Keywords
Abstract
Objective: This study aimed to assess Factors Affecting Non-Adherence to Pulmonary Tuberculosis Treatment Among Patients atthe Institute of Chest Diseases, Kotri.
Study Design: An analytical cross-sectional study was conducted.
Place and duration of study: An analytical cross-sectional study was conducted using a quantitative approach among 212 TB patients registered at a Directly Observed Treatment.
Material and Methods: An analytical cross-sectional study was conducted using a quantitative approach among 212 TB patients registered at a Directly Observed Treatment, Short-course (DOTS) center in Kotri, Sindh, Pakistan. Data were collected on demographics, socio-economic status, knowledge about TB, and self-reported adherence levels. Statistical analyses, including Chi square tests, were applied to assess associations between adherence and selected variables.
Results: The majority of participants (86.8%) demonstrated low (44.3%) or medium (42.5%) adherence, while only 13.2% achieved high adherence. The mean age of participants was 43.69 ± 10.2years. Age did not show a significant relationship with adherence; however, non-adherence was strongly associated (p < 0.001) with male gender, marital status, low education, reduced family income, and rural occupation. Additionally, systemic barriers such as inadequate follow-up and lack of counseling significantly contributed to poor adherence.
Conclusion: The findings highlight that socio-demographic, economic, knowledge-related, and systemic challenges are strongly linked to poor TB treatment adherence. Addressing these through community-based, patient-centered interventions focusing on financial support, improved access to care, and enhanced health education is essential to improve adherence and reduce TB-related morbidity and mortality in high-burden regions such as Kotri, Sindh, Pakistan.
Keywords: Tuberculosis, Treatment Non-Adherence, Factors, Adherence , Knowledge
References
Chen Z, Wang T, Du J, Sun L, Wang G, Ni R, et al. Decoding the WHO global tuberculosis report 2024: a critical analysis of global and Chinese key data. Zoonoses. 2025;5(1):999.
Islam MS. Tuberculosis infection prevention and control policies, practices, and the risk of TB infection among
healthcare workers: University of New South Wales (Australia); 2021.
van den Boom M, Bennani K, Sismanidis C, Gunneberg C, Khawaja L, Safdar MA, et al. 2022 TB programme review in Pakistan: strengthening governance, with better patient diagnosis and treatment. IJTLD Open. 2024;1(3):136-43
Mehr M, Parveen H, Nisa Q, Jadoon A. Assessment of Medication Adherence Using Malaysia Medication
Adherence Assessment Tool in a Tertiary Care Hospital in Peshawar, Pakistan.
Ali A, Prins MH. Patient characteristics associated with nonadherence to tuberculosis treatment: a systematic review. Journal of Tuberculosis Research. 2020;8(2):73-92
Estaji F, Kamali A, Keikha M. Strengthening the global Response to Tuberculosis: Insights from the 2024 WHO
global TB report. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2025;39:100522
Nhassengo PP. The TB-poverty cycle: dynamics, determinants, and consequences of economic hardship faced
by people with TB in Mozambique: Karolinska Institutet; 2024.
Chibasa M, Kazonga E, Chilinya M, Chirambo W, Matekenya S, Sikobela S, et al. Factors Associated with Poor Treatment Outcomes in Newly Diagnosed Tuberculosis Patients in Sub Sahara Africa: A Systematic Review. 2024.
van der Werf MJ, Langendam MW, Huitric E, Manissero D. Multidrug resistance after inappropriate tuberculosis
treatment: a meta-analysis. European Respiratory Journal. 2012;39(6):1511-9.
Shringarpure K, Gurumurthy M, Sagili KD, Taylor M, Garner P, Tonsing J, et al. Patient adherence to tuberculosis treatment in the Indian subcontinent: systematic review and meta synthesis of qualitative 2023;13(5):e063926.
research. BMJ open.
Opperman M, Du Preez I. Factors contributing to pulmonary TB treatment lost to follow-up in developing countries: an overview. African journal of infectious diseases. 2023;17(1):60-73.
Yousaf R, Rana SM, Qureshi E, Hanif A, Nargus S, Khan MS, et al. Factors Associated With Non‐Adherence to Anti
Tuberculosis Treatment Among Patients in Lahore, Pakistan. International Journal of Current Research and Review.
;14(15):47.
Hansun S, Argha A, Bakhshayeshi I, Wicaksana A, Alinejad Rokny H, Fox GJ, et al. Diagnostic Performance of Artificial Intelligence–Based Methods for Tuberculosis Detection: Systematic Review. Journal of medical Internet research. 2025;27:e69068.
Habib SS, Jamal WZ, Zaidi SMA, Siddiqui J-U-R, Khan HM, Creswell J, et al. Barriers to access of healthcare services for rural women—applying gender lens on TB in a rural district of Sindh, Pakistan. International journal of environmental research and public health. 2021;18(19):10102.
Organization WH. Guidance on social protection for people affected by tuberculosis: World Health Organization; 2024.
Reupert A, Gladstone B, Helena Hine R, Yates S, McGaw V, Charles G, et al. Stigma in relation to families living with parental mental illness: An integrative review. International Journal of Mental Health Nursing. 2021;30(1):6-26.
Ullah H, Ahmed H, Salman A, Iqbal R, Hussaini SJ, Malikzai A. The rising tide of tuberculosis in Pakistan: Factors, impact, and multi‐faceted approaches for prevention and control. Health Science Reports. 2024;7(10):e70130.
Afşin E, Bolu F, Kaymak Ş, Özsarı E, Konuk S. Retrospective evaluation of 5-year tuberculosis cases in Bolu, Turkey (before, during and after the COVID-19 pandemic). Respiratory medicine. 2025;247:108287.
19.Hou Y, Zhang F, Sun H, Liang T, Sun Z. Silver-loaded hollow copper sulfide particles for antibacterial therapy. 2025.
Al Awaidy S, Khamis F, Al Mujeini S, Al Salman J, Al Tawfiq JA. Ending tuberculosis in Gulf Cooperation Council
countries: an overview of the WHO End TB Strategy 2025 milestones. IJID regions. 2025;16:100681.
Singh S. End Tuberculosis: Challenges and Opportunities. Tuberculosis research and treatment 024; 2024:2307742.Cho Y, McKay MJ, Zadro JR, Hoffmann T, Maher CG, Harris I, et al. Development of a patient
decision aid for people with chronic low back pain and degenerative disc disease considering lumbar fusion: A
mixed-methods study. Musculoskeletal Science and Practice. 2025;76:103261.
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