Socio-economic status and adherence to tuberculosis treatment: a case-control study in a district of Nepal.
METHODS
A western hill district in Nepal, where tuberculosis (TB) treatment under DOTS was offered by the regional tuberculosis centre, two primary health centres, eight health posts, three sub-health posts and one ward of sub-metropolitan Pokhara.


OBJECTIVE
To analyse the contribution of socioeconomic status to non-adherence to DOTS.


METHODS
Case-control study. Data were collected by questionnaire-based face-to-face interviews. The study sample consisted of 50 cases and 100 controls. The participation rate was 80% for cases (non-adherents) and 95% for controls.


RESULTS
Logistic regression analysis showed that the risk of non-adherence to TB treatment was significantly associated with unemployment (odds ratio [OR] 9.2), low status occupation (OR 4.4), low annual income (OR 5.4), and cost of travel to the TB treatment facility (OR 3.0). Factors significant in the bivariate analyses--living conditions, literacy and difficulty in financing treatment--were not found to be significantly associated with non-adherence when adjusted for other risk factors in the multivariate regression model.


CONCLUSIONS
Low socio-economic status and particularly lack of money are important risk factors for non-adherence to TB treatment in a poor country such as Nepal.
Mishra
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Department of Social Pharmacy, Danish University of Pharmaceutical Sciences, Copenhagen, Denmark. mishramp2000@yahoo.com
Hansen
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Sabroe
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Kafle
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D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009390:Nepal / Q000453:epidemiology; D010349:Patient Compliance; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents