Open Access Research article

Adherence to isoniazid preventive therapy in Indonesian children: A quantitative and qualitative investigation

Merrin E Rutherford12*, Rovina Ruslami2, Winni Maharani2, Indria Yulita3, Sarah Lovell4, Reinout Van Crevel5, Bachti Alisjahbana2 and Philip C Hill1

Author Affiliations

1 Centre for International Health, University of Otago, Dunedin, New Zealand

2 Health Research Unit, Faculty of Medicine, Universitas Padjadjaran, Building 5th Floor, JL Eijkman No. 38 Bandung, Bandung, Indonesia

3 Bandung community Lung Clinic, Bandung, Indonesia

4 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand

5 Department of Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

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BMC Research Notes 2012, 5:7  doi:10.1186/1756-0500-5-7

Published: 6 January 2012

Abstract

Background

It is recommended that young child contacts of sputum smear positive tuberculosis cases receive isoniazid preventive therapy (IPT) but reported adherence is low and risk factors for poor adherence in children are largely unknown.

Methods

We prospectively determined rates of IPT adherence in children < 5 yrs in an Indonesian lung clinic. Possible risk factors for poor adherence, defined as ≤3 months prescription collection, were calculated using logistic regression. To further investigate adherence barriers in-depth interviews were conducted with caregivers of children with good and poor adherence.

Results

Eighty-two children eligible for IPT were included, 61 (74.4%) of which had poor adherence. High transport costs (OR 3.3, 95% CI 1.1-10.2) and medication costs (OR 20.0, 95% CI 2.7-414.5) were significantly associated with poor adherence in univariate analysis. Access, medication barriers, disease and health service experience and caregiver TB and IPT knowledge and beliefs were found to be important determinants of adherence in qualitative analysis.

Conclusion

Adherence to IPT in this setting in Indonesia is extremely low and may result from a combination of financial, knowledge, health service and medication related barriers. Successful reduction of childhood TB urgently requires evidence-based interventions that address poor adherence to IPT.