Factors associated with adherence to anti-tuberculosis treatment among children attending TB clinics in Mulago Hospital, Nsambya Home Care and Kawempe (KCCA Health Centre)
Introduction: Tuberculosis(TB) is a major cause of mortality and morbidity with about 8.8 million new TB cases globally in 2010.Uganda like most of Sub-Saharan Africa, has a high burden of TB and this is fueled by the HIV/AIDS epidemic. Treatment of tuberculosis involves taking tuberculosis drugs for at least six months. Adherence to TB treatment in children has not been studied in Uganda. This study therefore established the level of adherence to anti tuberculosis treatment and factors associated with adherence to these drugs. Methodology: It was a cross sectional study with qualitative data component that was conducted at the Paediatric TB clinics of Mulago hospital, and Nsambya Home Care and Kawempe (KCCA clinic) from March 2013 to Feb 2014.. Adherence to TB medication was defined as taking >90% of the prescribed drugs in a previous month and was assessed using self-report. Results: A total of 253 children aged one month to 14 years who were on anti-TB drugs for at least 1 month(4 weeks) were enrolled in the study .Male to female ratio was 1:1,The overall level of adherence was: 85.4% (95%CI: 81%-89.8%) at one month (28days) using self report. The factors that were independently associated with non adherence included inability to get drugs from health facility and having no confidence in drugs prescribed. Twenty five (67.6%) of the 37 non adherent children were able to get their drugs from the health facility compared to the 196 out of 216 children who adherent.There was 85% reduced likelihood of non adherence among caregivers who were always able to get their drugs from health facility compared to those who were not able to get drugs. OR 0.15 (95%CI 0.06 – 0.37) p<0.001. Two hundred thirty three (92.1%) of the 253 respondents were confident that the drugs will help their children while twenty (7.9%) of 253 had no confidence in the anti-tuberculosis drugs. There was 11-fold increased risk of non adherence among parents who had no confidence in the prescribed drugs compared to those who had confidence in the prescribed drugs. OR 11.17 (95%CI 3.64-34.20)p<0.001. From qualitative data the factors that enhance adherence to TB drugs included concern of child’s health, counselling and sensitisation about TB, availability of free drugs in most TB clinics, ease of administration of drugs, fear of resistance to the drugs. Factors that caused children to miss their drugs included, inability to get drugs from health facility, drug stock outs, forgetting to give the drugs, long distance from clients’ homes, seeing the child was much better and had improved. Conclusions: The level of adherence to anti-tuberculosis treatment among children attending TB Clinics in Mulago Hospital, Nsambya Home care and KCCA health centre was high at 85%. Factors which were independently associated with non adherence to anti-tuberculosis treatment included inability to get drugs from health facilities and caregivers who have no confidence in the TB medication prescribed. Recommendations: Ministry of Health should ensure constant supply of anti-tuberculosis drugs in all health centres. Health care workers caring for children on anti-tuberculosis treatment should pay special attention to children of caregivers who are not able to get drugs and those who have no confidence in the drugs prescribed. A larger prospective study should be done to follow up these children and determine the outcome of treatment.