Tuberculosis treatment non-adherence and its associated factors among school-going children with TB in Meru County, Kenya

Abstract

Background: Tuberculosis (TB) is still a significant threat to the health of the community in low- and middle-income countries. It was projected that 10 million individuals will get sick with tuberculosis in 2020 globally, with 1.1 million of these cases occurring in children. Children who are old enough to attend school are nonetheless at risk for tuberculosis because of risk factors such as contact with adult TB patients, overcrowding, and malnutrition. The severity of TB is also significantly increased in children. Adherence to treatment means taking medication as prescribed- right dose, right time, right way and frequency. It is vital to adhere to treatment in order to reduce further transmission of TB in the community, the development of medication resistance or even death. Meru county was placed second out of the 47 counties in terms of the TB burden in the year 2020. In addition, the county had the highest rise (181%) of drug-resistant TB cases in Kenya. Objectives: To determine the prevalence of non-adherence to tuberculosis treatment and identifying the associated health system, clinical related, school related and socio-demographic characteristics among school-aged children with TB in Meru County, Kenya. Methodology: Hospital-based cross-sectional research was carried out on children on TB treatment, aged 6 to 19 years old who were attending school in Meru County. The interviews were carried out at the facility level on treatment collection days in the facilities offering TB treatment. Participants were selected from the TB registers using a systematic selection method and the total number of patients in the sample was 207. A person was considered to be non-adherent if they failed to do any of the following: maintain all of their clinic visits, swallow their medications on a regular basis, or take the appropriate quantity of pills. A questionnaire was developed and it included socio-demographic, clinical, school-related, and health system characteristics was administered to the children and their care givers. The proportions were used to describe the categorical data, while mean and standard deviation were used to summarize the continuous variables. We estimated both the raw and adjusted odds ratios, as well as the 95% confidence interval. At both the bivariate and the multivariate levels, factors were deemed significant if they had p-values of less than 0.05. Results: A total of 207 school―going children with TB were interviewed. The mean age was 14.5 years (S.D.=±4), females were 105 (50.7%) and 96 (46.4%) were found to be non-adherent. The adjusted odds of TB treatment non-adherence were 3.02 times higher (p-value=0.006) among those whose waiting time was more than 30 minutes and 15.04 times higher (p-value= 0.0001) among those who did not receive health education on TB. Other factors associated with non-adherence included being in secondary school, aOR=3.01 (p-value=0.0009) and not having someone reminding the patient to take treatment aOR=6.95 (p-value=0.0001). Conclusion: The percentage of school-aged children in Meru County who did not take their anti-tuberculosis medication as prescribed was rather high. Long waiting times, not having received any kind of health education and not having a treatment supporter were key factors that contributed to non-adherence. Recommendations: The distribution of TB health education messages to school-aged children who have TB, the assignment of a treatment supporter to secondary school students and the prioritization of school-aged children on TB clinic days in order to decrease waiting time are all things that this study recommends in order to improve adherence.