PATTERN OF TUBERCULOSIS INFECTION AND ADHERENCE TO DIRECTLY OBSERVED TREATMENT STRATEGY AT LAGOS UNIVERSITY TEACHING HOSPITAL, NIGERIA

Abstract

Tuberculosis is one of the leading causes of morbidity in developing countries and Nigeria ranks fifth among the countries with high burden of the disease. Understanding the distribution pattern of tuberculosis infection as well as adherence to treatment guidelines could help to strengthen existing policy aimed at reducing morbidity associated with the disease. This study was carried out to assess the pattern of sputum smear–positive tuberculosis infection and adherence to Directly Observed Treatment Strategy (DOTS) at Lagos University Teaching Hospital (LUTH), Lagos. This was a retrospective cohort study involving 210 sputum smear-positive tuberculosis patients with complete data out of 226 that underwent DOTS at LUTH from January 2008 to June 2011. Variables extracted from the patients DOTS follow-up register included, socio-demographic characteristics, proximity of patients’ residence to the hospital, family support received, anatomical location of lesion, HIV status and treatment outcomes, including conversion time to smear-negative sputum. Adherence was defined as the number of days a patient took the drugs divided by the number of days expected to have taken the drugs. Patients that had >0.5 of the fraction were regarded as having adhered to treatment. Data were analysed using descriptive statistics, Chi-square and Log-rank tests at 5% level of significance. Mean age of patients was 39.1±10.4 years, 67.6% were males, 40.7% were Yoruba and 73.1% were married. Sixty-nine of the patients had ever smoked, out of which 60.7% were current smokers. The percentage of patients who had family support was 83.0%. About two-third of patients (66.2%) were HIV positive and 75.9% had pulmonary tuberculosis. The proximity of residence to the hospital was ≤25km for majority (65.7%) of the patients. About three-quarter (75.9%) of the patients adhered with DOTS. Treatment outcomes included 72.5% cured, 8.6% dead and 12.4% defaulted. Median sputum conversion time was 67 (range: 63 – 71) days. Patients who resided ≤25km to the hospital (65.7%) significantly adhered to treatment compared to those who lived >25km (31.6%). Also, patients who received family support significantly adhered to therapy (83.0%) compared to those who did not (14.6%). Median conversion time was lower among those who adhered to treatment [58 (range: 54 – 63) days] compared to those who did not [73 (range: 69 – 77) days]. Majority of smear-positive tuberculosis infected patients were males and their level of adherence was high. Family support received was identified to influence adherence. Integration of family support with directly observed treatment strategy as well as location of treatment centres close to patients residence could enhance effectiveness of the strategy.