Relationship of training and treatment practices in tuberculosis management in selected counties in Kenya

Abstract

Background: Tuberculosis is an infectious and preventable disease that causes high morbidity and mortality not only in Kenya but globally. Poor adherence to medication leads to worsening of this preventable disease and emergence of drug resistance, a situation which is likely to be attributed to poor patient management by healthcare workers. This study focused on tuberculosis patients in urban and rural areas in Kenya. Objectives: The objectives of the study were: to review the training curricula for nurses and clinical officers used in the training institutions to prepare this cadre of healthcare workers, to examine health care delivery factors that influence non-adherence to TB treatment, to identify healthcare givers’ factors that contribute to non-adherence to medication and to identify training interventions to enhance treatment among tuberculosis patients. Methods: The study adopted a qualitative research design in purposely selecting a sample consisting of retrospective cohort of non-adherent tuberculosis patients. Target population was smear positive tuberculosis patients registered in the tuberculosis registers in the two counties, within the past six months (June-December 2015) at the commencement date of the study. Data was collected using developed interview schedules and questionnaires administered to patients and healthcare workers together with focus group discussions for tuberculosis managers. Respondents were traced non-adherent smear positive tuberculosis patients (defaulters), health care workers and tuberculosis managers. Age, gender, educational level, ignorance on need for treatment adherence, stigma, alcoholism, social and economic factors such as low income, lack of social support, low education, financial problems, and drug side effects were analyzed using Statistical Packages for Social Sciences (SPSS) platform that generated graphs and tables. Current institutional training curricula for healthcare workers and tuberculosis managers were reviewed for content. Results: 1) Training curricula for both nurses and clinical officers were found to be deficient in content except in the cadre dealing with Lung and Skin, which was shallow and did not touch on hard and soft skills development. 2) Tuberculosis drugs including pyridoxine were inadequate among other factors. 3) Healthcare workers were inadequately prepared (>40%) to offer Tb treatment, were never briefed (>90%) on tuberculosis management prior to posting to tuberculosis clinics and were rarely given Tb updates (>30%) in their routine work. 4) Medical intervention gaps noted included inappropriate training curricula, few poorly trained healthcare workers deficient in counselling skills and poorly prepared in soft skills application when handling patients and irregular and unscheduled tuberculosis updates and continuing medical education updates(CMEs). 5) From focus group discussions, it was apparent that tuberculosis education is essential not only for people with tuberculosis but also for the general public regarding importance of adherence to medication. Conclusion:1) Training curricula for nurses and clinical officers were inadequate. 2) Shortage of Tb drugs including pyridoxine essential for counteracting drug side effects among other factors contributed to medication non-adherence. 3) There was no evidence of regular CMEs. 4) Tuberculosis education is essential for both patients and the general public. Recommendations: Existing training curricula in training institutions need to be revised and updated to include competency development on hard and soft skills acquisition. Tuberculosis drugs including pyridoxine should regularly be availed in adequate amounts. A deliberate and sustained emphasis on tuberculosis education is essential not only for people with tuberculosis but also for the general public regarding importance of adherence to medication. Staffs’ updates on tuberculosis treatment should be regularly enhanced through continuing medical education forums.