A STUDY OF FACTORS CONTRIBUTING TO FIRST LINE ANTI TUBERCULOSIS TREATMENT FAILURE AMONG PATIENTS AGED 15-56 YEARS. ARUA DISTRICT.

A descriptive cross sectional and retrospective study was carried out to assess the TB treatment failure in ARRH in Arua District.
In this chapter, the results of the study are discussed
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DISCUSSION

Objective one: Determine the patient’s adherence to drug therapy.

The results have shown that 50% of patients do not adhere to drugs, they would pick their medicine after 5 days of appointment.

The result also showed that majority of the respondents 9 (45%) were taking drugs on alternate days. They would have more than 5 drugs with them by the time they came to pick more drugs. This meant that there were some days when TB patients would miss taking drugs completely. The highest proportion of respondents 11 (55%) missed more than 5 days in taking drugs in the course given,

A total of 12 (60%) of patients had stopped taking Anti TB completely and resumed after 5 days because drugs were too big and many.  18 (90%) of TB patients had difficulties in taking medications due to too chores, daily taking of drugs was hard, bad smell of the drugs which irritated them, difficulty in swallowing of drugs, hunger and lack of proper knowledge the about drug therapy.  17 (85%) of patients had experienced side effects while taking drugs such as headache, nausea, vomiting, dizziness, blurred vision, loss of libido, skin rashes, diarrhea, body itching and weakness. All these had affected them in a way that some had to stop taking medications as noted before. This failure to adhere to therapy due to fear, loss of interest in taking drugs, laziness and hence patients would feel irritated to proceed with medication.

 

Objective two: Identify anti TB first line medicines stock out rate.

The results have shown that months in which drugs were in stock included March, April, May, June, July, August, October and December. Months in which drugs were out of stock included; January, February, September and November. At least drugs were 66.7% stocked in a year, leaving stock out rate to be 33.3% in a year which is a significant figure.

In a month, there were at least four (4) orders made for the drug combination of Rifampicin (R), Isoniazid (H), Pyrazinamide (Z) and Ethambutol (E). Patients missed taking their drugs during periods of out of tock which became a potential contributor to non-adherence.

Objective three: Find out the sero status of patients with resistant TB to first line treatment.

The study showed that 47.3% of MDR TB patients were HIV positive and 52.7% HIV negative.
So, these findings suggested that HIV co-infection is not a direct driver of Mtb drug resistance. He continued to say that HIV epidemic serves as an amplifier of TB outbreaks by providing a reservoir of susceptible hosts. Therefore HIV co-infection is not a direct driver for the emergence and transmission of resistant strains.

Objective four: Assess nutritional status of patients resistant to first line TB treatment.

The results have shown that more than a half, 12 (60%) of TB patients had BMI below 18.5. This indicated that they were malnourished (under nourished). Most patients had a meal once  a day, ate boiled food, had no access to fruits, would not eat meat or fish in a week and were of a  low socio economic status.

Analysis also showed that most patients ate a  meal once in a day i.e. 10 (50%) followed by those who ate twice in a day 8 (40%), then a smaller number ate more than twice.  Having a meal once in a day would contribute to under nutrition which is a factor to body immune compromise hence leading to drug resistance to M strain of Tuberculosis.

The researcher noted also that patients who had meals once in a day had low social economic status as stated before and hence most of them were wasted, these were those who ate fried food, contributed to 12 (60%). Those who ate boiled food and pasted food equalized (20%). The group of patients who eat fried food and greens 10 (50%) more often in a week were those who were financially stable and they looked physically healthy. They would eat a balanced diet.

CONCLUSIONS

Following conclusions were drawn chronologically as per the specific objectives

  • There is poor adherence to treatment by TB patients. This came about due to drug side effects, too many activities at home,
    and forgetfulness among others. The crop of this practice among patients in ARRH could be one of the reason as to
    why TB patients become resistant to first line TB drugs.
  • In most cases drugs were in stock but in those few months where drugs were out of stock, each month
    would contribute to 8.33% rate of out of stock of drugs which is a significant figure.
  • HIV is not the sole reason as to why TB patients develop MDR TB. It acts as a risk factor to the development of active TB (MDR TB) in a way that it shortens the latency period through which a patient has to go through to become an MDR TB patient. Therefore, it lowers the body immunity hence increasing the latency period for development of drug resistance
  • Most patients are malnourished (under nourished). A greater percentage was due to poor feeding options opted by them.
    Malnutrition is a potential factor that contributes to the development of active TB. One reason is that it lowers the body immunity.