THE NON-COMPLIANCE TO TUBERCULOSIS TREATMENT AMONG PATIENTS SUFFERING TUBERCULOSIS

1.1 Introduction

Tuberculosis (TB) is a primordial infectious disease that mainly affects the lungs. Mycobacterium tuberculosis is the etiological agent of TB and currently more than one- third of the world population is suffering from TB. Tuberculosis (TB) is the most prevalent infectious disease of human beings, which causes illness and large number of deaths worldwide (WHO, 2015). This contagious disease is mainly caused by the bacterium known as Mycobacterium tuberculosis. TB primarily affects the lungs, but it can also influence the central nervous system, lymphatic and circulatory system (Kumar et al., 2007; Respir, 2000; Golden et al., 2005).

The diagnosis process of active contagious TB mainly involves radiology techniques such as chest X-rays but also includes microscopic examination and microbiological culture of body fluids like multiple sputum cultures. However in case of latent TB, where the bacteria present in the body remain inactive and produce no symptoms, the diagnosis relies on the Mantoux tuberculin skin test and/or Interferon gamma release assays (IGRAs) of the blood samples (Jacob et al., 2009). Prevention of TB mainly includes screening programs and vaccination such as Bacillus Calmette Guerin (BCG) vaccine (Jacob et al., 2009).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

1.2 Background of Study

Tuberculosis is a problem of global importance among communicable diseases. It is second leading disease causing death worldwide killing nearly 2 million people each year in Nigeria. Non-compliance of patients on tuberculosis treatment in an irregular and unreliable way has greatly caused risk of treatment failure, relapse and the development of drug-resistance tuberculosis strains. There are varieties of reasons why patients fail to take their medications. The center for disease control (2008) states the following:

1. The patients compliant are that medicines must be taken with empty stomach to facilitate absorption. This can be difficult for patients to follow especially waking up an hour earlier than usual everyday just to take medicine on empty stomach.
2. Another complains is the size of tablet
3. Side-effect of the drugs can lead to patients not complying to their treatment.
4. Issues on denial, stigmatization, emotional distress, cultural and life-style factors make patients not to take their treatment.
5. Poverty, transportation, religion and attitude of health workers contribute to non-compliance of patients on tuberculosis treatment.

World Health Organization (2009) has estimated that 2 billion people have latent tuberculosis disease which has killed 1.7 million people in Nigeria. In Nigeria, 81% patients are non-compliant to treatment for more than one month before presenting at chest clinics. The patients visit traditional healers and have low level of knowledge about the disease or due to high cost of treatment, transportation and poverty. World health organization (2013) reported worldwide that some countries like South Africa, Kenya, Nigeria, Malaysia, Ghana, China, United States of America and Canada were implementing the directly observed treatment short-course strategy by the end of 2013. World health organization (2015) currently recommends a case detection rate of 70% and a treatment success rate of 85% for all tuberculosis cases. It is believed that achieving these targets will lead to a reduction in tuberculosis prevalence, incidence, transmission and drug-resistance to tuberculosis treatment.

Persons with latent TB infection do not feel sick and do not have any symptoms, but usually have a positive reaction to the tuberculin skin test. They are infected with Mycobacterium tuberculosis, but do not have active TB disease. Those with latent TB infection are not infectious and cannot spread TB infection to others. However, persons with latent TB infection may develop active TB disease at some time in the future. About 10% of infected persons will develop active TB disease at some time in their lives, but the risk is considerably higher in the first two years of infection particularly for persons whose immune systems have been weakened by HIV infection. Persons with latent TB infection should be treated in good time, in order to prevent the infection from progressing to active disease.

The end TB Strategy target is to accelerate the annual decline of TB incidence rates from 2% in 2015 to 10% per year by 2025, WHO (2016). This strategy addresses the challenges facing many countries with high tuberculosis (TB) burden including Nigeria, which remains one of the worst TB affected countries in the world, Onyedum CC (2017). Evidence suggests that the TB prevalence and mortality rates in Nigeria were previous under estimated. Adamu AL (2017). Despite being ranked the 4th TB affected country in the world in 2009, it was estimated that 590,000 new TB cases were reported in 2015.WHO (2013).

Non-compliance of patient on tuberculosis treatment is a serious problem for national tuberculosis control programs (2007) states that this case tends to have higher morbidity and mortality rate when compared to those who are not cured. They remain infectious for prolonged period of time, hence affected patient continues to transmit the disease in the community. World Health Organization (2009) has estimated that 2 billion people have latent tuberculosis disease which has killed 1.7 million people in Nigeria. In Nigeria, 81% patients are non-compliant to treatment for more than one month before presenting at chest clinics.

The patients visit traditional healers and have low level of knowledge about the disease or due to high cost of treatment, transportation and poverty. World health organization (2013)reported worldwide that some countries like South Africa, Kenya, Nigeria, Malaysia, Ghana, China, United States of America and Canada were implementing the directly- observed treatment short-course strategy by the end of 2013. World health organization 2015) currently recommends a case detection rate of 70% and a treatment success rate of 85% for all tuberculosis cases. It is believed that achieving these targets will lead to a reduction in tuberculosis prevalence, incidence, transmission and drug-resistance to tuberculosis treatment.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Non-Compliance to Tuberculosis Treatment among Patients Suffering Tuberculosis.

1.3 Statement of Problems

Investigation revealed that despite the global effort to reduce the incidence of tuberculosis worldwide through mass media, there is still non-compliance to treatment which may be due to the bulkiness of the drugs and taking the drugs on empty stomach. Noticing the incidence of tuberculosis on orthodox and other clinics motivates the researcher to carry out a research to determine the reasons for non-compliance of patients to tuberculosis treatment. TB Infection Prevention Control is one of the major strategies to prevent and control TB disease in patients and healthcare workers (HCWs) in the health care setting (Federal Ministry of Health, 2010).

However, tuberculosis transmission among HCWs, patients and families is still a threat especially to nurses who have the closest and longest contact with patients than other care givers (Lopez, 2008). In the state where the current study was conducted, there was no available official data on students infected with TB. The TB coordinator of the school clinic indicated that this was so because the TB reporting format does not include the patients’ occupation.

1.4 Aim and Objectives of Study

The aim of the study is to determine the Non-Compliance to Tuberculosis Treatment among Patients Suffering Tuberculosis. In achieving this aim, the following specific objectives were laid out as follows:

1. To ascertain the knowledge of people about tuberculosis, its causes and its effects;
2. To identify the knowledge of patients based on the importance of complying with treatment;
3. To ascertain the knowledge of people about tuberculosis, its causes and its effects of tuberculosis; and
4. To identify strategies for improvement of patients’ acceptance of care and treatment of tuberculosis.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• What are the knowledge levels of people about tuberculoses disease, its cause and its effects?
• What are the causes of patients not complying to their treatment?
• What is the people’s knowledge about the importance of complying to their treatment?
• What are the strategies for improvement of patients' acceptance of care and treatment of tuberculosis?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There are no significant factor instigating patients not complying to tuberculosis treatment
• H1: There are significant factor instigating patients not complying to tuberculosis treatment

1.7 Significance of Study

To The Client: The study will help the individual to have the knowledge on health investigation and screening in order to indicate the early signs and symptoms. It will also help the patient to know the importance of treatment given to them.

To the Family: It will help the family members to have the knowledge on the cause & prevention of tuberculosis.

To the Community: This will educate people on the importance of good personal and environmental hygiene and also avoid over-crowding.

To the Country: It will reduce mortality and morbidity rate in the county.

To the Health Worker: It will help the health care provider to have adequate knowledge on the management and treatment of the patient.

1.8 Scope of the Study

The scope of the research is focused on the Non-Compliance to Tuberculosis Treatment among Patients Suffering Tuberculosis using Imo State University Teaching Hospital, Orlu, Local Government Area as a case study.

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

1.10 Definition of Terms

Tuberculosis (TB): It is a common and often deadly infectious disease caused by various strains of Mycobacteria, usually Mycobacterium tuberculosis in humans.