title: Levels of tuberculosis treatment adherence among sputum smear positive pulmonary tuberculosis patients attending care at Zomba Central hospital, southern Malawi, 2007-2008.
abstract: BACKGROUND
  Despite great efforts to control Tuberculosis (TB), progress is compromised by low adherence to medication, leading to prolonged duration of infectiousness and continued transmission. Investigating low adherence is of high importance from TB programmatic perspective. Though data on actual days of missed treatment exist, the effect of such on TB cure rates has not been investigated.
  
  
  METHODS
  TB operational research data were extracted for smear-positive pulmonary TB patients registered at Zomba Central hospital, Malawi from January 2007 to December 2008.
  
  
  RESULTS
  Of the 524 patients, 302 (57.6%) were males and 340 (64.9%) fully adhered to treatment. Excluding 5 individuals with missing data on cure, four hundred and eighty-one (92.7%) were cured of TB, and of these 162 (33.7%) missed at least one day of treatment. Respectively, 49/64 (76.6%) and 71/76 (93.4%) of those who missed treatment in the intensive and continuation phases were cured of TB (p = 0.005). The adjusted logistic regression analysis showed that those who missed 15-29 days of treatment (OR = 0.04, 95% CI: 0.01, 0.14) were less likely to be cured of TB compared with those who fully adhered.
  
  
  CONCLUSIONS
  Treatment non-adherence was high and was observed even within the first 2 months of treatment. Thus, even at an earlier critical stage of treatment, simple algorithms need to be developed to identify and monitor patients at higher risk of non-adherence. Efforts on treatment compliance counselling should focus on enhanced counselling to improve adherence during the intensive treatment phase.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand (Wits), Johannesburg, South Africa. tobias.chirwa@wits.ac.za
authors.forename: Tobias
authors.initials: T
authors.lastname: Chirwa
authors.forename: Peter
authors.initials: P
authors.lastname: Nyasulu
authors.forename: Esnat
authors.initials: E
authors.lastname: Chirwa
authors.forename: Akeem
authors.initials: A
authors.lastname: Ketlogetswe
authors.forename: George
authors.initials: G
authors.lastname: Bello
authors.forename: Isiah
authors.initials: I
authors.lastname: Dambe
authors.forename: Dennis
authors.initials: D
authors.lastname: Ndalama
authors.forename: Martias
authors.initials: M
authors.lastname: Joshua
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D013183:Sputum / Q000382:microbiology*; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology*