FAMILY SUPPORT AS A PREDICTOR OF DRUG ADHERENCE AMONG TUBERCULOSIS (TB) PATIENTS IN LAGOS (Chapter 1-5)

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CHAPTER ONE
INTRODUCTION

1.1 Background to the Study
Tuberculosis (TB) is one of the leading communicable diseases among the ten causes of global mortality (Borgdoff, 2010). It is caused by tubercle bacillus, known as mycobacterium tuberculosis, whose host is human (World Health Organization, 2005). One-third of the world’s population is infected, while 8 million new cases emerge annually (Dey, Mishra, Hansen & Kafle 2005). About 5000 persons are infected per day, out of which 95% are from developing countries. The highest mortality rate is recorded in the African region (WHO, 2004). Nigeria ranks 10th among the 22 high-burden TB countries in the world. WHO estimates that 210,000 new cases of all forms of TB occurred in the country in 2010, equivalent to 133/100,000 population.

Tuberculosis (TB) has been declared a global public health emergency by the World health Organization (WHO, 2006). The disease causes significant mortality and morbidity globally. TB kills more people than any other single infectious agent and death from TB comprises 26% of all avoidable deaths in developing countries (WHO, 2007). Besides well-known risk factors, the most important unresolved challenges in TB control are the treatment completion. Treatment will only be effective of the patients completes the regimen which includes a combination of drugs recommended by the physicians. Poor adherence and adherence contributes to the assessing of the TB situation by increasing incidence and initiating drug resistance.

Drug adherence is defined as the extent to which a person’s behaviour (in terms of taking medications, following diets, or executing life style changes) coincides with medical or health advice (Belbert, 2005). He further stated that adherence assumes collaboration between the patient and the health care provider regarding the patient’s health care and health related decision. People who are prescribed self-administered medications. Tuberculosis treatment is difficult and requires long courses of multiple antibiotics. Non adherence to anti TB’ drugs has emerged as an important obstacle in the control of the diseases. World wise patient adherence with anti-TB therapy with an estimate of as low as 40% in developing countries remains the principal cause of treatment failure (Fox, 2008).

Tuberculosis patients have not only medical also social problems related to their illness which may influence their motivation for the completion of treatment. Most TB patients have poor motivation al status and live in crowded environments. They face joblessness and negative attitudes from their neighbors and relatives (Karyadi, 2006). Family support appears to protect people in crisis from a wide range of health problems including arthritis, tuberculosis, cancer, depression and so on. Loss of supportive family relationships can increase the risk of mortality and morbidity (Kumento, 2009). As the treatment of TB requires at least six to eight months, family support is needed to encourage the family member to adherence to treatment. Lack of support and strength from family members during the treatment period prolongs sickness and lower self.

Confidence and the sense of worth of patients; and further demoralizes and weakens the TB patients. Support from the family is very important in motivating the patient to complete the treatment, prevent diseases transmission, manage environmental hygiene, have adequate nutrition, have adequate sleep, have appropriate and adequate physical activity, avoid smoking and alcohol use, and live normally (Utama, 2008). Family support for TB patients’ goals is to motivate and encourage the patients to follow the treatment regimen or motivate the patients complying with. DOTs program, because having TB is not only a physical problem but also-a psychosocial problem, therefore family must consider the treatment regimen and the psychosocial factor of the patients. Tuberculosis (TB) is an airborne infection disease, thought to infect almost one third of the world’s population (WHO, 2005). It commonly manifests as an infection of the lungs, usually with symptoms of anything, weight loss and other constitutional symptoms.

Tuberculosis has become telling indicators of a society’s wealth or poverty (Khut, 2008). At present, 95% of the million new cases of TB, and 98% of deaths from TB, worldwide are in developing countries. In there regions, disease and death from TB occurs most often in the most economically active segment of the population; among the 1.5 – 2million people dying annually from TB every year, 75% are between the ages of 15 and 54, with TB accounting for almost one-fifth of all deaths in this age group. Country studies document between three and four month work time lost annually to the disease, and lost earnings of 20 to 30% of household income. Families of persons who die from the disease lose about 15years of income. Therefore, commitment of family members to give support to TB patients is very important to influence patient adherence to TB Treatment (Department of Health and Social Welfare, 2006).

1.2 Statement of the Problem
The epidemic of diseases such as tuberculosis can cause great mortality and morbidity coupled with grave socio-economic consequences if not property curtailed. In many countries globally, the adoption of Directly Observed Treatment (DOT) has been associated with reduced rate of treatment failure, relapse and drug resistance. However, its impact in reducing TB incidence has been limited by non-compliance to DOT, which occurs when patients do not turn up for treatment at the health facility or community DOT point (Tessema, 2009). In countries where DOT has had little impact on TB control, poor or non-compliance to self-administered TB treatment is common and has been identified as an important cause of failure of initial treatment, leading to relapse.

Tuberculosis is an infectious disease which comes along with prolonged treatment and stigmatization; and this could potentially discourage students in adhering to their drugs, especially if there is no support from family members, friends and even health care providers.

The cost of purchasing tuberculosis drugs is on the high side; and if the support of the patient’s family is absent through ways such as financial support, encouraging the patient to take his drugs, provision of nutrient-rich meals for the patient, and the provision of emotional support, adhering to his/her drug regimen could be really challenging, therefore posing a threat to the success to the Directly Observed Treatment (DOT) scheme. It is in line with these observations that this study is being carried out.

1.3 Purpose of the Study
The purpose of this study is to examine drug adherence in tuberculosis patients with family support.

1.4 Significance of the Study
The significance of this study is as follows:
For health education, the study will be useful for better understanding by health educators and health workers who can apply the knowledge to promote how family support influences patient adherence to drugs.
It can be used as a baseline data for further research related to family support and adherence.

1.5 Research Questions
Answers will be provided for the following questions:
i. Will availability of drugs predict drug adherence among TB patients in Yaba Local Government Area?
ii. Will family financial support predict drug adherence among TB patients in Yaba Local Government Area?
iii. Will family emotional support predict drug adherence among TB patients in Yaba Local Government Area?

1.6 Research Hypotheses
The following hypotheses were tested
HO1: Availability of drugs will not significantly predict drug adherence among TB patients in Yaba Local Government Area.
HO2: Family financial support will not significantly predict drug adherence among TB patients in Yaba Local Government Area.
HO3: Family emotional support will not significantly predict drug adherence among TB patients in Yaba Local Government Area.

1.7 Limitation of the Study
Any limitation faced in this study would be documented. However, the following limitations may be encountered.
1. The unwillingness of some of the participants to fill and return the questionnaire is considered a likely setback to this study but efforts will be made to persuade the participants to fill and return the questionnaire on the spot.
2. Some questionnaire may be filled wrongly

1.8 Delimitation of the Study
The scope of this study was to examine family support as a predictor of drug adherence among TB patients.
Conclusively, the study was delimited to the following:
Mainland Hospital in Yaba Local Government Area of Lagos State. The simple random sampling technique was adopted to select the respondents. A self structured and validated questionnaire was used to obtain data from the respondents. A sample of Two hundred (200) participants was adopted.

1.9 Operational Definition of Terms
Tuberculosis: It is an infection disease which is caused by tubercule bacillus; it can be spread from infected person to non-infected person through air.
Drug Adherence: It is the degree to which a tuberculosis patient correctly follows drug prescription and sticking with the use of the drug without break of flow.
Family support: It is the support of rendered to a tuberculosis patient by his/her family towards ensuring that she adheres to her drug regimen.
DOTs: Directly Observed Treatments short course is a control strategy recommended by World Health Organization in the treatment of TB.
Mortality Rate: The death rate of tuberculosis patients.
Morbidity Rate: The rate at which tuberculosis occurs among people in Yaba Local Government.

Project Overview
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