Ethiopians With TB Must Overcome Barriers To Complete Treatment

One in five Ethiopians treated for tuberculosis fails to complete the length course of drugs required, according to a study by Ethiopian and Norwegian researchers, published in PLoS Medicine. The research has made clear some of the difficulties that patients must overcome in order to succeed in completing a course of treatment. People who cannot easily travel to a treatment centre are the most likely to 'default'.

Tuberculosis is one of the world's leading causes of death and the number of cases is increasing. Ethiopia is one of the worst affected countries. The treatment recommended by the World Health Organization (WHO) can be very effective for most patients but it does involve taking drugs for at least six months. Patients may find it difficult to complete the full treatment, although it helps to have a system where trained observers help make sure that each patient takes all the necessary pills. WHO promotes this approach - known as DOTS (directly observed treatment short course) - and says national programs should aim for a treatment completion rate of at least 85%. Ethiopia was already known to have made good progress towards this goal during the 1990s. However, the researchers wanted to know why those people still not completing treatment were failing to do so.

They studied over 400 patients diagnosed and registered for treatment in a hospital in Hossana Hospital in southern Ethiopia over a two-year period. Using questionnaires they recorded information about the patients' circumstances. They recorded who completed or failed to complete treatment and analysed their data to determine which factors were most closely associated with failure to complete.

The overall completion rate was 80% (i.e. 20% failed to complete), still some way short of the WHO target. The patients who needed to use public transport, which is expensive for many Ethiopians, in order to reach a treatment centre were the most likely to fail to complete. This was despite the fact most of the patients in the study lived in less remote areas than the majority of southern Ethiopians. Other factors were also noted; for example people aged over 25 were less likely to finish their treatment.

The researchers concluded that it will be necessary for the Ethiopian government to continue to expand its efforts to improve access to treatment centres for patients with TB.

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Citation: Shargie EB, LindtjГёrn B (2007) Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in southern Ethiopia. PLoS Med 4(2): e37.

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CONTACT:

Estifanos Shargie
Centre for International Health,
University of Bergen
Bergen, Norway

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