ABSTRACT
Tuberculosis (TB) is a global public health problem in Nigeria, only 22 countries account for
80% of the TB burden in the world and Nigeria with estimated incidence of 311 cases per
100,000 populations occupies the fifth position among the twenty-two high TB burden countries.
The country uses the World Health Organization recommended directly observed treatment short
course (DOTS) strategy for its control. The DOTS strategy involves daily observation of the
patient swallowing their drug at least in the intensive phase of therapy. The health care workers
have strategic role to ensure accessibility of the services to patients, educate patients on
treatment including duration, prompt detection of patient who miss their daily drugs collection
and undertake tracing of the defaulter. The outcome of TB treatment is proxy indicators for the
assessments of the performance of the programme; poor treatment outcome implies a failing
control program. Adherence of the patients on the long duration of treatment is influenced by the
patient, the programme and the service providers. In plateau state, TB control using the DOTS
strategy started in 2001, the cured and default rates had remained below and above the expected
targets set by the National control programme respectively. There is lack of understanding of the
factors that determine the outcome of treatment in the state; furthermore, no study had been done
in the state on the factors that determine outcome of the TB treatment.
This study explored the factors that affect the outcome of treatment to help the control program
to plan and target intervention to specific problematic areas to improve the cure rates in the state
and to contribute to meeting the national targets for TB control in Nigeria.
We conducted cross sectional studies, using checklist and structured questionnaires to extract
information on patients' clinical, socio-demographic characteristics and knowledge on TB and
their association with the outcome of treatment. Self administered questionnaire was used to
extract information from the health workers on their demographic characteristic, trainings and
knowledge of TB control services including patients' education and prevention of defaulting
from treatment. We conducted focus group discussion with TB patients and health workers. We
performed, univariate, bivariate and multivariate analysis using epiInfo software.
Of the 378 patients interviewed, 229 (60.6%) were male; their mean age was 37.6 �13.5 years.
Seventy-one (18.8%) had interrupted their treatment. Unfavorable treatment outcome was
associated with Interruption of treatment (OR 81.96; CI 95%: 10.61 - 633.03), lack of
knowledge of duration of treatment (AOR 18.48; CI 95%: 1.82 - 187.18), cigarette smoking
(AOR 23.89; CI 95%: 2.40 - 237.28) and distance > 5 km from TB treatment site (AOR 18.27;
CI 95%: 1.82 - 187.18). The patients identified long distance and transport cost to TB treatment
sites, daily clinic visit and unfriendly attitude of the health workers as the major barriers to
adherence to TB treatment, additionally, the health care workers identified lack of training on TB
control services leading to poor education of the TB patients and their unfriendly attitudes
towards the patients as the barriers to adherence to treatment by the patients.
This study revealed that lack of knowledge of the patients on the disease and duration of
treatment due to poor education, living far from the TB treatment site, history of smoking of
cigarette and unfriendly attitude of the health workers towards the patient as the factors
associated with unfavorable outcome of TB treatment in Plateau state. These findings suggest
that improving the knowledge of the patients on the duration of treatment, reducing their
distances to health facilities and smoking cessation among TB patients will improve the
outcomes of TB treatments in the state.