Socio-cultural and behavioral factors affecting adherence to Tuberculosis treatment in Malawi.

Abstract

Background: Non-adherence to TB treatment poses a major challenge to Tuberculosis (TB) control programs because it increases the risk of treatment failure, relapse and the emergence of drug resistant tuberculosis. Aim: The study aimed to describe socio-cultural and behavioral factors affecting adherence to TB treatment in Malawi. Methods: A cross-sectional and mixed methods study design was used. A simple random sample of 200 participants who were on TB treatment at the time of the study and were getting their TB drugs from Bwaila hospital, in Lilongwe District, Malawi was selected. A pretested and structured questionnaire and Focus Group Discussions were used to collect data. Data were entered and analyzed using Microsoft excel. Focus Group Discussions data were subjected to a thematic content analysis. Results: The majority of the respondents had ever heard about TB before being diagnosed with the disease (77.5%) and the most frequent source of information about TB was from friends, relatives and workmates (45.5%). 95.5% of the respondents disclosed their TB status to others and 90.0% of the respondents did not perceive having TB as shameful. 88.5% of the respondents reported taking their TB medication according to guidelines. While 88.5% of respondents reported that there were no barriers that prevent TB patients from adhering to their TB medication, the following barriers were reported by other respondents: travelled without medication (3.5%), forgetfulness (2.5%), long travel distance to health facility (2.5%), didn’t understand dose instructions (1.5%). Conclusions: This study found that TB patients who have the correct knowledge and information about TB and its treatment are more likely to adhere to treatment than those who have no knowledge about TB, and that having TB is not self-stigmatized and shameful. Despite the fact that most of the respondents reported facing no barriers preventing them from adhering to TB treatment, there were some reported barriers that prevent TB patients from adhering to treatment. There is a need therefore to address these barriers through support from the government and the community at large.