Abstract

Mohammed El-Muttalut* and Mustafa KhidirElnimeiri

Tuberculosis is a global health problem. Sudan shoulders 8% of tuberculosis burden in the Eastern Mediterranean Region. Kassala State, in Eastern Sudan, is one of the most affected states with annual TB risk of 120 new cases per 100,000 of populations. Non-compliance to tuberculosis treatment is common, and is the most important cause of failure of initial therapy, relapse and emergence of multidrug resistant tuberculosis cases. The overall objective of this study was to determine the risk factors associated with non-compliance with TB treatment among TB patients in Kassala State. A cross-sectional study was conducted in Kassala State. The sample size mounted to 366 participants who were selected using simple random sampling technique. A standardized administered pre-tested, pre-coded questionnaire was used to collect the data. The questionnaire consisted of 10 sections with a total of 80 questions. A multivariate logistic regression analysis model was built using the enter method for the statistically significant variables at univariate analysis level taking P-value of 0.25 to determine the association between non-compliance and the study outcomes. 366 TB patients were included in this study, of whom 60 were treatment defaulters. TB patients aged 40 years and above, and those living in rural areas were found to be at higher risk of default with P-value 0.023 and 0.013 respectively. Lower education level and low income were also found to be significantly associated with treatment default with P-value 0.024 and 0.045 respectively. The study revealed that discontinuing treatment after feeling better (and wrongly perceiving it as cure) at the start of continuation phase was the most important predictor of treatment default with P-value 0.004. Non-compliance was found to be influenced by multiple factors including lack of patient knowledge and awareness about TB and its treatment (stopping treatment after feeling better), low education level, low income level and age and residence of the patient. It is necessary to educate patients about various aspects of tuberculosis and its treatment as it is the key intervention to lower the default rate. Moreover, effective supervision, close follow up and support for TB patients is crucial, particularly for those aged 40 years and above, living in rural areas and those of low education and income level.