Project Materials

THE NON-COMPLIANCE TO TUBERCULOSIS TREATMENT AMONG PATIENTS SUFFERING TUBERCULOSIS

Chapter one

INTRODUCTION

1.1 Background of the Study.

Tuberculosis is an airborne infectious illness caused by bacteria from the genus Mycobacterium. Tuberculosis (TB) primarily attacks the lungs, resulting in pulmonary tuberculosis (PTB). It can also affect regions of the body other than the lungs, resulting in extra-pulmonary tuberculosis (EPTB).

Military tuberculosis is caused by the extensive dispersion of tubercle bacilli via the bloodstream and lymphatic system. Tuberculosis was labelled a global emergency by the World Health Organisation in 1993, and it continues to be one of the leading causes of sickness and death worldwide.

Tuberculosis is both preventable and cured. One-third of the world’s population (two billion people) has tuberculosis bacterium. Every year, more than nine million people become ill with active tuberculosis, which can be transmitted to others.

Latent tuberculosis disease cannot be spread. Tuberculosis disproportionately affects people in resource-poor areas, particularly in Africa and Asia. It presents a huge problem to emerging economies because it primarily affects people at their peak working years.

Over 90% of new tuberculosis cases and fatalities occur in underdeveloped nations. In Nigeria, it is one of the disorders routinely reported to the Federal Ministry of Health through the Integrated Disease Surveillance and Response mechanism.

Both diagnosis and treatment are provided at no cost by the WHO, the government, and charitable organisations. The Global Fund to Fight Aids, Tuberculosis, and Malaria (GFATM) is a WHO organisation that supports TB control efforts.

Tuberculosis is one of the top 10 causes of hospitalisation in adults, as well as a primary source of morbidity and mortality. TB is a disease connected with poverty that almost often affects urban slum dwellers who live in overcrowded conditions. The fact that tuberculosis is a major public health issue in Nigeria cannot be overstated.

Prior to 2012, the exact burden of tuberculosis in Nigeria was unknown; however, the WHO estimated in 2007 that the incidence rate for all forms of tuberculosis was 311 per 100,000 people, the incidence of smear positive pulmonary tuberculosis was 131 per 100,000 people, and the prevalence was 546 per 100,000 people (WHO report, 2009).

These results position Nigeria fourth among the 22 high-burden countries in the world, and second in Africa. (The Federal Ministry of Health, 2015).

However, according to WHO projections for 2012, Nigeria remains one of the 22 nations that contribute 80% of the worldwide tuberculosis burden, but the estimated incidence and prevalence of tuberculosis in the country are 108/100,000 and 161/100,000 persons, respectively. (WHO, 2012).

The NTBLCP performed a national TB prevalence survey throughout the country between March and November 2012. Based on the findings of the national prevalence survey, adult tuberculosis prevalence rates per 100,000 population are estimated to be 318 (95% CI, 225-412) smear positive and 524 (95% CI, 378-670) bacteriologically proven (smear positive and/or culture positive).

According to the survey data, males had the highest prevalence of tuberculosis cases, and when broken down by age, individuals (including males and females) aged 35 to 54 have the highest frequency. The survey excluded children under the age of 15 years.

According to the survey report, the prevalence of smear-positive TB in men is greater (484, 95% CI: 333-635) than in women (198, 95% CI: 108-289).

A similar pattern was observed in the bacteriologically positive cases, with 751 (95% CI: 538-965) and 359 (95% CI: 213-505) per 100,000 males and females, respectively.

When the survey report was released in early 2014, the reported prevalence of 524 (95% CI, 378-670) cases per 100,000 population was found to be significantly higher than the previously projected prevalence for 2012, which was 161 per 100,000 population (WHO, 2013).

In 2013, with an estimated population of 174 million, TB prevalence was 570, 000 (including HIV+TB) cases (430,000-730,000), while incidence was 590,000 (340,000-880,000).

In 2013, the country’s estimated incidence and prevalence of tuberculosis were 338/100,000 (194-506) and 326/100,000 (246-418), respectively. These estimates shifted when the survey reports were released in early 2014.

Multiple-drug resistance (MDR) According to the WHO global TB report, there were an estimated 3.5% (95% confidence interval: 2.2-4.7%) of new cases and 20.5% (95% confidence interval: 13.6-27.5%) of previously treated MDRTB cases globally in 2013.

In Nigeria, the WHO reported an MDRTB prevalence of 3.1% and 10.1% among new and retreatment cases in 2012 (WHO, 2010).

The FMoH/NTP conducted the first national drug resistant TB prevalence survey in Nigeria from October 2009 to November 2010.

The prevalence of new smear positive TB cases was 2.9% (weighted 95% CI: 2.1 – 4.0%), while retreatment smear positive TB cases were 14.3% (95% CI: 10.2 – 19.3%). The survey report was published in late 2012.

In 2013, the global average for isoniazid resistance without concurrent rifampicin resistance was 9.5% (95% confidence interval: 8.0-11.0%). The global averages for new and previously treated tuberculosis cases were 8.1% (95% CI: 6.5-9.7%) and 14% (95% CI: 11.6-16.3%) (WHO, 2010).

According to the Nigerian survey report, any resistance to Isoniazid (excluding concurrent resistance to Rifampicin or any other medicine) was discovered in all cases (usually) in 139 (9.6%; 95% CI: 8.1 – 11.3% of) respondents evaluated by Line Probe Assay.

The prevalence rate for new TB cases was 7.2% (95% CI: 6.0 – 8.8%), while for retreatment TB cases it was 20.0% (95% CI: 15.2 – 25.6%) (Federal Ministry of Health, 2013).

Resistance to Rifampicin (excluding concurrent resistance to Isoniazid or any other treatment) was discovered in 115 (7.9%; 95% CI: 6.6 – 9.5%) of all cases (generally) examined by Line Probe Assay.

Stratified by treatment category, new TB cases had a prevalence rate of 4.4% (95% CI: 3.4–5.6%), while retreatment TB patients had a prevalence rate of 24.9% (95% CI: 19.6–30.9%).

Statement of the Problem

To reduce the development of medication resistance, tuberculosis treatment must include various drug combinations. Multi-drug-resistant Mycobacterium tuberculosis (MDRTB) strains, which are resistant to at least Rifampicin (RIF) and Isoniazid (INH), are becoming a serious global public health concern.

As of 2011, the WHO projected that MDRTB rates in Nigeria were 3.1% among new cases and 10% among re-treatment cases. (WHO report, 2012). The development of HIV/AIDS has raised the global incidence of tuberculosis while also complicating clinical care and laboratory detection.

The majority of victims are of reproductive age, which has a severe impact on Nigeria’s economy. Young men and women who should be contributing to economic progress are instead burdening the economy.

The nationwide DR-TB study also verifies the well-known fact that tuberculosis is prevalent among economically active adults. These groups account for around 70% of the survey respondents.

1.3 Objectives of the Study

The primary goal of this study is to identify the characteristics that influence noncompliance with tuberculosis therapy among tuberculosis patients. Specific aims include:

i. Determine the characteristics that influence noncompliance with tuberculosis treatment among tuberculosis patients.

ii. Determine the impact of noncompliance with tuberculosis therapy on patients with tuberculosis.

iii. To identify the barriers to tuberculosis control in Usiomu, Eku, Delta state.

1.4 Research Questions.

1. What factors influence tuberculosis patients’ noncompliance with their treatment?

2. Does noncompliance with tuberculosis treatment have a major impact on tuberculosis patients’ outcomes?

3. What are the obstacles confronting the TB Control Programme in Usiomu, Eku, Delta State?

1.5 Research Hypotheses.

Hypothesis I

H0: There are no significant factors impacting noncompliance with tuberculosis therapy among tuberculosis patients.

Hi: There are several factors that influence tuberculosis patients’ noncompliance with their treatment regimens.

Hypothesis II.

H0: Noncompliance with tuberculosis therapy has no substantial impact on tuberculosis patients’ outcomes.

Hi: Noncompliance with tuberculosis therapy has a substantial influence on people suffering from tuberculosis.

1.6 Significance of the Study

This study will be extremely beneficial to other researchers who want to learn more about it, and it may also be utilised by non-researchers to expand on their own research. This study adds to our understanding and may serve as a model for future research.

1.7 Scope of Study

This study aims to determine the factors that influence non-compliance with TB treatment among tuberculosis patients in Usiomu, Eku Delta State. The research study will include all patients at General Hospitals Usiomu.

The study’s data gathering will include a sample of all hospital departments. The study will include a balanced representation of male and female hospital patients.

1.8 Limitations of the Study

Respondents’ hectic schedules made it difficult for them to participate in the poll. As a result, retrieving copies of questionnaires in a timely manner proved difficult.

Furthermore, the researcher is a student and thus has limited time and resources to cover the substantial literature available in doing this research.

The information provided by the researcher may not be applicable to all research under this study, but it is limited to the selected respondents used in this survey, particularly in the location where this study is being performed.

Finally, the researcher is limited to the evidence offered by the research participants and thus unable to assess the reliability and quality of the information presented. Other constraints include:

Financial constraints: Insufficient funds tend to restrict the researcher’s efficiency in accessing relevant materials, literature, or information, as well as in data collecting (internet, questionnaire, and interview).

Time constraint: The researcher will conduct this investigation alongside other academic activities. This will reduce the amount of time spent on research.