DETERMINANTS OF RETREATMENT WITH FIRST LINE ANTI-TUBERCULOSIS DRUGS IN SMEAR POSITIVE PATIENTS

(A CASE STUDY OF ADAMAWA STATE, OCTOBER 2012 �“ JUNE 2013)

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Author

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Department of Medicine

ABSTRACT
Retreatment is indicated in tuberculosis (TB) patients if they fail or default from initial treatment or relapse after initial treatment success. TB retreatment in Nigeria grew from 2,395 in 2002 to 8,787 in 2011. Adamawa state alone from 2002 – 2012, recorded an average of 177 retreatment cases per year. Retreated patients transmit TB including potentially drug resistant-TB, waste drugs and incur extra cost to TB Control Programme. We investigated retreatment determinants in smear positive patients, age ≥15 years, taking first line anti-TB drugs (FLADs), in Adamawa state from 4th quarter 2012 to 2nd quarter 2013. Case-control study conducted. Cases, pulmonary TB (PTB) patients, on retreatment with FLADs, and with pretreatment smear positive result. Controls, PTB patients, with pretreatment smear positive result and converted to smear negative in 5th month while on the initial FLADs, and in whom there is no default, failure or relapse. Sociodemographic, knowledge and attitude, treatment adherence and disease severity factors obtained using pre-tested questionnaires through physical interview and data abstraction from TB registers. Data cleaned and analysed using Epi Info version 3.4.3 at 5% alpha level of significance and 95% confidence. Odds ratio (OR) used to compare association. Ethical clearance obtained from the state Research Ethics Committee (Ref.No S/MOH/1131/I/24). Of 243 patients studied (81 cases, 162 controls), mean age 35.2 11.7 years (cases 37.8 10.6; controls 33.9 12.0), 70.4% young adults 20 – 40 years (cases 71.6%; controls 69.8%), 69.1% males (cases 79.0%; controls 64.2%), 59.3% married (cases 56.8%; controls 60.5%), and 46.1% attained secondary education (cases 44.4%; controls 46.9%). Determinants identified– Knowledge on causative agent based on score below its mean 80.74% crude odds ratio (cOR) 1.98; 95% CI: 1.05-3.74 and attitude on measures to improving health while on anti-TB based on score below its mean 42.47% (cOR 1.77; 95% CI: 1.01, 3.08). Male gender (cOR 2.1; 95% CI: 1.13-3.92), unemployment (cOR 1.9; 95% CI: 1.09-3.30) and clinic location ≥5 km from residence (cOR 2.6; 95% CI: 1.12-6.16). Smoked till at least onset of treatment (cOR 2.5; 95% CI: 1.42-4.26), daily smoking ≥11 cigarettes (cOR 3.2; 95% CI: 1.29-7.75), alcohol consumption till at least onset of treatment (cOR 2.4; 95% CI: 1.39-4.29) and alcoholism (cOR 3.1; 95% CI: 1.19-7.92). Ever discriminated against (cOR 2.2; 95% CI: 1.17-4.16), ever missed clinic (cOR 2.3; 95% CI: 1.25-4.03), ever missed anti-TB doses (cOR 2.3; 95% CI: 1.28-4.08), TB/HIV comorbidity (cOR 1.95; 95% CI: 1.07-3.56), concurrent drug use (cOR 2.1; 95% CI: 1.17-3.74) and used of social support and adherence measures (cOR 0.46; 95% CI: 0.24-0.88). Independent predictors identified were distance ≥5 km from house to clinic adjusted odds ratio (aOR) 3.69; 95% CI: 1.38-9.90, ever smoking ≥11 cigarettes daily (aOR 3.21; 95% CI: 1.18-8.71), negative attitude on measures to improving health while on anti-TB (aOR 2.28; 95% CI: 1.15-4.52), TB/HIV comorbidity (aOR 2.49; 95% CI: 1.23-5.06) and use of social support/adherence measures (aOR 0.37; 95% CI: 0.17-0.78). The State and Local Government Areas are recommended to site clinics closer at distances of less than 5 km from homes, introduce tobacco dependence and cessation programme in clinics, closely monitor TB-HIV comorbidity, promote healthy measures to improving health while on anti-TB and reinforce social support and other adherence measures. Keywords: Tuberculosis, smear positive, retreatment, first line anti-tuberculosis drugs, determinants, factors.