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Background 1

Background 1. § About 1/3 of world population infected with Tuberculosis (TB) § 25% of all avoidable deaths in developing countries due to TB § In Nepal, 45% of the population is infected with TB; of whom 60% in productive age group

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Background 1

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  1. Background 1 § About 1/3 of world population infected with Tuberculosis (TB) §25% of all avoidable deaths in developing countries due to TB §In Nepal, 45% of the population is infected with TB; of whom 60% in productive age group §44,000 people develop active TB annually with 20,000 having infectious pulmonary form

  2. Background 2 §Directly Observed Treatment Short-course (DOTS) started in Nepal in 1996 and was implemented throughout the country by April 2001 §However, still in 2001/2002, 6,000-8,000 people died from TB §Under DOTS, 8 months treatment schedule is followed and anti-TB drugs are given free of charge §Non-adherence is a principal cause of treatment failure.

  3. Objective To analyse the association between socio-economic position and patients’ adherence to anti-TB treatment under DOTS

  4. Setting: §Study conducted in Kaski, a western hilly district in Nepal §TB treatment under DOTS offered by the Regional TB Center (RTC), 2 Primary Health Centers (PHCs), 8 Health Posts (HPs), 3 Sub-health Posts (SHPs), etc Population: §All sputum positive patients, whether they completed their treatment (adherents) or not (non-adherents) §From mid-July 1999 to mid-July 2001, totally 50 non-adherent and 309 adherent patients were registered Methods 1

  5. Design: §Case-control study §Cases: patients who did not complete treatment §Controls: patients who completed treatment Data collection method: §Face-to-face questionnaire based interviews Socio-economic variables: §Gender, age, marital status, literacy, occupation, living area, caste, income, living conditions, travel cost to the TBtreatment facility, and affordability of treatment Methods 2

  6. Methods 3 Analyses: §Relationship of all socio-economic risk factors with non-adherence (outcome) performed by cross-tabulation § Significance of risk (OR) of becoming non- adherent were calculated by Chi-square and Chi- square trend tests §Means calculated by independent sample t-tests § Bivariate and multivariate analyses performed to identify factors associated with non-adherence

  7. Table 1: Background characteristics of respondents

  8. Table 2: Risk of nonadherence to anti-TB treatment by socioeconomic position estimated from multivariate logistic regression analysis (N=129)

  9. Table 2: Risk of nonadherence to anti-TB treatment by socioeconomic position estimated from multivariate logistic regression analysis (N=129) (contd)

  10. Conclusions & recommendations 1 §Even in DOTS and with free drugs, low socio- economic position is an important risk factor for nonadherence , especially lack of cash in hand §Raises pertinent issues ”Are DOTS and free distribution of anti-TB drugs enough to make patient adherent towards their treatment?” §Considerations of indirect costs in addition to direct costs are important in National TB control pogrammes in poor countries

  11. Conclusions & recommendations 2 § Research on other aspects needed to get fuller understanding of the lack of success of the DOTS strategy, for example n Norms and values in local community n Health care providers’ attitudes, values and behaviour n Meaning of treatment from patients’ own perspective

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