Dataset Information

Medication nonadherence and associated factors in patients with tuberculosis in Wau, South Sudan: a cross- sectional study using the world health organization multidimensional adherence model.

ABSTRACT:

Background

Tuberculosis medication nonadherence is a multi-dimensional public health problem with serious consequences worldwide. There is little information available for medication nonadherence in South Sudan. This study assessed the proportion, reasons, and associated factors for nonadherence among patients with TB in Wau Municipality, South Sudan.

Methods

A health facility based cross-sectional study was conducted among 234 tuberculosis (TB) patients receiving first line anti-TB regimen in Wau Municipality. Urine isoniazid metabolite testing (IsoScreen^®) was used to determine nonadherence (visualized by negative test results) and a questionnaire was used to describe the reasons for nonadherence. Modified poisson regression with robust standard errors was performed since the proportion of nonadherence was < 10%, to identify nonadherence associated factors using the WHO Multidimensional adherence model.

Results

Out of 234 participants, 24.8% (95% CI, 19.2 - 30.3) were nonadherent to the TB treatment regimen. At multivariate analysis, nonadherence was significantly associated with: relief of symptoms (APR 1.93, 95% CI 1.12 - 3.34, p = 0.018), alcohol use (APR 2.12, 95% CI 1.33 - 3.96, p = 0.019) and waiting time to receive drugs (APR 1.77, 95% CI 1.11 - 2.83, p = 0.017).

Conclusion

Tuberculosis medication nonadherence was high, and it's associated with patients' relived of symptoms, alcohol use, and prolonged waiting time at health facility. Hence, addressing these barriers and the use of multifaceted interventions e.g. counseling, health education and improve appointments are crucial to reduce nonadherence among patients with TB in South Sudan.

SUBMITTER: Marin PM

PROVIDER: S-EPMC11250949 | biostudies-literature | 2024 Jul

REPOSITORIES: biostudies-literature

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Publications

Medication nonadherence and associated factors in patients with tuberculosis in Wau, South Sudan: a cross- sectional study using the world health organization multidimensional adherence model.

Marin Peter Michael PM Munyeme Musso M Kankya Clovice C Jubara Ambrose Samuel AS Matovu Enock E Waiswa Peter P Romano Javier Sanchez JS Mutebi Francis F Onafruo David D Kitale Estella E Benard Owori O Buhler Kayla J KJ Tryland Morten M

Archives of public health = Archives belges de sante publique 20240715 1

<h4>Background</h4>Tuberculosis medication nonadherence is a multi-dimensional public health problem with serious consequences worldwide. There is little information available for medication nonadherence in South Sudan. This study assessed the proportion, reasons, and associated factors for nonadherence among patients with TB in Wau Municipality, South Sudan.<h4>Methods</h4>A health facility based cross-sectional study was conducted among 234 tuberculosis (TB) patients receiving first line anti- ...[more]

PMID: 39010212

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Project description:BackgroundSouth Sudan has endured decades of armed conflict, with the most recent in 2016. This has left the health system and infrastructure overstretched by a myriad of infectious diseases like tuberculosis. Our study aimed at quantitatively and qualitatively documenting TB dynamics and challenges with access to health care during a period of civil unrest in Wau.Materials & methodsA cross sectional study was carried out between January and February 2016 at Wau Teaching Hospital (WTH). Sputum was randomly collected from 207 of the 1035 TB suspects and analyzed using Ziehl-Neelsen (ZN) and Fluorescent Microscopy (FM), Culture, Capilia MTBC Neo, and DST. The laboratory results and questionnaire metadata were used for descriptive statistics, logistic regression in R version 3.4.2. These results were presented along with results from a qualitative assessment of the situation at WTH.ResultsOf 207 TB suspects, 39 (18.8%) were positive on FM with bacilli growth on culture, later confirmed as Mycobacterium tuberculosis complex. Only 5.4% of the cases were resistant to Isoniazid. Age; 20-45 OR = 13 (95%CI = 2.4-25.6, p = 0.011), > 46 OR = 3 (95%CI = 0.5-58, p = 0.005) and raw milk consumption OR = 2.2 (95%CI = 0.37-42.48, p = 0.005) were associated with being TB positive. The qualitative evaluation reveals that gunfights in the surroundings of Wau influenced the number of patients attending WTH, with some travelling up to 545 km to seek medical attention.ConclusionWe report a high prevalence of tuberculosis among patients who presented at WTH, with approximately 1 out of 5 individuals testing positive for tuberculosis. This is likely an underestimation given the challenges patients had to endure as they sought medical attention. Tuberculosis epidemiology is likely to be driven by individual and household factors, but further investigations are needed to fully understand the risk profile. The tools in use were adequate for TB diagnostics and we observed a remarkably low prevalence of drug resistance, a statistic that is worth preserving. We therefore call for action from all stakeholders.

Project description:PurposeTo assess the accuracy of 5 subjective self-assessment tools (3 adherence measures and 2 psychometric scales) and pharmacy refill data in predicting objective electronically monitored nonadherence.DesignProspective cohort study.ParticipantsGlaucoma patients (> 40 years old, >1 medication with poor self-reported adherence) were recruited from University of Michigan Kellogg Eye Center for a study assessing the impact of a personalized glaucoma coaching program on medication adherence.MethodsParticipants completed an initial assessment including 5 self-assessment tools and a 3-month period of electronic monitoring of glaucoma medication adherence (AdhereTech); pharmacy refill data were obtained. Electronically monitored adherence was calculated monthly as the percentage of doses taken on time. The median of these adherence rates was designated as baseline adherence. Patients with adherence of ≤80% by electronic monitoring were considered nonadherent. Self-assessment tools were scored, and pharmacy refill data were summarized as the proportion of days covered. Correlation between measures of adherence was estimated with Pearson and Spearman correlation coefficients. Receiver operating characteristic curves, including estimation of area under the curve (AUC), sensitivity, specificity, and accuracy were used to compare measures of adherence with respect to predicting electronically monitored nonadherence.Main outcome measuresAccuracy of self-reported and pharmacy refill data adherence measures in predicting electronically monitored nonadherence.ResultsNinety-five patients completed 3 months of electronic monitoring with a median monthly adherence of 74 (± 21%); 53 patients (56%) were nonadherent. Pharmacy refill data were not correlated significantly with electronically monitored medication adherence (r = 0.12; P = 0.2). Of all the measures, a single-item adherence question ("Over the past month, what percentage of your drops do you think you took correctly?") showed the largest correlation with median electronically monitored adherence (r = 0.47; P < 0.0001), largest AUC for predicting nonadherence (AUC = 0.76 [95% confidence interval [CI], 0.66-0.87]), best accuracy (71% [95% CI, 61%-82%]), and good sensitivity (84% [95% CI, 73%-96%]).ConclusionsThe single-item question was the most accurate in predicting electronically monitored nonadherence among participants with poor self-reported adherence. In clinical practice, where alternatives are too resource intensive, this free single-item screening question can help to identify glaucoma patients at risk of poor medication adherence with reasonable accuracy.

Project description:Slaughterhouses in South Sudan mirror the economic losses resulting from cattle organs and carcass condemnation due to zoonotic and epizootic diseases of livestock, such as tuberculosis, cysticercosis, and hydatidosis in cattle. However, due to the war, slaughterhouse record keeping has been inconsistent in South Sudan, and thus the estimation of diseases in cattle and their impact may be underestimated. Therefore, this study was conducted to estimate the major causes of carcasses and organ condemnation of cattle slaughtered at Lokoloko abattoir and the resulting financial losses. A cross-sectional active abattoir survey involving antemortem and postmortem examinations was conducted on 310 cattle between January 2021 and March 2021. Furthermore, five-year (September 2015-September 2020) retrospective data on meat inspection records were also collected and analyzed. During the antemortem inspection of the active abattoir survey, 103 (33.2%) cattle had signs of disease. These signs included herniam 17 (5.5%), local swelling 16 (5.2%), lameness 15 (4.8%), emaciation 13 (4.2%), blindness 12 (3.9%), depression 11 (3.5%), pale mucus membrane 7 (2.3%), nasal discharge 5 (1.6%), lacrimation 4 (1.3%), and salivation 03 (0.97%). Postmortem inspection revealed gross pathological findings on 180 (58.6%) carcasses, out of which 47 (26.1%) livers and 31 (17.2%) hearts were condemned due to various causes. The active abattoir survey and the retrospective data revealed that tuberculosis, fascioliasis, hydatidosis, and heart cysticercosis were the leading causes of condemnation of carcasses and organs. In the active abattoir survey, a total of 19,592,508 South Sudanese Pounds, equivalent to US$29,686 was lost from organ condemnation, while in the retrospective data; the overall direct financial loss during the five years was estimated to be 299,225,807 South Sudanese Pounds equivalent to US$453,372. This study revealed that bacterial and parasitic diseases were the common causes of carcass and organ condemnations and caused significant financial losses at Lokoloko abattoir in Wau, South Sudan. Therefore, there is a need for training farmers on cattle disease management, heightened meat inspections, and proper disposal of condemned meat.

Project description:BackgroundMedical nonadherence is a significant problem associated with worse clinical outcomes, higher downstream rehospitalization rates, and a higher use of resources. To improve medication adherence, it is vital for researchers and practitioners to have a solid theoretical understanding of what interventions are likely to work. To achieve this understanding, we propose that researchers should focus on creating small-scale laboratory analogs to the larger real-world setting and determine what interventions, such as nudges or incentives, work to change behavior in the laboratory. To do this, we took inspiration from the literature on serious games and gamification and experimental economics. We call our approach "gamified behavioral simulation." In this paper, we modeled everyday life as the state of being engaged in a simple but addictive game, illness as being interruptions to the functionality of that game, treatment as being a series of actions that can be taken to prevent or mitigate those interruptions, and adherence as sticking to a prescribed rule for the application of those actions.ObjectiveThis study carries out a behavioral diagnosis of the medication adherence problem through a theoretically informed framework and then develops the gamified behavioral modeling approach to simulate medication nonadherence.MethodsA laboratory experiment was conducted using a modified popular and addictive open-source video game called "2048," which created an abstract model for the medication adherence behavior observed in real life. In total, 509 participants were assigned to the control and 4 intervention groups ("incentive" group, "reminder" group, "commitment device" group, and "elongated duration for symptoms" group).ResultsThe results of the modeling experiment showed that having theoretically informed interventions can increase the likelihood for them to be successful. In particular, there is evidence that the use of reminders improves the medication adherence rates for patients, and the same result was found in the modeling experiment, as they improved adherence significantly by 23% (95% CI -33.97% to -11.72%; P<.001). However, providing an incentive did not improve the adherence rate. We also tested the use of commitment devices, which, in line with real-world evidence, did not improve adherence rates. The fourth treatment tested elongated duration for symptoms, which attempted to show the power of modeling experiments where we test a what-if scenario that is extremely difficult to test in a real setting. The results indicated that if symptoms last longer, people did not adhere more to their medication regimen.ConclusionsGamified behavioral simulation is a useful tool to explain real health behaviors and help in identifying which interventions are most likely to work in a randomized trial.

Project description:BackgroundPoor adherence to medication regimens and medical record inconsistencies result in incomplete knowledge of medication therapy in polypharmacy patients. By quantitatively identifying medications in the blood of patients and reconciling detected medications with the medical record, we have defined the severity of this knowledge gap and created a path toward optimizing medication therapy.Methods and findingsWe validated a liquid chromatography-tandem mass spectrometry assay to detect and/or quantify 38 medications across a broad range of chronic diseases to obtain a comprehensive survey of patient adherence, medical record accuracy, and exposure variability in two patient populations. In a retrospectively tested 821-patient cohort representing U.S. adults, we found that 46% of medications assessed were detected in patients as prescribed in the medical record. Of the remaining medications, 23% were detected, but not listed in the medical record while 30% were prescribed to patients, but not detected in blood. To determine how often each detected medication fell within literature-derived reference ranges when taken as prescribed, we prospectively enrolled a cohort of 151 treatment-regimen adherent patients. In this cohort, we found that 53% of medications that were taken as prescribed, as determined using patient self-reporting, were not within the blood reference range. Of the medications not in range, 83% were below and 17% above the lower and upper range limits, respectively. Only 32% of out-of-range medications could be attributed to short oral half-lives, leaving extensive exposure variability to result from patient behavior, undefined drug interactions, genetics, and other characteristics that can affect medication exposure.ConclusionsThis is the first study to assess compliance, medical record accuracy, and exposure as determinants of real-world treatment and response. Variation in medication detection and exposure is greater than previously demonstrated, illustrating the scope of current therapy issues and opening avenues that warrant further investigation to optimize medication therapy.

Dataset Information

Medication nonadherence and associated factors in patients with tuberculosis in Wau, South Sudan: a cross- sectional study using the world health organization multidimensional adherence model.

Background

Methods

Results

Conclusion

Publications

Medication nonadherence and associated factors in patients with tuberculosis in Wau, South Sudan: a cross- sectional study using the world health organization multidimensional adherence model.

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