Factors Associated with Adherence to Tuberculosis Treatment among Patients in Mwingi East, Kitui County, Kenya

Abstract

Tuberculosis (TB) is the leading cause of death globally due to a single infectious agent (CDC, 2021). In 2020, an estimated 10 million people fell ill with TB worldwide (WHO, 2021). Of the 10 million, approximately 3million were “missed” by health systems and did not get the care they need, allowing the disease to continue being transmitted where 1·6 million people died from tuberculosis in 2021 compared with 1·5 million in 2020. In Sub-Saharan Africa, approximately 1.4million people were diagnosed with TB in 2019, but epidemiologists estimated that 1 million more had TB but were neither diagnosed nor treated. According to WHO estimates, 139,000 people have newly developed TB in Kenya in 2020, of which 72,943 got notified. Kenya is included in the list for the top 30 TB/HIV high burden countries, Children accounting for 8% of all cases, and many also suffer from TB-HIV co-infection. This study was designed to assess factors associated with adherence to TB treatment among patients attending TB clinic. The study adopted a descriptive cross sectional design which utilized quantitative techniques. A method of data collection was by use of a structured questionnaire. Data was analyzed using SPSS version 20.0 software with the p value for statistical significance set at p<0.05. Relationship of variables was done using logistic regression analysis. Results were presented in tables, charts and graphs. About half (50.3%) of the respondents were female. More than half (57.3%) of the patients were aged between 30-45 years. More than one-third (35.9%) of the respondents were married, half (50.3%) of the patients had tertiary education. Christians comprised the majority (75.9%) of the respondents. Regarding occupation, about 41.4% of the respondents were business men/women with about half (50.3%) earning above Ksh. 15000. Almost half (49%) were reported to have been offered TB treatment services while 37.9%, 5.5% and 7.6% were only offered with diagnostic services, regarding level of adherence about 26.8% were diagnosed with TB five months ago followedby21.8% and14.1% who mentioned they were diagnosed with TB two and four months ago respectively. Age (p = 0.009) and Primary occupation (p = 0.026) were the only socio- demographic and economic factors that had significant influence on adherence to TB treatment. Reasons identified by respondents for failure to visit TB clinics were lack of transport (27.8%) and tiredness. In a regression analysis, distance (p=0.002) and means of transport (p=0.010) to a health facility were factors significantly associated with adherence to TB treatment. This study shows that higher socio-demographic & economic status affecting adherence was factors such as age, primary occupation of the patients and facility related factors which included distance to health facility and means of transport. Improvement on treatment adherence, comprehensive health education, and improvement on social support mechanisms.