Authors : Daliso Phiri; Kingford Chimfwembe; Brian Mukuka Wiza Namfukwe; Spencer Benjamin Changwe

Volume/Issue : Volume 9 - 2024, Issue 10 - October

Google Scholar : https://tinyurl.com/yhshcs5d

Scribd : https://tinyurl.com/56p4fpyh

DOI : https://doi.org/10.38124/ijisrt/IJISRT24OCT005

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Background of the Study: Tuberculosis (TB) is the ninth leading cause of death worldwide. According to WHO at least 1.5 million people each year succumb to TB, thus making it the world's top infectious killer as well as the leading cause from a single infectious agent, ranking above HIV/AIDS. Zambia is one of the top 30 high TB burden countries. People with active TB can infect 5– 15 other people through close contact over the course of a year. TB patients with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die. Defaulting on TB medication is a major barrier to both local and global TB control. Defaulting increases, the risk of drug resistance, treatment failure, relapse and death, and may prolong infectiousness. Poor adherence to treatment means that patients remain infectious for longer and are more likely to relapse or succumb to tuberculosis. The rate of anti-TB treatment compliance, adherence and perpetual defaulting TB treatment was and is still high during the intensive phase of treatment. Most people who are called “lost to follow up” don’t have adequate information as to why they should continue and finish their TB medication.  Methodology: A qualitative, phenomenological cross-sectional research design was used. Namuseche Prison Clinic and surrounding compounds of Chipata Township in Eastern Province Zambia. A total of 141 participants was recruited through purposive sampling. In-depth interviews were conducted. The SPSS package version 23 was applied to conduct quantitative analysis. The proposal was approved by the Chreso University Ethics Clearance Committee and National Health Research Authority. Researcher ensured confidentially and voluntary participation with informed consent.  Results: The age of the respondents in this study ranged from 18 years to 50 years. Knowledge on TB related questions was very high in this study and stood at 87.3%. TB treatment default was found in 34 (32.7%) respondents and was associated with distance to the facility and transport costs, feeling unwell and the drug side effects.  Conclusion: TB treatment default was found in 34 (32.7%) respondents and was associated with distance to the facility and transport costs, feeling unwell and the drug side effects.

Keywords : Adherence, Compliance, Defaulting, Predictive.

References :

1. Ajao KO, Ogundun AO, Afolabi OT, Ojo TO, Atiba BP, Oguntuase, DO. (2014). Treatment compliance and challenges among tuberculosis patients across selected health facilities in Osun State Nigeria. African Journal of Medicine and Medical Science 2014; 43:21-28.
2. Alipanah N, Jarlsberg L, Miller C, Linh NN, Flazon D, Jaramillo E, et al. (2018). Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLOS Medicine 2018;15(7):59-64 Available at: http://www.who.int/tb/publications/Radiography_TB_factsheet.pdf.
3. Basavanthappa, T. (2014). Comprehensive Research Methodology. London: London University Press.
4. Basavanthappa, T. (2014). Comprehensive Research Methodology. London: London University Press.
5. Belay Mergya Eticha et al. (2014). Patients’ perspectives of the quality of tuberculosis treatment services in South Ethiopia, American Journal of Nursing Science. Vol. 3, No. 4, 2014, pp. 48-55. doi: 10.11648/j.ajns.20140304.12.
6. Bernard N Muture, Margaret N Keraka, Peter K Kimuu, Ephantus W Kabiru, Victor O Ombeka and Francis Oguya. Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: A case control study. doi: 10.1186/1471-2458-11-696.
7. Bhat S, Singal N, Aggarwal CS and Jain RC. (1999). Knowledge attitudes and practices of newly diagnosed sputum positive cases of pulmonary tuberculosis. Journal of Communicable Diseases. 1999; 31 (4): 247-252.
8. Chakaya JM, Kibuga D, Nganga L, Githui WA, Mansoer JR, Gakiria G, Kwamanga D, Maende J. (2002). Tuberculosis re-treatment outcomes within public service in Nairobi, Kenya. East African Medical Journal 2002, 79.
9. Chan-Yeung M, Noertjojo K, Leung CC, Chan SL, Tam CM. 2003. Prevalence and predictors of default from tuberculosis treatment in Hong Kong. Hong Kong Medical Journal 2003, 9(4):263-8.
10. Charles P. Felton National Tuberculosis Center. Adherence to Treatment for Latent Tuberculosis Infection. A Manual for Health Care Providers. 2005.
11. Chauhan M, Mehta JP, Kansagara M, Dave P, Patel M. (2016). Relationship between various social and demographic factors and its relation with treatment outcome in category II cases of tuberculosis in corporation area of Jamnagar, Gujarat, India. International Journal of Community Medicine and Public Health 2016;3(12):3353-3356.
12. Chee CBE, Boudville IC, Chan SP, Zee YK, Wang YT: Patient and disease characteristics and outcome of treatment defaulters from the Singapore. TB control unit-a one-year retrospective survey. International Journal of Tuberculosis and Lung diseases 2000, 4(6):496-503.
13. Cherkaoui I, Sabouni R, Ghali I. (2014). Treatment default amongst patients with tuberculosis in urban Morocco: predicting and explaining default and post default sputum smear and drug susceptibility results. PloS one 2014.
14. Choi H, Chung U, Muntaner C. (2016). The impact of social conditions on patient adherence to pulmonary tuberculosis treatment. The International Journal of Tuberculosis and Lung Disease 2016;20(7):948-954.
15. Comolet TM, Rakotomalala R, Rajaonarioa H. (1998). Factors determining compliance with tuberculosis treatment in urban environment, Tamatave, Madagascar. International Journal of Tuberculosis and Lung diseases 1998, 2(11):891-897.
16. Daniel OJ, Oladapo OT, Alausa OK. (2006). Default from treatment programme in Sagamu, Nigeria. Nigeria Journal of Medicine 2006, 15(1):63-7.
17. Demissie M, Kabede D. (1994). Defaulting from tuberculosis treatment at the Addis Ababa TB Centre and factors associated with it. Ethiopian Medical Journal 1994, 32(2):97-106.
18. Diagnosis and Screening of Active Tuberculosis in People Living with HIV. Geneva: WHO; 2015. Available at:
19. Dodor EA, Afenyandu GY. (2005). Factors associated with tuberculosis treatment default and completion at Effia-Nkwanta Regional Hospital in Ghana. Trans R Soc Trop Med Hygiene 2005, 99(11):827-832.
20. Dooley KE, Lahlou O, Ghali I, Knudsen J, Elmessaoudi D, Cherkaoui I, Aouad RE. Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco. BMC Public Health. 2011; 11:140. doi: 10.1186/1471-2458-11-140. - DOI - PMC - PubMed
21. Dye C, Gamett GP, Sleeman K, Williams BG. (1998). Prospects for worldwide tuberculosis control under the WHO DOTS strategy. Lancet 1998, 352: 1886-91.
22. Evaluation of TB surveillance and TB epidemiological analysis in Zambia Mission report June 6-17, 2016.
23. Finlay A F, van der Walt M, Holtz T H, Thorpe, L E, Wells C D, Weyer K. (1999–2000) Treatment outcomes of patients with multidrug resistant tuberculosis in South Africa using a standardized regimen, 1999–2000. Boston, MA: Infectious Disease Society of America, September 2004, Poster session 58, N_2101.
24. Fry RS, Khoshnood K, Vdovichenko E, Granskaya J, Sazhin V, Shpakovskaya L. (2005). Barriers to completion of tuberculosis treatment among prisoners in St. Petersburg, Russia. International Journal on Tuberculosis and Lung Diseases 2005, 9:1027-33.
25. Gelaw SM. (2016). Socioeconomic factors associated with knowledge on tuberculosis. Tuberculosis Research and treatment
26. Hong Kong Chest Service/British Medical Research Council: Controlled trial of 2, 4, and 6 months of pyrazinamide in 6-month three times weekly regimens for smear-positive pulmonary tuberculosis, including an assessment of a combined preparation of isoniazid, revamping and pyrazinamide: results at 30 months. Am Rev Respir Dis 1991, 143:700-706
27. http://www.who.int/tb/areas-of-work/laboratory/policy_statement_lam_web.pdf.
28. Jaiswal A, Singh V, Ogden JA, Porter JDH, Sharma PP, Sarin R, Arora VK, Jain RC. (2003). Adherence to tuberculosis treatment: Lessons from the urban setting of Delhi, India. Journal of Tropical Medicine and International Health 2003, 8(7):625.
29. Jakubowiak WM, Bogorodskaya EW, Borisov ES, Danilova DI, Kourbatova EK. (2007). Risk factors associated with default among new pulmonary TB patients and social support in six Russian regions. The International Journal of TB and Lung Disease 2007, 11(1):46-53. WHO: Global tuberculosis control, surveillance, planning, financing report 2008.
30. Kaona ADF, Tuba M, Siziya S, Sikaona L. An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. BMC Public Health. 2004; 4:68. [PMC free article] [PubMed] [Google Scholar]
31. Kaona FAD, Tuba M, Siziya S, Sikaona S. (2004). An assessment of factors contributing to treatment adherence and Knowledge of TB transmission among patients on TB treatment. BMC Public Health 2004, 4:68.
32. Kapata N, Chanda-Kapata P, Bates M, et al. (2013). Multidrug-resistant TB in Zambia: Review of national data from 2000 to 2011. Tropical Medicine & International Health. 2013;18(11): 1386–1391.
33. Kapata N, Chanda-Kapata P, Ngosa W, et al. (2016). The prevalence of tuberculosis in Zambia: results from the first National TB prevalence survey, 2013–2014. PLoS One. 2016;11(1):e0146392.
34. Kapata N, Chanda-Kapata P, O’Grady J, et al. (2011). Trends of Zambia’s tuberculosis burden over the past two decades. Tropical Medicine & International Health. 2011;16(11)1404–1409.
35. Kombo, D. K., and Tromp, D. A. (2007). Proposal and Thesis writing: An Introduction. Nairobi: Pauline Publications Africa.
36. Kooffreh ME, Offor JB, Ekerette EE, Udom UI. (2016). Prevalence of Tuberculosis in Calabar, Nigeria: A case study of patients attending the outpatients Department of Dr. Lawrence Henshaw Memorial Hospital, Calabar. Saudi Journal for Health Science 2016; I5(3):130-133.
37. Kothari, C. R. (2004). Research Methodology. New Delhi: New Age International.
38. Krasniqi S, Jakupi A, Daci A, Tigani B, Jupolli-Krasniqi N, Pira M, et al. (2017). Treatment adherence of patients in Kosovo. Hindawi Tuberculosis Research and Treatment.
39. Lemeshow S, Hosmer DW, Klar J, Lwanga SK. (1986). Adequacy of sample size in health studies John Wiley & Sons, WHO/HST/ESM/86, 1986, revs 1.
40. Lilian Bulage et al, The Quality of Tuberculosis Services in Health Care Centres in a Rural District in Uganda. (2014). The Providers’ and Clients’ Perspective, Hindawi Publishing Corporation Tuberculosis Research and Treatment Volume 2014, Article ID 685982, 11 pages.
41. Michael, P. S. (2012). Differences between Scientific and Artistic Approaches to Qualitative Research. Oxford: Oxford University Press.
42. Mohamed S, Shankar K., Kalifulia S. (2015). Socio-economic profile and risk factors among pulmonary tuberculosis patients in Mundurai, India: a cross-sectional study. International Journal of Research in Medical Sciences 2015;3:3490-3498.
43. Muture, B.N., Keraka, M.N., Kimuu, P.K. et al. Factors associated with default from treatment among tuberculosis patients in nairobi province, Kenya: A case control study. BMC Public Health 11, 696 (2011). https://doi.org/10.1186/1471-2458-11-696.
44. Mwaba P, Maboshe M, Chintu C, Squire B, Nyirenda S, Sunkutu R, Zumla A. The relentless spread of tuberculosis in Zambia—trends over the past 37 years 1964-2000. South African Medical Journal. 2003;93(2):149–152.
45. Nabong PT. (2017). Socio-cultural and health system factors affecting tuberculosis case detection and treatment in the upper west region of Ghana. British Medical Journal 2017;12(4):14-22
46. Moyo, S., & Mbewe, R. (2020). "Factors influencing adherence to tuberculosis treatment in Zambia." International Journal of Health Sciences, 12(4), 23-31. DOI: 10.53730/ijhs.v12n4.1792.
47. Chanda, D., & Musonda, P. (2019). "The importance of health education in tuberculosis management: A review." Journal of Community Medicine & Health Education, 9(5), 1001. DOI: 10.4172/2161-0711.10001001.
48. Munyati, S., & Bwanali, R. (2020). "Patient education and tuberculosis treatment adherence: A systematic review." Tropical Medicine and Health, 48(1), 30. DOI: 10.1186/s41182-020-00205-5.
49. Nezenega ZS, Gacho YH, Tafere TE. (2013). Patient satisfaction on tuberculosis treatment service and adherence to treatment in public health facilities of Sidama zone, South Ethiopia. BMC Health Services Research 2013;13(6):110-121.
50. Ogbo FA, Ogeleka P, Okoro A, Olusanya BO, Olusanya J, Ifegwu IK, et al. (2018). Tuberculosis disease burden and attributable risk factors in Nigeria, 1990-2016. Tropical Medicine and Health 2018;46(5):34-43.
51. Oladimeji O, Joyce TG, Lungelo M, Lehlogonolo M, Olusegun A. (2018). Patient and health system related factors impacting on tuberculosis program implementation in resource constrained settings: Experience from multi-TB facilities in Oyo state, South west of Nigeria, Mycobacterium Research and Development 2018.
52. Oliveira VL, da Cunha AJ, Alves R. (2006). Tuberculosis treatment default among Brazilian children. International Journal on Tuberculosis and Lung Diseases
53. Pablos-Méndez A, Knirsch CA, Barr RG, Lerner BH, Frieden TR: Non- adherence in tuberculosis treatment: predictors and consequences in New.
54. Pablos-Mendez A, Knirsch CA, Barr RG, Lerner BH, Frienden TRL. (1997). Nonadherence in tuberculosis treatment: Predictors and consequences in New York City. American Journal of Medicine 1997, 102:164-170.
55. Prassad R, Rizavi DM, Surya Kant and A Jain. (2001). A comparison of unsupervised treatment along with intensive health education and directly observed treatment in pulmonary tuberculosis. Indian Journal of Tuberculosis. 2001; 48 (1): 21-24.
56. Rondags A, Himawan AB, Metsemakers JF. (2014). Factors influencing non-adherence to tuberculosis treatment in Jepara, central Java, Indonesia. Southeast Asian Journal of Tropical Medicine and Public Health 2014;45:859-868.
57. Ruru Y, Matasik M, Oktavian A, Senyorita R, Mirino Y, Tarigan LH, et al. (2018). Factors associated with non-adherence during tuberculosis treatment among patients treated with DOTS strategy in Jayapura, Papua Province, Indonesia. Global Health Action 2018;11(1):151-159.
58. Rutherford ME, Hill PC, Maharani W. (2013). Risk factors for treatment default among adult tuberculosis patient. International Journal of Tuberculosis and Lung Disease 2013;17(10):1304-1309.
59. Sajith M, Thomas A, Kothia JJ, Chandrakar B, Bargaje MD. (2015). Socio-demographic characteristics of tuberculosis patients in a tertiary care hospital. International Journal of Medical and Health Research 2015;1(3):25-28.
60. Salla AMunro, Simon ALewin, Helen JSmith, Mark EEngel, Atle Fretheim, Jimmy Volmink. (2007). Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research PLoS Med. 2007, 4(7):e238, © 2007.
61. Sawsan Elbireer, David Guwatudde, Peter Mudiope, Juliet Nabbuye-Sekandi and Yukari C. (2011). Tuberculosis treatment default among HIV-TB co-infected patients in urban Uganda. Journal of Tropical Medicine and International Health. doi: 10.1111/j.1365-3156.2011.02800.
62. Shargie EB, Lindtjorn B. (2007). Determinants of treatment adherence among smear-positive tuberculosis patients in Southern Ethiopia. PLOS medicine. 2007;4:280–287. PubMed. [PMC free article] [PubMed] [Google Scholar]
63. Sumartojo E. (1993). When tuberculosis treatment fails: a social behavioural account of patient adherence. Am Rev Respir Dis 1993; 147: 1311–1320.
64. Talbot E A, Halabi S, Manchanda R, Mwansa M A, Wells C D. (2004). Knowledge, attitude, and beliefs about directly-administered antiretroviral therapy among tuberculosis patients, Botswana 2002. Int J STD AIDS 2004; 15: 282–283.
65. Tekle B, Mariam DH, Ali A. (2002). Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia. Internal Journal of Tuberculosis and Lung Diseases. 2002:573–579. [PubMed] [Google Scholar]
66. Tola HH, Azar TOL, Hojaeizadeh D, Gholamreza G. (2015). Tuberculosis treatment non-adherence and lost to follow up among tb patients with or without HIV in developing countries: A Systematic review. Iran Journal of Public Health 2015;44(1):1-11
67. Ubajaka CF, Azuike EC, Ugoji JO, Nwibo OE, Ejiofor OC, Modebe IE, et al. (2015). Adherence to drug medications amongst tuberculosis patients in a tertiary health institution in South East Nigeria. International Journal of Medicine 2015;6:399-406.
68. Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database of Syst Rev. 2007;17:CD003343. - PubMed
69. Wasonga J: Factors contributing to tuberculosis treatment defaulting among slum dwellers in Nairobi, Kenya, International congress on drug therapy in HIV. The Gardiner-Caldwell Group Ltd; 2006, 310.
70. WHO . Global tuberculosis report 2012. WHO/HTM/TB/2012,6. Geneva: Switzerland; 2012.
71. WHO. 1998. Available at: http://whqlibdoc.who.int/hq/1998/WHO_TB_98.258_(part2).pdf.
72. WHO: 2003. Adherence to long-term therapies, Evidence for Action 2003, Chapter 5(1):11-15.
73. WHO; 2014. Available at: http://www.who.int/tb/publications/ISTC_3rdEd.pdf.
74. World Health Organization (WHO). (2013). Definitions and Reporting Framework for Tuberculosis
75. World Health Organization (WHO). 2017. Chest Radiography in Tuberculosis Detection 2017. Geneva: WHO;
76. World Health Organization (WHO). Global Tuberculosis Report 2017. Geneva: WHO; 2017.
77. World Health Organization (WHO). International Standards for Tuberculosis Care 2014; 3rd edition. Geneva:
78. World Health Organization (WHO). Laboratory Services in Tuberculosis Control; Part II: Microscopy. Geneva:
79. World Health Organization (WHO). The Use of Lateral Flow Urine Lipoarabinomannan Assay (LF-LAM) for the
80. World Health Organization (WHO). Xpert MTB/RIF Implementation Manual: Technical and Operational
81. World Health Organization WHO, Report on Treating patients for multidrug-resistant tuberculosis in Somalia; 2014 access available: http://www.emro.who.int/som/somalianews/multidrug-resistant tuberculosis-somalia-treatment.html.
82. World Health Organization. (2003). Treatment of Tuberculosis Guidelines for National Program. WHO/CDS/TB/2003.313. Third edition. Geneva, Switzerland: World Health Organization; 2003.
83. World Health Organization. 2017. Global Tuberculosis Report.
84. World Health Organization. Adherence to long term therapies: evidence for action. WHO/MNC/03.01. Geneva, Switzerland: WHO, 2003.
85. World Health Organization. Prevalence of Tuberculosis report 2016. International organization based in Switzerland.
86. World vision, an impact evaluation of the world vision managed TB program, report on the evaluation of the global fund TB program in Somalia (2013).