Verah Gesare Nyaenya
Verah Gesare Nyaenya
Verah Gesare Nyaenya
D/UPHRIFT/20011/241
FEBRUARY, 2022.
DECLARATION
This dissertation is my original work and has not been presented for a diploma in any other
institution.
Signature……………………………………. Date………………………………………………
D/UPHRIFT/20011/241
i
SUPERVISOR’S APPROVAL
The following undersigned certify that they have read and recommended the department of health
records and information for the acceptance of dissertation entitled; factors influencing adherence
to tb treatment among patients attending t clinic in port reitz sub county hospital, Mombasa county.
Internal supervisor
Signature…………………Date …………………
External supervisor
Signature……………………Date ……………………
ii
DEDICATION
My sincere gratitude to the God for His gift of life, knowledge, power and guidance throughout
this study, special thanks to my loving father Innocent Nyaenya and mother Conceptor Kemunto,
and my siblings for your encouragements and reminder that all is possible in God and your
iii
ACKNOWLEDGEMENT
First and foremost, I thank God for giving me strength to pursue this study. I also wish to extend
my sincere gratitude to my research tutor Mr. Muriki Kenneth for taking me through research
theory tutorials, my internal supervisors Ms. Okiru Beverlyne for Her continued efforts, guidance
and advice that has made the success dissertation and to my external supervisor Mr. Dominic
iv
TABLE OF CONTENTS
DECLARATION ............................................................................................................................. i
SUPERVISOR’S APPROVAL ...................................................................................................... ii
DEDICATION ............................................................................................................................... iii
ACKNOWLEDGEMENT ............................................................................................................. iv
TABLE OF CONTENTS ................................................................................................................ v
LIST OF TABLES ....................................................................................................................... viii
LIST OF FIGURES ....................................................................................................................... ix
DEFINITION OF TERMS ............................................................................................................ xi
ABSTRACT .................................................................................................................................. xii
CHAPTER ONE: INTRODUCTION ............................................................................................. 1
1.1 Background of the Study ................................................................................................................................. 1
1.2 Problem statement ......................................................................................................................................... 3
1.3 Justification of the study ................................................................................................................................. 4
1.4 Research Questions ........................................................................................................................................ 4
1.5 Objectives of the study ................................................................................................................................... 5
1.5.1 Broad objective ........................................................................................................................................ 5
1.5.2. Specific Objectives .................................................................................................................................. 5
1.6 Scope of the study .......................................................................................................................................... 5
CHAPTER TWO: LITERATURE REVIEW ................................................................................. 7
2.1 Awareness of tuberculosis .............................................................................................................................. 7
2.1.1 knowledge ............................................................................................................................................... 7
2.1.2 Level of Education. ................................................................................................................................... 8
2.1.3 Source of information .............................................................................................................................. 9
2.2 Follow up care system..................................................................................................................................... 9
2.2.1 Distance ................................................................................................................................................... 9
2.2.2 Guidance and counseling ....................................................................................................................... 10
2.3 Doctor-patient relationship ........................................................................................................................... 11
2.3.1 Waiting Time .......................................................................................................................................... 11
2.3.2 Attitude.................................................................................................................................................. 12
CHAPTER THREE: RESEARCH METHODOLOGY ............................................................... 13
3.1 Study Design ................................................................................................................................................. 13
3.2 Study area ..................................................................................................................................................... 13
3.3. Target Population ........................................................................................................................................ 13
3.3.1 Inclusion criteria..................................................................................................................................... 13
v
3.3.2 Exclusion criteria .................................................................................................................................... 13
3.4 Variables ....................................................................................................................................................... 14
3.4.1 Dependent variables .............................................................................................................................. 14
3.4.2 Independent variables............................................................................................................................ 14
3.5 Sampling technique ...................................................................................................................................... 14
3.6 Sample Size ................................................................................................................................................... 14
3.7 Data Collection Instruments .......................................................................................................................... 15
3.8 Data collection process ................................................................................................................................. 15
3.9 Pretesting ..................................................................................................................................................... 15
3.10 validity ........................................................................................................................................................ 16
3.11 Reliability .................................................................................................................................................... 16
3.12 Data Analysis .............................................................................................................................................. 16
3.13 Ethical consideration ................................................................................................................................... 16
CHAPTER FOUR: FINDINGS, ANALYSIS AND PRESENTATION ...................................... 17
4.0 Demographic characteristics of patients ....................................................................................................... 17
4.1 Awareness .................................................................................................................................................... 18
4.1.1 Respondent’s response on level of education ........................................................................................ 18
4.1.2 Knowledge about TB .............................................................................................................................. 19
4.1.3 Source of information ............................................................................................................................ 20
4.2 Follow-up care system .................................................................................................................................. 20
4.2.1 Respondent’s response on distance ....................................................................................................... 20
4.2.2 Counselling and Guidance ...................................................................................................................... 22
4.3 Doctor-patient Relationship .......................................................................................................................... 22
4.3.1 staff’s Attitude ....................................................................................................................................... 22
4.3.2 Waiting Time .......................................................................................................................................... 23
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION .................... 24
5.1 Discussion ..................................................................................................................................................... 24
5.1.1 Awareness about tuberculosis treatment ............................................................................................... 24
5.1.2 Follow up care system ............................................................................................................................ 25
5.1.3 Doctor patient relationship .................................................................................................................... 25
5.2 Conclusion .................................................................................................................................................... 26
5.3 Recommendation ......................................................................................................................................... 27
5.4 Further research ........................................................................................................................................... 27
REFERENCES ............................................................................................................................. 28
INTERVIEW SCHEDULE .......................................................................................................... 31
APENDIX I: REASERCH PERMIT ............................................................................................ 36
APPENDIX II: WORK PLAN ..................................................................................................... 37
vi
APPENDIX III: BUDGET ........................................................................................................... 39
APPENDIX IV: MAP ................................................................................................................... 40
vii
LIST OF TABLES
viii
LIST OF FIGURES
ix
ABBREVIATIONS
TB -Tuberculosis
x
DEFINITION OF TERMS
TB treatment.
Follow up system -It’s a further action taken after treatment or procedure is finished
Doctor-patient relationship -Its formed when a doctor attends to a patient medical need.
xi
ABSTRACT
xii
CHAPTER ONE: INTRODUCTION
is transmitted through the air or by ingesting infected milk or meat (Bovine TB) and it is both
preventable and curable (WHO, 2014). Adherence to treatment is described as the extent to which
the patients follow instructions on how the medication prescribed is to be undertaken (Osterberg
& Blaschke, 2015) People who have pulmonary tuberculosis (TB disease in the lungs) can infect
others through droplet infection when they cough, sneeze or talk (WHO, 2014). The disease is
Tuberculosis, and M. bovis, which are spread when infected persons cough, sneeze or speak and
susceptible persons inhale the infected air, (karumba, 2015). TB/HIV list and MDR-TB (WHO,
2013). It’s however easily preventable (BCG at birth) and treatable if medication is taken as
prescribed.
Tuberculosis is highly ranked in all the lists of countries having high per capita burden of TB,
combination of correct dosage, sufficient time and adequate drugs (Tang, Zhao, Wang &Yin,
2015). According to (WHO, 2014) there were at least 2.5 million individuals in Africa who fell ill
as a result of TB in 2016 alone which accounts for at least a quarter of the new cases in the world.
Additionally, 417,000 people in Africa died due to TB which accounts for 25% of all TB deaths
occurring in the African region. The biggest number of new TB cases occurs in Asia estimated to
be at 61 percent, followed by Africa in countries like Nigeria and South Africa with 26 percent,
making 87 percent of new TB Cases that occur amongst 30 TB endemic countries, (WHO, 2013).
1
In Chennai city of India, the prevalence of pulmonary tuberculosis is estimated to be high and
concentrated in some areas of the city, with men having higher rates than women in all ages and
those above the age of 55 have a prevalence > 1%. (Dhanaraj B et al, 2015).
In Africa, the incidence rate for tuberculosis is noted to be high mostly in the African WHO regions
with 290/100,000 per year. It appears that 9 percent of all new tuberculosis cases among adults
(aged15-49years) are attributed to HIV infection, but the proportion is much greater in the African
WHO region accounting for 3 percent and some industrialized countries, notably the US having
26 percent. The prevalence rate for co-infection equals or exceeds 5 percent with South Africa
In Sub Saharan Africa, there are a varying proportion of patients whose defaulting rate increased
from 11.3 percent to 26.9 percent, which is attributed to distance from the hospital, experiencing
side effects, having no family support, inadequate knowledge about tuberculosis treatment, and
In East Africa, the distribution of adherence to TB treatment varies from country to country for
among TB patients who opted for the home-based treatment under the PCT (Patient Centered
Treatment) approach (Mkopi et al, 2014). In Rwanda however, reported poor adherence to anti-
TB treatment as it was estimated to be at 10%. This was a reflection of many TB patients taking
less than 90% of the TB treatment. Poor adherence to anti TB treatment is an important
2
Kenya uses a standard six months treatment for TB as guided by WHO but treatment adherence
remains a major challenge to the effectiveness of treatment (WHO, 2013). Factors associated with
non-adherence can be categorized into Health- Care- System related or Individual (social
Economic or Behavioral) related (Ali & Prins, 2016). Other factors found to impact on adherence
were inadequate of knowledge about TB, smoking, distance travelled to collect medicine and
patient feeling well after few months of treatment (Kastien et al, 2016).
TB cases notified in Mombasa were 1067 with 600 occur in Port Reitz Sub County Hospital
(WHO, 2014). Out of the patients attending tuberculosis treatment in Port Reitz Sub County
Hospital, 35% of the patients default from treatment. However, this provides a perfect ground for
conducting research on factors influencing to TB treatment among patients attending Port Reitz
Treatment is availed free of charge to all TB patients and the disease being highly treatable, the
world should be TB free by 2030, among other epidemics (WHO, 2014). The national Strategic
Plan on TB in Kenya aims to reduce TB incidence by 5%, reducing mortality by 3%, and raising
treatment success to 95%, from 2014 figures, by 2018 (WHO, 2014). Adherence to TB treatment
continues to be one of the major obstacles that TB control programmed worldwide have to deal
2015). Defaulting can result in acquired drug resistance, which requires a prolonged period of
treatment with more expensive medicines than treatment for drug-susceptible TB (Caminero,
2014). A report issued in 2019 showed that the patients who attended TB treatment in Port Reitz
Sub County Hospital, 35% of TB patients defaulted (WHO, 2013) this report and statistics provide
3
a perfect ground for conducting a research on factor influencing adherence to TB treatment among
Treatment adherence is a key factor for treatment success and non-adherence is associated with
adverse outcome like highly mortality. The findings of the study will act as a source of empirical
data and reference point for other scholars interested in the field, particularly those who will be
among patients attending Port Reitz Sub County Hospital in Kenya. Furthermore, the results from
this study will be used to update and equip the health workers of Port Reitz Sub County Hospital
, with knowledge about factors influencing adherence to TB treatment among TB patients in order
to increase the level of adherence to TB treatment and also reduce on the number of patients lost
to follow and those who default the TB treatment, resulting in improving the general outcomes of
TB patients. The information will also offer useful information to the Ministry of Health.
What is the level of awareness of patient on tuberculosis treatment attending Port Reitz Sub
County Hospital?
What is the follow up care that supports patients adhering to tuberculosis treatment among
4
1.5 Objectives of the study
The main objective of this study is to determine the factors that influence adherence to tuberculosis
To examine the follow up care that supports patients adhering to tuberculosis treatment among
The scope of the study is to determine the factors that influence adherence to tuberculosis treatment
among patients in Port Reitz Sub County Hospital. The study targeted a total population of 51 TB
patients who attends TB clinic in Port Reitz Sub County Hospital. The research was carried out
5
Conceptual Framework
Knowledge
Awareness
education
source of information
Adherence to TB
Follow up Care treatment
Distance
Guidance and
counselling
Doctor-patient relationship
Waiting time
Attitude
6
CHAPTER TWO: LITERATURE REVIEW
INTRODUCTION
This chapter presented the literature review that was relevant to the factors that influence adherence
to tuberculosis treatment among patients in Port Reitz Sub County Hospital. It also looked at the
theories informing the study. The literature review is from other related studies that have been
carried out in Kenya and elsewhere in the world. It also has some related studies on specific
2.1.1 knowledge
Tuberculosis awareness is an effort to raise awareness of tuberculosis and reduce the disease
burden by educating people about its signs and symptoms, prevention measures and treatment
option. Most studies reviewed which directly explore the knowledge of patients towards TB are
drawn from developing countries where there is a high incidence of TB. Despite the international
attention of TB and DOTS, awareness of TB is not well established in Africa. There are still many
superstitions and cultural beliefs surrounding TB which hamper its prevention, diagnosis and
treatment (Nthaita, 2014). In a study done in Asmara Eritrea it was found that most of patients had
no knowledge about TB causation, transmission and length of treatment duration, most of patient’s
common reason for discontinuation is that they “felt cured” and did not know the standard
treatment duration should be at least 6 months (Frezghi H.G. et al, 2018). In comparison to a study
in Plateau state Nigeria, it was found that only 43.4% of patients were knowledgeable on actions
to take when missed their drugs or clinic (Luka Mangveep Ibrahim et al, 2014).
It has been reported that TB infected patients seek assistance for treatment when the disease is
well advanced and that this delay is the result of factors, such as a lack of knowledge, lack of
7
awareness of the significance of the symptoms (Bayouni et al, 2016). The fact that the disease is
transmitted by bacteria is important information not understood by many patients, and health care
providers often fail to give patients any in-depth explanation of disease causation (Bayouni et al,
2016). Patients believed that TB is a result of breaking cultural rules that demand abstinence from
sex after the death of a family member or after a woman has a spontaneous abortion. They believed
that only traditional healers could cure TB. Lack of knowledge (Edginto et al, 2014) about TB can
limit people’s ability to prevent its spread and seek treatment. People’s knowledge, attitudes, and
perceptions with respect to health in general and specific illness, such as TB, influences their
behavior (PEtrovici et al, 2015). People’s awareness and attitudes with respect to health in general
and specific illnesses, such as TB, influence their behavior (PEtrovici et al, 2015).
Level of education affects the extent of adherence to tuberculosis treatment. Patient’s level of
education has been strongly associated with adherence to treatment of tuberculosis with studies
from Eretria proving that patients who receive health information or education from health
facilities were more adherents than those who didn’t receive education (kebede et al, 2016).
According to a study carried out in Ilorin teaching hospital in Nigeria, it was stated that there was
statistically significant association level of education and treatment adherence among the TB
patients with adherence being higher among the illiterate people. In this study it was discovered
that patients who had no formal education were most likely to miss drugs accounting for 19.4
percent out of the 280 respondents than those with formal education (Bellos et al, 2014). In another
study that was carried out in the same hospital about adherence to TB therapy which included 544
TB patients and it was observed that, the greatest number of patients that missed drugs were those
8
with no formal education accounting for 19 percent. The study also noted out that patients with
tertiary education were less likely to miss their drugs accounting for 4.3 percent as compared to
those with no formal education with a percentage of 19.4 percent (Anyaike et al, 2013).
Availability of the source information about tuberculosis has influenced the adherence to
tuberculosis treatment. Healthcare providers are still patients preferred, most trusted information
source (Nthaita, 2014). Nonetheless, many patients use the internet as a source of information in
addition to their provider (Feather et al, 2016). One of the distinctive characteristics of the internet
is that it contains information that is often unverified, inaccurate, biased, or misleading and
difficult to comprehend (Langille et al, 2013).According to (Wallen et al, 2013) studies done in
Ethiopia, patients source of information included books, other patients attending TB clinics and
Mass media leaving out health care professionals who should be key informant to patient on
Follow up care is the act of making contact with a patient or a caregiver at later, specified date to
check on the patient’s progress since the last appointment. The distance and the counselling
2.2.1 Distance
In a study carried out in Argentina, it was observed that cost of transport and access to the health
care center greatly affected adherence to TB treatment among the TB patients whereby the risk for
defaulting from treatment increases as a result of economic barriers in accessing health care
facility. Most of the patients who had difficulties in accessing and meeting the transportation costs
9
were at a higher risk of non-adherence than those who never encountered such problem (Herrero
et al, 2015).
Also, other studies carried out in different parts of Argentina indicated that distance to the health
care facility and attitude of the health care workers influence the level of adherence to TB treatment
among the patients. A research study carried out in Ethiopia districts concerning the quality of
tuberculosis care and its association with treatment adherence indicated that out of the 44 health
facilities, 44 percent (18) health centers, the TB care providers were untrained and in 13 out of the
44 health facilities, daily outpatient care was not being given. The unavailability of daily TB care
at the health facility contributed to patients missing treatment, the health workers were usually
under supervised by the district TB control experts and some of them were unable to deal with the
patients minor illnesses as a result of these, TB patients were fond of missing their treatment and
out of 237 patients, 43 percent interrupted their treatment for more than 15 days and 30 percent
In a study in Nepal inconvenient opening times for TB clinics situated far from patients‟ homes
accounted for defaulting in 28% of non-compliant TB patients (Bam et al, 2015). Both studies
A study from Peshawar showed good treatment outcome in TB patients who received counseling.
Counseling is significantly beneficial in improving patient knowledge and behavior in all aspect:
disease, treatment and prevention. The counsellor gives information to families of affected to act
10
as agent of change, remove stigma, common misconception and promote treatment adherence,
Several studies have tried to look at the relationship of the doctor and patient to their health status,
seen as important to gain a better understanding of the causes associated with adverse health
outcomes, identifying patients at risk of such adverse outcomes and subsequently developing
A study carried out in Thailand aimed at determining the patient factors predicting successful
treatment. Out of 1,241 patients studied, 81% with good doctor-patient relationship and knowledge
of tuberculosis were successfully treated, the argument being that these factors are associated with
better compliance to TB treatment and subsequently treatment success (Bam et al, 2015) . Several
of treatment compliance (Winkvist et al, 2018). Meanwhile, a Malaysian study demonstrated that,
among other factors, non-compliance was associated with poor doctor-patient relationship
(O"Boyle et al , 2013). The patient waiting time and attitude affected the doctor relationship.
According to (Berkman, 2014),waiting time can be defined as objective evaluation of the quality
of services received against the individual expectations. In a study by (Kenagy et al, 2014),patients
this delays in services there is increasing effect of waiting time one of them being non adherence
to treatment. In Ethiopia, most of TB patients in attending clinics complained about time taken to
serve them verse time taken waiting to be served has a concern, they had to wait for more than 30
11
minutes before they were seen and due to this most of them fall in trap of defaulting treatment
because they felt like they did get enough time to interact with doctors rather than having long
waiting time hence unforeseen cost implications for those who use hired means of transports and
2.3.2 Attitude
Attitude of health workers to patients who attend TB clinics is one of major factors promoting to
non-adherence of those patients to treatment. In a study done in Plateau State Nigeria it was found
that only 74.3% of health care workers hard good attitude toward TB seeking treatment patients.
The study included the unfriendly attitude towards TB patients was a major barrier to patient’s
12
CHAPTER THREE: RESEARCH METHODOLOGY
Introduction
This chapter begins by addressing the research design of the study. It goes ahead and discusses the
target population, Sample size and Sampling Procedures and instruments. A method of pretesting
is reviewed and finally discusses the methods of data collection and data analysis methods used.
In this study a descriptive cross-sectional design was used. It allows one to collect quantitative
data, which was analyzed quantitatively using descriptive and inferential statistics (Saunders et al,
2010). Also allows to observe, describe and document aspect of a situation as it naturally occurs.
Port Reitz Sub County Hospital is based in Changamwe subcounty, Mombasa County. Its current
services include outpatient service, inpatients services, special clinic, MCH, CCC, nutrition
department laboratory, dental services, Intensive care services and bed capacity of 250 patients.
The main economic activity around Port Reitz Sub County Hospital is business trading, fishing
and tourism
The target population consist of patients attending tuberculosis clinic at Port Reitz Sub County
The study exclude patient who are not willing to participate and those who were critically ill.
13
3.4 Variables
Adherence to TB treatment.
Extent of knowledge
Follow up care
A simple random sampling method was used to get responses from the target population.it enables
each person to have an equal chance to participate in the study. The 51 respondents were divided
by the number of days which was 20 days, where each day 3 respondents were interviewed on
N=Z2 pq/d2
14
N=384
If the target population is 10,000 the required sample size will be smaller. In such case a final
Nf=n/1+n/N
n=384
Nf=384/1+384/60
nf=51 respondents
The data was collected using primary method. The study used interview schedule to collect
primary data from the respondents. The questions contained open-ended and closed-ended
questions. The interview was used since the literacy of the patients was not known. The questions
were structured in order to obtain information on the factors that influence adherence to
The researcher asked the consent from the respondent before interviewing. The researcher asked
the questions to the respondents as the researcher filled the interview schedule.
3.9 Pretesting
The research was pretested at Kinango Sub County hospital. 10% of the sample size were
administered with the interview schedule under supervision to stimulate formal data collection on
small scale to identify practical challenges with the regard to data collection instruments.
15
3.10 validity
Validity of tools was done by HRI experts to check whether the questions are consistent with
research objectives.
3.11 Reliability
Reliability of the tools was done during data collection by asking the respondents similar questions
The data that was collected from the interview schedule was analyzed using Microsoft excel.
Permit to conduct research was obtained from NACOSTI, a letter of authorization was obtained
from the principal KMTC Msambweni to Port Reitz Sub County Hospital administration and
Voluntary consent to participate was sought by explaining the benefits of the study, the rights
protection and manner that the study would be conducted appropriate to them and confidentiality
was obtained.
16
CHAPTER FOUR: FINDINGS, ANALYSIS AND PRESENTATION
This chapter presents all the finding of the study. The study was analyzed using descriptive
statistics, scientific calculator and a computer. Results were presented in form of tables, charts and
graphs. The research sought to collect data from respondents by use of interview schedule. The 51
printed interview schedules were correctly answered representing 100% response rate.
n=51
18-25 7 14%
26-33 14 27%
34-50 18 35%
Above 50 12 24%
Total 51 100%
Gender
Male 31 61%
Female 20 39%
Total 51 100%
Religion
Christianity 22 44%
Muslims 29 56%
Total 51 100%
17
Marital status
Single 15 30%
Married 26 50%
Widowed 6 12%
Divorced 4 8%
Total 51 100%
Employment status
Employed 14 27%
Unemployed 17 33%
Totals 51 100%
4.1 Awareness
n=51
level of education
3%
21%
primary
32%
secondary
college
44% university
18
In this figure above the most of the respondents 44% were educated up to secondary level, 32%
unto primary level,21% up to college level while the lowest was at the university level with 3% of
total respondents.
n=51
The table above, most of the respondents 76% knew about signs and symptoms of TB while 24%
didn’t knew,92% knew causes of TB while 8% didn’t knew what causes TB, 82% could correctly
identify that TB is cured within 6 months of adherence while 18% could not correctly identify the
19
4.1.3 Source of information
n=51
source of information
60% 57%
50%
40%
30%
20% 17%
13%
9%
10%
4%
0%
Healthcare providers fellow attending mass media internet book/magazine
patients
source of information
From the above figure, majority 57% of the respondents acquired information about TB from
healthcare wokers,17% heard from fellow TB attending patients, 13% heard from mass
media,9% form internet while 4 % acquired information on TB via reading books and magazine.
n=51
20
5-10km 8 16
11-15km 3 7
16-20km 0 0
In the table above, more than half of the respondents 77% said they travel less than 5km,16%
n=51
cost
2% 0%
12%
10%
walking distance
100-200
200-300
76% 300-400
more than 500
Figure above shows, 76% of the respondents walk to the facility for treatment,10% use Ksh 100-
200 to get to the hospital,12% use Ksh200-300 to get to the facility for treatment,2% use Ksh 300-
21
4.2.2 Counselling and Guidance
n=51
YES 49 94.2
NO 2 3.8
Above table, 94.2% respondents said they were guided and counselled on TB adherence while
3.8% of the respondents said they did not receive any guidance or counselling.
n=51
Friendly 19 37.2
Table above shows,52% of respondents perceived that staffs had good attitude since they were
friendly and payed time for patients’ inquiries while 48% perceived staffs to have poor attitude
22
since they were harsh and didn’t pay much attention to patients’ inquiries but only limited to
treatment.
n=51
respondents percentage
30 minutes -1hr 25 50
Table above shows 39% said they waited less than30 minutes,50% waited for 30 minutes to 1
23
CHAPTER FIVE: DISCUSSION, CONCLUSION AND
RECOMMENDATION
This chapter addresses discussion, conclusion and recommendation as per the objective of the
study. The purpose of this study was to determine factors influencing adherence to Tuberculosis
treatment among patients in Port Reitz Sub county hospital, Mombasa county.
5.1 Discussion
The findings show that 44% of the respondents were educated up to secondary level,32% and 3%
up to university level, these study finding agrees with another study done in Eretria proving that
patients who receive health information or from health facilities and attained higher education
level such as universities and colleges were more adherents than those who didn’t receive health
education or with primary level of education and below (kebede et al, 2016)
The study results revealed also that healthcare providers 57% were the main sources of information
where patients acquired information while 4 % acquired information about TB by reading books
and magazines. These finding disagrees with similar study done in Ethiopia, patients source of
information included books, other patients attending TB clinics and Mass media leaving out health
care professionals who should be key informant to patient on treatment adherence to TB (Wallen
et al, 2013) .
The findings also show that majority of respondents were knowledgeable about TB as 92% could
correctly identify its causes, 76% could identify the signs and symptoms of TB,82% of respondents
knew length of treatment while 90% knew how can be prevented, these results disagree with a
24
study done in Asmara Eretria where it was found that most of patients had no knowledge about
TB causation, transmission and length of treatment duration and did not know the standard
said they travelled 5-10km to get their drugs, 7% said 11-15km. These study findings disagree
with a study in Argentina which showed that most respondents walked for longer distances of
greater than 5 Km from the treatment site were being associated with poor adherence to TB
The findings of these study also revealed that 94.2% of the respondents said the doctor encourages
the patients to take their medicines as prescribed and 3.8% said the doctor does not encourage
them. These results are similar to another study done Peshawar in that revealed that 86% of the
respondents in the study said that health workers guided and counselled them on TB adherence
The findings showed the health care providers attitude influences the adherence to tuberculosis
treatment. Majority 52% of healthcare providers had poor attitude since they were harsh and didn’t
pay much attention to patients’ inquiries but only limited to treatment while 48% perceived that
staffs to have good attitude since they were friendly and payed time, these study disagrees to a
study done in Plateau State Nigeria it was found that only 74.3% of health care workers hard good
attitude toward TB seeking treatment patients (Luka Mangveep Ibrahim et al, 2014).
25
The finding also revealed that they usually wait for 30 minutes-1hour before being attended to
whenever they visit the health facility for the treatment. Majority 50% 30minutes 1 hour, 39% less
than 30 minutes and 11% more than 1 hour, these result findings conforms to another study in
Ethiopia where patients in TB clinics complained about time taken to serve them verse time taken
waiting to be served had a concern, they had to wait for more than 30 minutes before they were
seen and due to this most of them fall in trap of defaulting treatment because they felt like they
did get enough time to interact with doctors rather than having long waiting time hence unforeseen
cost implications for those who use hired means of transports and time wasting felt among the
5.2 Conclusion
On awareness, the study concludes that majority of tuberculosis patients were educated and had
attained up secondary level of education, most of respondents were knowledgeable at TB and their
The conclusion made on follow up care system its concluded that majority of the patients travelled
less than 5km distance and most of them it’s a walking distance to the health facility collect their
drugs while majority had to wait for long more than 30 minutes before being severed or clerked.
The conclusion made on doctor patient relationship majority of patients agreed that the health care
provider had Poor attitude towards TB patients whenever they visit the health facility for the
treatment. The study also showed that the respondents waited for 30 minutes to 1 hour before being
attended to.
26
5.3 Recommendation
Intensify the health education to communities and all TB patients, particularly at the beginning of
treatment, with the reinforcement at each visit using the language locally used. The information
should be complete encompassing duration of treatment and possible side effects and how to deal
with them, in order for patients to make their own judgements on their capabilities.
County ministry of health to set-up more TB treatment centers to cut down long distance and travel
cost experienced by patients in search for medication, furthermore hospital management to ensure
that guiding and counselling sessions offered regularly to all TB patients so as to improve on
Healthcare providers to be motivated to work through seminars, incentives, timely salaries and
provided with good working conditions so as to remain in good attitude mode while serving their
clients, Furthermore, patients waiting time at the TB clinic to be reduced by providing more health
care workers and early scheduling of clinics and also initiate flexible hours for tuberculosis
A study to be conducted to investigate how availability drugs and staffs influence TB treatment
adherence.
27
REFERENCES
Ali & Prins. (2016). factors associated with non adherence among patients attenting tuberculosis
Anyaike et al. (2013). education level on TB patient attending treatment of tuberculosis. ethiopia:
Public health.
Bayouni et al. (2016). lack of knowledge on Tuberculosis among patients attending tuberculosis
Bellos et al. (2014). Level of education on TB patients attending treatment . international journal
Berkman. (2014). Doctor patient relationship on TB patient. geneva: world health organization.
Caminero. (2014). factors influencing patients from defaulting of tuberculosis treatment. mexico:
Castel nuovo. B et al. (2014). factors influencing adherence to tuberculosis treatment . The
Dhanaraj B et al. (2015). Prevalence of pulmonary TB. India: Biomedical center of public health.
DLTLD. (2012).
Edginto et al. (2014). Beliefs on tuberculosis treatment among patients . America: Am J med .
Feather et al. (2016). source of information on TB adherence treatment. International Journal for
Frezghi H.G. et al. (2018). knowledge on TB. Biomedical center journal of journal health, 4:68.
28
Herrero et al. (2015). patient follow up care on TB treatment. ethiopia: plos medicine.
Kastien et al. (2016). knowledge factor influencing to tuberculosis treatment among patients.
Kayigamba et al. (2015). Factors influencing poor adherence to TB treatment amomg pulmonary
kebede et al. (2016). level of education on TB patients attending treatment. ethiopia: BMC Public
health.
Kenagy et al. (2014). patients waiting time on treatment of TB. journal of american association,
296-2767.
Langille et al. (2013). source of information on TB adherence treatment. int J Equitybhealth, 10:8.
Luka Mangveep Ibrahim et al. (2014). knowledge adherence on TB treatment and perception. Trop
Mkopi et al. (2014). Patient centered treatment of tuberculosis. international journal for
tuberculosis, 6(4);307-312.
Nthaita. (2014). knowledge on tuberculosis and practices among patients with tuberculosis
attending treatment. international journal for tuberculosis and lung disease, 10:1479-1483.
Osterberg & Blaschke. (2015). Adherence to TB treatment. private practitioners and public health
PEtrovici et al. (2015). Knowledge and attitude on TB in pastoral communities in the middle and
29
Saunders et al. (2010). descriptive and inferential statistics. geneva: qualitative health research .
Tang, Zhao, Wang &Yin. (2015). Effectivenness of TB treatment. int journal tuberc lungs Dis,
7(11).
WHO. (2019). Global Tuberculosis treatment on patients attending tuberculosis clinics. world
WHO. (2020). Global health tuberculosis treatment report. GENEVA SWITZERLAND: world
health organization.
Winkvist et al. (2018). doctor patient realtionship on TB treatment. The southern journal of
30
INTERVIEW SCHEDULE
My name is Verah Gesare Nyaenya, a Diploma student of health records and information
interview you. Information given will be treated with utmost confidentiality. Your cooperation
a) 18-25 ()
b) 26-33 ()
c) 34-50 ()
d) above 50 ()
a) male ()
b) female ()
a) Christianity ()
b) Islamic ()
c) Hindu ()
d) non believer ()
a) single ()
31
b) married ()
c) widowed ()
d) divorced ()
a) employed ()
b) self-employed ()
c) unemployed ()
a) primary ()
b) secondary ()
c) college ()
d) university ()
a) Yes ()
b) No ()
a) Healthcare providers ()
c) Internet ()
a) Yes ()
32
b) No ()
a) Yes ()
b) No ()
a) 1 month
b) 3 months
c) 6 months
d) 12 months
10. Is TB preventable?
a) Yes ()
b) No ()
c) Complete treatment ()
33
SECTION B: FOLLOW-UP CARE SYSTEM
11. How much distance do you travel to collect your TB medicines (km)?
b) 5-10 km ()
c) 11-15 km ()
d) 16-20 km ()
12. How much does it cost you to get to the health facility (Ksh)
a) Walking distance ()
b) 100-200 ()
c) 200-300 ()
d) 300-400 ()
13. Do your doctor always encourage you to take the medicine as prescribed without skipping
a) Yes ()
b) no ()
15. Did the doctor issue you any TB card that shows for your check up?
a) Yes ()
b) no ()
34
SECTION D: DOCTOR PATIENT RELATIONSHIP
16. How do you find the health care provider when you visit the hospital?
a) Friendly ()
c) harsh ()
b) 30 mins -1 hr ()
c) more than 1 hr ()
THANK YOU
35
APENDIX I: REASERCH PERMIT
36
APPENDIX II: NACOSTI LETTER
37
REPORTING DATA DATA PROPOSAL TOPIC MONTH
YEAR
AND ANALYSIS COLLECTION WRITING IDENTIFI
DESERTATI CATION
ON JAN 2021
FEB
MAR
APR
MAY
38
JUN
JUL
AUG
APPENDIX III: WORK PLAN
SEP
OCT
NOV
DEC
2022
JAN
APPENDIX IV: BUDGET
Pens 4 20 80
Pencils 5 20 100
Ruler 1 30 30
Rubber 1 20 20
Total =24,110/-
39
APPENDIX V: MAP
40
41