Management of pulmonary tuberculosis patients in an urban setting in Zambia: a patient's perspective
1 Tropical Diseases Research Centre, Biomedical Sciences Department, P. O. Box 71769, Ndola, Zambia
2 Institute of Tropical Medicine, Department of Microbiology, Mycobacteriology Unit, 2000, Antwerp, Belgium
3 Institute of Tropical Medicine, Department of Parasitology, Helminthology Unit, 2000, Antwerp, Belgium
4 Ministry of Health, National Tuberculosis and Leprosy Program, Lusaka, Zambia
5 Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
6 University of Antwerp, Department of Sociology and Research Centre for Longitudinal and Life Course Studies (CELLO), 2000, Antwerp, Belgium
7 University of Antwerp, Faculty of Biomedical, Pharmaceutical and Veterinary Sciences, Department of Biomedical Sciences, 2000, Antwerp, Belgium
BMC Public Health 2010, 10:756 doi:10.1186/1471-2458-10-756Published: 7 December 2010
Zambia continues to grapple with a high tuberculosis (TB) burden despite a long running Directly Observed Treatment Short course programme. Understanding issues that affect patient adherence to treatment programme is an important component in implementation of a successful TB control programme. We set out to investigate pulmonary TB patient's attitudes to seek health care, assess the care received from government health care centres based on TB patients' reports, and to seek associations with patient adherence to TB treatment programme.
This was a cross-sectional study of 105 respondents who had been registered as pulmonary TB patients (new and retreatment cases) in Ndola District between January 2006 and July 2007. We administered a structured questionnaire, bearing questions to obtain individual data on socio-demographics, health seeking behaviour, knowledge on TB, reported adherence to TB treatment, and health centre care received during treatment to consenting respondents.
We identified that respondents delayed to seek treatment (68%) even when knowledge of TB symptoms was high (78%) or when they suspected that they had TB (73%). Respondent adherence to taking medication was high (77%) but low adherence to submitting follow-up sputum (47%) was observed in this group. Similarly, caregivers educate their patients more often on the treatment of the disease (98%) and drug taking (100%), than on submitting sputum during treatment (53%) and its importance (54%). Respondent adherence to treatment was significantly associated with respondent's knowledge about the disease and its treatment (p < 0.0001), and with caregiver's adherence to treatment guidelines (p = 0.0027).
There is a need to emphasise the importance of submitting follow-up sputum during patient education and counselling in order to enhance patient adherence and ultimately treatment outcome.