Determinants of adherence to anti-tuberculosis treatment among paediatric patients in urban Kenya
Background Tuberculosis is an infectious bacterial infection caused by Mycobacterium tuberculosis. It remains a major cause of morbidity and mortality worldwide and is the most common cause of death from a single infectious disease particularly in children. The management of TB involves the use of multi-drug regimens for a period of six months. Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment taking behavior. Adherence to anti-tuberculosis medication is extremely important if the treatment for TB is to be successful. Objective To determine the rate of patient adherence to anti-tuberculosis treatment and to determine the factors which affect adherence to treatment in TB paediatric patients. Method This was a hospital based cross sectional study which was carried out at the Kenyatta National Hospital (KNH) TB clinic. The convenient sampling technique was used to sample 55 caregivers of children aged 0 to 14 years who met the inclusion criteria. The sampled caregivers were interviewed using a structured questionnaire. After the interview the patients were requested to provide a urine sample which was tested for the presence of INH or its metabolites using TaxoINH urine strips to verify adherence to anti-tuberculosis medication. Results The rate of adherence to anti-TB medication as determined by the INH urine test strips was 91.8%. Marital status, an economic and structural factor that was found to be significantly associated with adherence to medication. Among the patient/caregiver factors, administration of medicine at 24 hour intervals was significantly associated with adherence to medication. Bivariate analysis showed that patients whose caregivers were married or administered medication at 24 hour intervals were more likely to adhere to medication. The ORs (95% CIs) were 4.57(1.04-20.11) and 7.70(1.85-33.33) respectively. In multivariate analysis, administration of medication at 24 hour intervals was significantly associated with adherence to medication (OR: 6.47; 95% CI 1.44-29.10). There was no significant association between regimen complexity factors, relationship between health care provider and patient/caregiver, pattern of healthcare delivery and adherence to medication. Conclusion The adherence rate to anti-TB medication in the study population was found to be generally high. The high rate of adherence observed was probably due to free anti-TB <;lrugs,extensive distribution of TB treatment services in various health facilities up to the com nunity level and the sustained training of health care workers to promote adherence to treatment at community level and to improve TB case management also at the community level. The marital status of the caregiver which was an economic and structural factor and administration of medication at 24 hour intervals, a patient/caregiver related factor were significantly associated with adherence to anti-TB medication. Relationship between healthcare provider and patient/caregiver, regimen complexity and pattern of health care delivery were not significantly associated with adherence to anti-TB medication.