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OJHAS Vol. 9, Issue 3:
(Jul - Sep, 2010) |
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| DOTS Compliance by Tuberculosis Patients in District Raipur (Chhattisgarh) |
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Teeku Sinha,
Assistant Professor Department
of Community Medicine, Govt. Medical College, Jagdalpur
(CG)
Tiwari S,
Demonstrator Department of
Community Medicine, Govt. Medical College, Jagdalpur
(CG) |
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Address For Correspondence |
Assistant Professor,
Department
of Community Medicine,
Govt. Medical
College,
Jagdalpur (CG)
E-mail:
teekusinha@gmail.com |
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Sinha T, Tiwari S. DOTS Compliance by Tuberculosis Patients in District Raipur (Chhattisgarh). Online J Health Allied Scs.
2010;9(3):12 |
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Submitted: Aug 9, 2010;
Accepted:
Sep 28, 2010; Published: Oct 15, 2010 |
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| Abstract: |
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Background:
Compliance to therapy is one of the important factors that affect the
outcome. Non-compliance
to self administered multi drug tuberculosis treatment regimens is an important cause of failure of initial therapy and relapse
as well as acquired drug resistance, requiring
more prolonged and expensive therapy. Objective: To know the compliance of DOTS therapy in TB patients in District
Raipur and to find out the reasons of non-compliance of DOTS therapy
among the patients. Study Design: Cross sectional observational
community based study. Study Setting: Microscopic Centers in District Raipur. Participants: 695 patients of Tuberculosis. Result:
Study revealed that 65.93% patients had complied with the DOTS therapy and
33.38% were non compliant. Conclusion:
Most of the reasons of non-Compliance can be averted by proper counseling
of target group. Hence to achieve the goal of RNTCP, proper counseling
of target group must be given top priority.
Key Words: Counseling; DOTS; Non compliance |
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Compliance to
therapy plays an important role in the outcome of the therapy.
Compliance is defined as the extent to which the patient’s behavior coincides
with medical advice. Non-compliance to self administered multi drug tuberculosis
treatment regimens is common and is the most important cause of failure of initial
therapy and relapse. Non-compliance may also result in acquired drug resistance,
requiring more prolonged and expensive therapy that is less likely to be
successful than treatment of drug susceptible tuberculosis.(1)
Directly observed treatment
short course (DOTS) is a comprehensive strategy for TB control,
based largely on Indian research and it is now recognized world wide. DOTS
is the only strategy which has proved to be effective in controlling TB
on mass scale. DOTS ensures that patients take the medicines regularly
as per directions. The Revised National Tuberculosis Control Programme (RNTCP),
based on DOTS, was
started in Raipur on 15th August, 2002. This
study was undertaken to find out the extent of compliance of DOTS therapy and to suggest
suitable measures if need arises.
The present study was a cross sectional observational community based
study, undertaken in 6 treatment units (TUs) of 15 Microscopic Centers
(MC) of Raipur district (two each - one at MC headquarters and one
at periphery in Dharsiwa, Bhatapara, Baloda bazaar, Rajim and Gariaband
and one each at District Tuberculosis Centre, MC run by an NGO in Sonadih, Medical
College Hospital, Poly Clinic in Puranibasti, and District Hospital, Raipur.
A team led by
the first author visited the homes of all registered patients
in the above mentioned TUs and collected the data on predesigned
and pretested proformas between May and October, 2006. Patients missing
drugs for more than 2 consecutive weeks were taken as non compliant. The data thus collected were checked for their completeness
and correctness and then analyzed.
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Observations and Discussion |
On analysis of
the collected data (Table 1) reveals that 34.57% patients
were from District TB Centre, Raipur, which is obvious because it is
the district headquarters centre and more people attend with expectations of extra facilities in comparison to periphery,
followed by BalodaBazar (15.13%), Dharsiwa (14.38%), Rajim(12.94%), Gariaband
(12.23%) and Bhathapara (9.35%). Table 2 indicates that 463 (65.93%) in comparison
to 232 (33.38%) patients complied as per DOTS, similar to
the finding of Mehrotra et al (67.0%)(2), Santha T et al (72%)(3) and Bhat
S et al (76.89%) (4).
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Table 1: Tuberculosis Unit
Wise Distribution of Patients Under Study |
| Tuberculosis Unit |
No. of cases |
Percentage |
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DTC Raipur |
247 |
34.57 |
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Dharsiwa |
100 |
14.38 |
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Bhathapara |
65 |
9.35 |
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Balodabazar |
108 |
15.53 |
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Rajim |
90 |
12.94 |
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Gariyabandh |
85 |
12.23 |
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Total |
695 |
100 |
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Table 2:
Distribution of Patients According to Compliance |
| Compliance |
No. of Cases |
Percentage |
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Compliance |
463 |
65.93 |
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Non Compliance |
232 |
33.38 |
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Total |
695 |
100.0 |
A total of 232 patients,
who did not consume the drugs for more than 2 consecutive
weeks were considered as non compliant. The reasons
for non compliance were classified under three heads as suggested by Bansal AK et al.(5)
On further analysis, it was observed that out of the 232 non compliant patients,
140 (60.34%) patients failed to comply simply because of lack of information
(Table 3), whereas 7.75% and 31.89% were non-compliant because of lack of motivation and different
obstacles, respectively.
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Table 3: Reasons
for Non Compliance of DOTS
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Reasons |
No. |
% |
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Lack of Information |
Fear of
adverse reaction |
47 |
20.26 |
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Felt
better and stopped treatment |
80 |
34.48 |
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Another doctor advised to stop treatment |
13 |
5.60 |
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Lack
of Motivation |
Difficult to take so many
pills |
6 |
2.59
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Postponement
till another day (due to addiction etc.) |
7 |
3.02 |
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Others
(no faith in treatment, rumors etc) |
5 |
2.16 |
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Obstacles |
Moved away from treatment
center |
36 |
15.52 |
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Timing
not convenient |
15 |
6.46 |
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Nobody to accompany to the center |
9 |
3.88 |
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Non
availability of medicine |
6 |
2.59 |
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DOTS
center far away |
4 |
1.72 |
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Attitude
of DOTS provider not Good |
4 |
1.72 |
Various reasons observed in the present study for noncompliance are
more or less similar to the findings of different studies conducted
by different authors in different parts of the country. Main reason
for noncompliance in the present study was having felt better (34.48%), similar to the
findings of Juvekar SK et al (5) at 27%. Non compliance due to fear of adverse reactions
was found in 20.26%, similar to the studies of Bhat S et al (13.20%)(4) and Juvekar SK et al
(10.0%) (6). The 3rd most common
cause of non compliance was found to be being moved away from the treatment centre (15.52%), similar to the findings of
the study of Rani SM et al (22.0%).(8)
Other reasons for noncompliance were difficulty to find time from
work to visit the centre (6.46%), difficulty to take so many pills and non
availability of medicine (2.59%) etc., similar to the findings of other studies.
It is therefore
clear that
to achieve the target of RNTCP, proper counseling of patients regarding
various aspects of the disease is a must to ensure compliance.
- Pandit N, Chaudhary SK. A study of treatment compliance in directly observed
therapy for tuberculosis. Ind J Community Medicine. 2006;31:241.
Mehrotra ML, Gautam KD, Chaube CK. Shortest possible
acceptable, effective ambulatory chemotherapy in pulmonary tuberculosis. Am Rev Respir Dis. 1981;124:239-44
Santha T
et al. Risk factors associated with default, failure and death among
tuberculosis patients treated in a DOTS programme in Tiruvallur district, South
India, 2000. The International J of Tuberculosis and Lung disease.
2002;6(9):780-788.
Bhat S, Mukherjee M et
al. Unsupervised intermittent
short course chemotherapy with intensive health education. Ind J of Tub. 1998;45:146:207.
Bansal AK, Chandorkar RK.
Immunization Status of Tribal and Non Tribal children of Raipur district, Madhya Pradesh. Tribal Health Bulletin(ICMR);1997:3(2):12-14.
Juvekar SK et al. Social and operational determinants of patient behaviour in lung
tuberculosis. Ind J of Tub. 1995;42:87-94. Available at
http://lrsitbrd.nic.in/IJTB/Year%201995/April%201995/APR1995%20d.pdf
Mohan Rani S et al. Feasibility of community DOTS providers for tuberculosis.
Ind J of Tub. 2000;47:159.
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