The factors contributing to non compliance of Anti-Tuberculosis Medication, and Social Stigma Associated with the Disease.

Abstract

Background: Tuberculosis (TB) is a global threat infecting one third of the world’s population. Around 9 million
new cases occur, leading to about 2 million deaths annually. Because of non-compliance to the treatment drug
resistant cases are increasing terrifically. Non adherence causes enormous economic and human costs. Treatment compliance is also associated with beliefs and attitude of people.
Pakistan is among one of the highest TB burden countries with estimated incidence of 250/100,000 population.
Objectives: To explore non-compliance with tuberculosis treatment amongst patients and determine the contributing factors and the phobia for drugs and disease; and also find out social stigma associated with the disease.
Methodology:
Study Design: Cross-sectional
Place: Ojha Institute of Chest Diseases (OICD), Karachi
Duration of study: June to December 2009
Sample size: 210
Sampling Technique: Non-randomized convenient technique
Results: The male to female ratio was 68:32, and 60% of total study participants were of 40-50 years’ age group.
All were from very low / low socio-economic class. Majority of the patients came for treatment at OICD after six
months to two years of developing symptoms of T.B. All of them had gone to local GPs, who continued the treatment without a relief, but did not ask for diagnostic workup or referral. According to study participants, the mode
of spread of T.B included coughing and sneezing, food, water, touching, close body contact, sharing cloths, sharing razor, blood transfusion, used syringes and hereditary; and 19% of them had no idea of the spread route.
The patients were frightened to take treatment because it caused severe side-effects, other diseases, dependency, physical and sexual weakness. The various number of the patients thought that T.B was not a curable disease, treatment was not needed for long duration; the disease caused social isolation, marriage difficult / not possible for patients and off-springs, and also divorces. The factors contributing to non-compliance of T.B treatment
included long duration, number of drugs, cost, waiting for hours to get medicine at government health facility,
rude behaviour; and drugs not effective, better treatment / cure with homeopath / hakim / pir.
Conclusion: Non-compliance to the T.B treatment is the major cause of wide spread of the disease. There is a
need of mass awareness and social support of T.B sufferers; and sympathetic attitude of Health Care Providers.
Key Words: Tuberculosis, Non-compliance, Phobia, Social Stigma.