Factors associated with compliance among tuberculosis patients in Thailand

Somrat Lertmaharit, Pirom Kamol-Ratankul, Holger Sawert, Suksant Jittimanee, Sirinapa Wangmanee
Journal of the Medical Association of Thailand 2005, 88: S149-56

BACKGROUND: Tuberculosis (TB) is a major health problem in developing countries. There are so many factors which influence the cure rate and one of them is compliance. However in developing countries like Thailand, there is little information about the factors that can predict the compliance within TB patients.

OBJECTIVES: To study the level of compliance and associated factors among tuberculosis patients in Thailand.

DESIGN: A cross-sectional descriptive study.

SETTING: Three levels of health care facilities in the 4 regions of Thailand (Zonal TB Centers, Provincial Hospitals and District Hospitals), excluding Bangkok.

PARTICIPANTS: A total of 487 adult newly diagnosed TB patients with positive sputum smear at the study location and they were interviewed by trained health personnel with structured questionnaires.

MAIN OUTCOME MEASURES: Level of compliance classified into excellent (punctuality), good (missing < or =2 consecutive weeks) and poor (missing >2 consecutive weeks). The socio-economic variables were studied as the independent variables.

RESULTS: About 70% (342 out of 487)of the TB patients were males. Mean (SD) of age was 47.2 (16.65) years and ranged from 15 to 84 years. The excellent compliance rate of the TB patients was 65.7% (95% CI: 61.5-69.6%) while good and poor compliance were 22.8% and 11.5%, respectively. Using Chi-square test of association, the finding showed that the type of treatment (DOT and SS), gender, working, experience of contacting TB patient, perception in health status, attitude, knowledge and social support were significantly associated with the compliance (p < .05). Binary logistic regression (Excellent vs. Good and Poor) were used to adjust the confounding factors. Females were more likely to have excellent compliance than males (adjusted OR = 1.87, 95% CI: 1.17-2.99, p = .009). Patients having perception of fair health status was 2.26 times more to have excellent compliance (95% CI: 1.45-3.53, p < .001).

CONCLUSION: Compliance is one of the potential factors to increase the cure rate in TB patients. Finding the significant factors will pave the way to improve the effective treatment of tuberculosis.

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