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Free Content Socio-economic status and adherence to tuberculosis treatment: a case-control study in a district of Nepal

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SETTING: 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 socio-economic status to non-adherence to DOTS.

DESIGN: 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.

CONCLUSION: 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.
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Keywords: Nepal; case-control study; non-adherence; socio-economic status; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Social Pharmacy, Danish University of Pharmaceutical Sciences, Copenhagen, Denmark; and Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal 2: Department of Social Pharmacy, Danish University of Pharmaceutical Sciences, Copenhagen, Denmark 3: Department of Epidemiology and Social Medicine, Aarhus University, Aarhus, Denmark 4: Department of Clinical Pharmacology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Publication date: 01 October 2005

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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