2.3.2 Attitude

Attitude of health workers to patients who attend TB clinics is one of major factors promoting to

non-adherence of those patients to treatment. In a study done in Plateau State Nigeria it was found

that only 74.3% of health care workers hard good attitude toward TB seeking treatment patients.

The study included the unfriendly attitude towards TB patients was a major barrier to patient’s

adherence to treatment (Luka Mangveep Ibrahim et al, 2014).

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 CHAPTER THREE: RESEARCH METHODOLOGY

Introduction

This chapter begins by addressing the research design of the study. It goes ahead and discusses the

target population, Sample size and Sampling Procedures and instruments. A method of pretesting

is reviewed and finally discusses the methods of data collection and data analysis methods used.

3.1 Study Design

In this study a descriptive cross-sectional design was used. It allows one to collect quantitative

data, which was analyzed quantitatively using descriptive and inferential statistics (Saunders et al,

2010). Also allows to observe, describe and document aspect of a situation as it naturally occurs.

3.2 Study area

Port Reitz Sub County Hospital is based in Changamwe subcounty, Mombasa County. Its current

services include outpatient service, inpatients services, special clinic, MCH, CCC, nutrition

department laboratory, dental services, Intensive care services and bed capacity of 250 patients.

The main economic activity around Port Reitz Sub County Hospital is business trading, fishing

and tourism

3.3. Target Population

The target population consist of patients attending tuberculosis clinic at Port Reitz Sub County

Hospital at the time of study

3.3.1 Inclusion criteria

The study includes clients who are actively enrolled in TB clinic.

3.3.2 Exclusion criteria

The study exclude patient who are not willing to participate and those who were critically ill.

13
3.4 Variables

3.4.1 Dependent variables

The dependent variable was;

Adherence to TB treatment.

3.4.2 Independent variables

The independent variable was;

Extent of knowledge

Follow up care

Doctor patient relationship

3.5 Sampling technique

A simple random sampling method was used to get responses from the target population.it enables

each person to have an equal chance to participate in the study. The 51 respondents were divided

by the number of days which was 20 days, where each day 3 respondents were interviewed on

average on choosing respondents from the list randomly

3.6 Sample Size

Fisher formula was used

N=Z2 pq/d2

N=desired sample size (if the population is greater than 10,000)

Z= standard normal deviation at required confidence level (1.96)

P=proportion in target population estimated to have characteristics being measured (0.05)

D=degree of statistically significant (0.05)

Q=1-p which equals to (0.5)

N=1.96^2(0.5) (0.5) / (0.5) ^2

14
N=384

If the target population is 10,000 the required sample size will be smaller. In such case a final

estimate (nf) will be calculated using the following formula.

Nf=n/1+n/N

Nf=desired sample size

n=384

N=the estimate of the population size (60)

Nf=384/1+384/60

nf=51 respondents

3.7 Data Collection Instruments

The data was collected using primary method. The study used interview schedule to collect

primary data from the respondents. The questions contained open-ended and closed-ended

questions. The interview was used since the literacy of the patients was not known. The questions

were structured in order to obtain information on the factors that influence adherence to

tuberculosis treatment in Port Reitz Sub County Hospital.

3.8 Data collection process

The researcher asked the consent from the respondent before interviewing. The researcher asked

the questions to the respondents as the researcher filled the interview schedule.

3.9 Pretesting

The research was pretested at Kinango Sub County hospital. 10% of the sample size were

administered with the interview schedule under supervision to stimulate formal data collection on

small scale to identify practical challenges with the regard to data collection instruments.

15
3.10 validity

Validity of tools was done by HRI experts to check whether the questions are consistent with

research objectives.

3.11 Reliability

Reliability of the tools was done during data collection by asking the respondents similar questions

in two different ways.

3.12 Data Analysis

The data that was collected from the interview schedule was analyzed using Microsoft excel.

3.13 Ethical consideration

Permit to conduct research was obtained from NACOSTI, a letter of authorization was obtained

from the principal KMTC Msambweni to Port Reitz Sub County Hospital administration and

Voluntary consent to participate was sought by explaining the benefits of the study, the rights

protection and manner that the study would be conducted appropriate to them and confidentiality

was obtained.

16
 CHAPTER FOUR: FINDINGS, ANALYSIS AND PRESENTATION

This chapter presents all the finding of the study. The study was analyzed using descriptive

statistics, scientific calculator and a computer. Results were presented in form of tables, charts and

graphs. The research sought to collect data from respondents by use of interview schedule. The 51

printed interview schedules were correctly answered representing 100% response rate.

4.0 Demographic characteristics of patients

Table 4.1 Respondents demographic information

n=51

Age Frequency Percentage

18-25 7 14%

26-33 14 27%

34-50 18 35%

Above 50 12 24%

Total 51 100%

Gender

Male 31 61%

Female 20 39%

Total 51 100%

Religion

Christianity 22 44%

Muslims 29 56%

Total 51 100%

17
 Marital status

Single 15 30%

Married 26 50%

Widowed 6 12%

Divorced 4 8%

Total 51 100%

Employment status

Employed 14 27%

self employed 20 40%

Unemployed 17 33%

Totals 51 100%

4.1 Awareness

4.1.1 Respondent’s response on level of education

Figure 4.1 Respondents education level

n=51

level of education
3%

21%
primary
32%
secondary
college
44% university

18
In this figure above the most of the respondents 44% were educated up to secondary level, 32%

unto primary level,21% up to college level while the lowest was at the university level with 3% of

total respondents.

4.1.2 Knowledge about TB

Table 4.2 Respondent’s knowledge on tuberculosis

n=51

Knowledge about TB Frequency

Know Don’t know

Signs and Symptoms 39 (76%) 12 (24%)

Causes of TB 47 (92%) 4 (8%)

Length of Treatment 42 (82%) 9 (18%)

Prevention of TB 51 (100%) 0 (0%)

The table above, most of the respondents 76% knew about signs and symptoms of TB while 24%

didn’t knew,92% knew causes of TB while 8% didn’t knew what causes TB, 82% could correctly

identify that TB is cured within 6 months of adherence while 18% could not correctly identify the

length of treatment or cure, on TB prevention all respondents knew how to prevent.

19
4.1.3 Source of information

Figure 4.2 Source of information about TB

n=51

source of information
60% 57%

50%

40%

30%

20% 17%
13%
9%
10%
4%

0%
Healthcare providers fellow attending mass media internet book/magazine
patients
source of information

From the above figure, majority 57% of the respondents acquired information about TB from

healthcare wokers,17% heard from fellow TB attending patients, 13% heard from mass

media,9% form internet while 4 % acquired information on TB via reading books and magazine.

4.2 Follow-up care system

4.2.1 Respondent’s response on distance

Table 4.3 Respondents response on hospital distance

n=51

Distance to health facility respondents Percentage %

Less than 5km 40 77

20
 5-10km 8 16

11-15km 3 7

16-20km 0 0

In the table above, more than half of the respondents 77% said they travel less than 5km,16%

travelled 5-10km,7% travel 11-15km.

Figure 4.3 Respondents response on hospital distance cost

n=51

cost

2% 0%

12%

10%
walking distance
100-200
200-300

76% 300-400
more than 500

Figure above shows, 76% of the respondents walk to the facility for treatment,10% use Ksh 100-

200 to get to the hospital,12% use Ksh200-300 to get to the facility for treatment,2% use Ksh 300-

400 to get to the facility for treatment.

Table 4.4 Respondents response on doctors’ encouragement

21
4.2.2 Counselling and Guidance

n=51

Counselling and Guidance RESPONDENTS PERCENTAGE

YES 49 94.2

NO 2 3.8

Above table, 94.2% respondents said they were guided and counselled on TB adherence while

3.8% of the respondents said they did not receive any guidance or counselling.

4.3 Doctor-patient Relationship

4.3.1 staff’s Attitude

Table 4.5 Respondents response on medical providers

n=51

respondents Percentage (%)

Friendly 19 37.2

Pays time to patient 7 13.8

Unfriendly and harsh 15 29

Don’t pay time 10 19

Table above shows,52% of respondents perceived that staffs had good attitude since they were

friendly and payed time for patients’ inquiries while 48% perceived staffs to have poor attitude

22
since they were harsh and didn’t pay much attention to patients’ inquiries but only limited to

treatment.

4.3.2 Waiting Time

Table 4.6 Respondents response on waiting time

n=51

respondents percentage

Less than30 min 20 39

30 minutes -1hr 25 50

More than 1hr 6 11

Table above shows 39% said they waited less than30 minutes,50% waited for 30 minutes to 1

hour,11% said they waited for more than 1 hour.

23
 CHAPTER FIVE: DISCUSSION, CONCLUSION AND

RECOMMENDATION

This chapter addresses discussion, conclusion and recommendation as per the objective of the

study. The purpose of this study was to determine factors influencing adherence to Tuberculosis

treatment among patients in Port Reitz Sub county hospital, Mombasa county.

5.1 Discussion

5.1.1 Awareness about tuberculosis treatment

The findings show that 44% of the respondents were educated up to secondary level,32% and 3%

up to university level, these study finding agrees with another study done in Eretria proving that

patients who receive health information or from health facilities and attained higher education

level such as universities and colleges were more adherents than those who didn’t receive health

education or with primary level of education and below (kebede et al, 2016)

The study results revealed also that healthcare providers 57% were the main sources of information

where patients acquired information while 4 % acquired information about TB by reading books

and magazines. These finding disagrees with similar study done in Ethiopia, patients source of

information included books, other patients attending TB clinics and Mass media leaving out health

care professionals who should be key informant to patient on treatment adherence to TB (Wallen

et al, 2013) .

The findings also show that majority of respondents were knowledgeable about TB as 92% could

correctly identify its causes, 76% could identify the signs and symptoms of TB,82% of respondents

knew length of treatment while 90% knew how can be prevented, these results disagree with a

24
study done in Asmara Eretria where it was found that most of patients had no knowledge about

TB causation, transmission and length of treatment duration and did not know the standard

treatment duration should be at least 6 months (Frezghi H.G. et al, 2018).

5.1.2 Follow up care system

The findings of the study showed 77% of the travelled less than 5 km to collect their drugs,16%

said they travelled 5-10km to get their drugs, 7% said 11-15km. These study findings disagree

with a study in Argentina which showed that most respondents walked for longer distances of

greater than 5 Km from the treatment site were being associated with poor adherence to TB

treatment (Herrero et al, 2015).

The findings of these study also revealed that 94.2% of the respondents said the doctor encourages

the patients to take their medicines as prescribed and 3.8% said the doctor does not encourage

them. These results are similar to another study done Peshawar in that revealed that 86% of the

respondents in the study said that health workers guided and counselled them on TB adherence

(PEtrovici et al, 2015).

5.1.3 Doctor patient relationship

The findings showed the health care providers attitude influences the adherence to tuberculosis

treatment. Majority 52% of healthcare providers had poor attitude since they were harsh and didn’t

pay much attention to patients’ inquiries but only limited to treatment while 48% perceived that

staffs to have good attitude since they were friendly and payed time, these study disagrees to a

study done in Plateau State Nigeria it was found that only 74.3% of health care workers hard good

attitude toward TB seeking treatment patients (Luka Mangveep Ibrahim et al, 2014).

25
The finding also revealed that they usually wait for 30 minutes-1hour before being attended to

whenever they visit the health facility for the treatment. Majority 50% 30minutes 1 hour, 39% less

than 30 minutes and 11% more than 1 hour, these result findings conforms to another study in

Ethiopia where patients in TB clinics complained about time taken to serve them verse time taken

waiting to be served had a concern, they had to wait for more than 30 minutes before they were

seen and due to this most of them fall in trap of defaulting treatment because they felt like they

did get enough time to interact with doctors rather than having long waiting time hence unforeseen

cost implications for those who use hired means of transports and time wasting felt among the

employed (Mesfin, 2012).

5.2 Conclusion

On awareness, the study concludes that majority of tuberculosis patients were educated and had

attained up secondary level of education, most of respondents were knowledgeable at TB and their

main source of information was healthcare providers.

The conclusion made on follow up care system its concluded that majority of the patients travelled

less than 5km distance and most of them it’s a walking distance to the health facility collect their

drugs while majority had to wait for long more than 30 minutes before being severed or clerked.

The conclusion made on doctor patient relationship majority of patients agreed that the health care

provider had Poor attitude towards TB patients whenever they visit the health facility for the

treatment. The study also showed that the respondents waited for 30 minutes to 1 hour before being

attended to.

26
5.3 Recommendation

Based on the study findings, the following recommendations were made:

Intensify the health education to communities and all TB patients, particularly at the beginning of

treatment, with the reinforcement at each visit using the language locally used. The information

should be complete encompassing duration of treatment and possible side effects and how to deal

with them, in order for patients to make their own judgements on their capabilities.

County ministry of health to set-up more TB treatment centers to cut down long distance and travel

cost experienced by patients in search for medication, furthermore hospital management to ensure

that guiding and counselling sessions offered regularly to all TB patients so as to improve on

treatment compliance and clinic attendance.

Healthcare providers to be motivated to work through seminars, incentives, timely salaries and

provided with good working conditions so as to remain in good attitude mode while serving their

clients, Furthermore, patients waiting time at the TB clinic to be reduced by providing more health

care workers and early scheduling of clinics and also initiate flexible hours for tuberculosis

treatment to cater for patient’s needs.

5.4 Further research

A similar study to be done in different hospital and different geographical location as the

information maybe context specific.

A study to be conducted on how socio-demography factors influence adherence of TB treatment.

A study to be conducted to investigate how availability drugs and staffs influence TB treatment

adherence.

27
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Anyaike et al. (2013). education level on TB patient attending treatment of tuberculosis. ethiopia:

Public health.

Bam et al. (2015). compliance of TB treatment. jpak med j malaysia, 56:1-3.

Bayouni et al. (2016). lack of knowledge on Tuberculosis among patients attending tuberculosis

treatment. malaysia: med J Malaysia.

Bellos et al. (2014). Level of education on TB patients attending treatment . international journal

for tuberculosis, 8(4) 234-240.

Berkman. (2014). Doctor patient relationship on TB patient. geneva: world health organization.

Caminero. (2014). factors influencing patients from defaulting of tuberculosis treatment. mexico:

Biomedical central of public health.

Castel nuovo. B et al. (2014). factors influencing adherence to tuberculosis treatment . The

southern africa journal of epidemiology and infections, 20(1) 23-35.

Dhanaraj B et al. (2015). Prevalence of pulmonary TB. India: Biomedical center of public health.

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Edginto et al. (2014). Beliefs on tuberculosis treatment among patients . America: Am J med .

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Frezghi H.G. et al. (2018). knowledge on TB. Biomedical center journal of journal health, 4:68.

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Herrero et al. (2015). patient follow up care on TB treatment. ethiopia: plos medicine.

karumba. (2015). How TB spreads. qualitative health research, 7(521-531).

Kastien et al. (2016). knowledge factor influencing to tuberculosis treatment among patients.

communicable diseases and infection journal, 16(4)234-245.

Kayigamba et al. (2015). Factors influencing poor adherence to TB treatment amomg pulmonary

tuberculosis patients in southern. ethiopia: plos medicine.

kebede et al. (2016). level of education on TB patients attending treatment. ethiopia: BMC Public

health.

Kenagy et al. (2014). patients waiting time on treatment of TB. journal of american association,

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Langille et al. (2013). source of information on TB adherence treatment. int J Equitybhealth, 10:8.

Luka Mangveep Ibrahim et al. (2014). knowledge adherence on TB treatment and perception. Trop

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Mesfin. (2012). Defaulters ofTB. switzerland: Ethnobiol ethno med.

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Nthaita. (2014). knowledge on tuberculosis and practices among patients with tuberculosis

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Osterberg & Blaschke. (2015). Adherence to TB treatment. private practitioners and public health

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Saunders et al. (2010). descriptive and inferential statistics. geneva: qualitative health research .

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30
 INTERVIEW SCHEDULE

My name is Verah Gesare Nyaenya, a Diploma student of health records and information

technology at Msambweni medical training college. I am carrying out a research on factors

influencing adherence to TB treatment in Coast Provincial General Hospital. I would request to

interview you. Information given will be treated with utmost confidentiality. Your cooperation

will be highly appreciated.

SECTION A: DEMOGRAPHIC INFORMATION

1. What is your age

a) 18-25 ()

b) 26-33 ()

c) 34-50 ()

d) above 50 ()

2. What is your Gender?

a) male ()

b) female ()

3. What is your religion?

a) Christianity ()

b) Islamic ()

c) Hindu ()

d) non believer ()

4. what is your Marital status?

a) single ()

31
 b) married ()

c) widowed ()

d) divorced ()

5. What is your occupational status?

a) employed ()

b) self-employed ()

c) unemployed ()

SECTION B: AWARENESS ON TUBERCULOSIS

6. What level of education have you attained?

a) primary ()

b) secondary ()

c) college ()

d) university ()

7. Have you heard about TB?

a) Yes ()

b) No ()

If yes, where did you hear from?

a) Healthcare providers ()

b) Fellow attending patients ()

c) Internet ()

d) Books and magazines ()

8. Do you know causes of TB?

a) Yes ()

32
b) No ()

If yes, what are the causes?

a) Contact with infected people ()

b) Exposure to TB prone areas ()

c) Poor ventilated rooms, working conditions ()

d) Breaking taboos and culture ()

9. Does TB have treatment?

a) Yes ()

b) No ()

If yes, how long does it take?

a) 1 month

b) 3 months

c) 6 months

d) 12 months

10. Is TB preventable?

a) Yes ()

b) No ()

If yes, how can you prevent it?

a) Isolate yourself from others ()

b) Cover mouth while coughing ()

c) Complete treatment ()

d) Wash your hands after sneezing ()

33
SECTION B: FOLLOW-UP CARE SYSTEM

11. How much distance do you travel to collect your TB medicines (km)?

a) Less than 5km ()

b) 5-10 km ()

c) 11-15 km ()

d) 16-20 km ()

12. How much does it cost you to get to the health facility (Ksh)

a) Walking distance ()

b) 100-200 ()

c) 200-300 ()

d) 300-400 ()

e) more than 500 ()

13. Do your doctor always encourage you to take the medicine as prescribed without skipping

a) Yes ()

b) no ()

14. If yes how many times………….

15. Did the doctor issue you any TB card that shows for your check up?

a) Yes ()

b) no ()

34
SECTION D: DOCTOR PATIENT RELATIONSHIP

16. How do you find the health care provider when you visit the hospital?

a) Friendly ()

b) Pays time for inquires ()

c) harsh ()

d) Less attention too patients ()

17. How long do you usually wait before attended to?

a) Less than 30 mins ()

b) 30 mins -1 hr ()

c) more than 1 hr ()

THANK YOU

35
APENDIX I: REASERCH PERMIT

36
APPENDIX II: NACOSTI LETTER

37
 REPORTING DATA DATA PROPOSAL TOPIC MONTH

YEAR
AND ANALYSIS COLLECTION WRITING IDENTIFI

DESERTATI CATION

ON JAN 2021

FEB

MAR

APR

MAY

38
JUN

JUL

AUG
APPENDIX III: WORK PLAN

SEP

OCT

NOV

DEC
2022

JAN
 APPENDIX IV: BUDGET

ITEM QUANTITY COST@ TOTAL

Pens 4 20 80

Pencils 5 20 100

Full scalps 1 realm 500 500

Ruler 1 30 30

Rubber 1 20 20

Transport 3000 3000

Printing questionnaire 78 10 780

Photocopy/printing 2 500 1000

Binding 2 100 200

Meals 100 14 days 1400

Flash disk 4gb 1000 1000

Community guider 14 days 1000 14000

Miscellaneous 2000 2000

Total =24,110/-

39
APPENDIX V: MAP

40
41