Factors associated with the unsuccessful Tuberculosis treatment outcomes of the DOTS programme in Kunene and Oshana regions, Namibia
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Date
2022
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University of Namibia
Abstract
Tuberculosis (TB) is among the leading causes of death globally. In Namibia, the disease has a huge burden, with a case notification rate of at least 442 per 100,000. To date, Namibia is still among the countries with the highest global TB burden, despite all efforts in place to reduce it. The purpose of this study was to determine the factors associated with the unsuccessful treatment outcomes of the Directly Observed Therapy or Directly Observed Treatment (DOTS) programme in the Kunene and Oshana regions. The study utilised a mixed-methods explanatory-sequential design to collect data from all TB patient records as well as healthcare workers who work directly with the DOT strategy for TB patients. The relationship between independent variables and dependent variables was analysed using multiple logistic regression analysis, while interviews were analysed using inductive thematic analysis. The overall treatment success rates of Kunene and Oshana regions throughout the entire review period were 50.6% and 43.9%, respectively. The type of DOT used (OR=1.67, 95% CI:1.15-2.42, p=0.007) and age group (OR=1.12, 95% CI:1.05-1.19, p=0.001) were the only factors found to be statistically significant with unsuccessful treatment outcomes in Kunene and Oshana region, respectively. The study further revealed that patients in Kunene region are difficult to reach owing to their nomadic lifestyle, adversely affecting their ability to directly observe therapy. Furthermore, lack of transport also affected the direct observation of therapy. In Oshana region, it was found that mixing anti-TB medication with alcohol among adult patients was a prevalent issue affecting TB therapy. Moreover, stigma and poor TB awareness among adult patients were also found to adversely affect possibilities of direct therapy observation, impacting the overall treatment outcome of the Oshana region. The main recommendations that arose from the study include the need for the regional heath directorates to establish a robust patient tracing system to enhance inclusive access to all health services, particularly among nomadic patients. Moreover, it is recommended that the regional management should improve their patient monitoring methods, particularly for those who do not take anti-TB medication under healthcare workers' observation, to ensure adherence. Lastly, extensive TB health education should be regularly conducted in both regions to increase awareness among the affected, to educate patients and their guardians about their responsibilities, as well as the TB management process and the dangers of using alcohol while on treatment.
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Keywords
Tuberculosis, TB medication, TB therapy