Article Text


Epidemiology and policy
P1-67 Factors affecting patient's adherence to directly observed treatment (DOT) care practices in Dhaka city
  1. M A Hafez1,
  2. M Shahjahan1,
  3. M S Flora2,
  4. A Afroz1,
  5. K Kobura1,
  6. S M Satter3,
  7. S J Mumu1,
  8. A Akhter1,
  9. F Rahman1,
  10. N Sumi1,
  11. K Fatema1
  1. 1Bangladesh Institute of Health Sciences (BIHS), Dhaka, Bangladesh
  2. 2National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh
  3. 3International Center for Diarrhoeal Disease Research, (ICDDR), Dhaka, Bangladesh


Introduction Directly Observed Treatment Short course (DOTS) was introduced in Bangladesh in 1993. Thereafter case detection and cure rate have increased remarkably. This cross sectional study aimed to estimate proportion of patients adhering to DOT and its influencing factors.

Method A two-stage cluster sampling method was followed. Dhaka city has 90 wards and 159 clinics providing DOT service of which 30 wards (clusters) were selected using systematic sampling technique. A total of 215 Pulmonary TB cases aged 315 years, registered with all the 40 clinics of these 30 clusters were interviewed.

Results Of the respondents 61% were males. About 65% were aged between 20 and 39 years, mean age 31 (SD±12.6) years, about 50% had little or no education with average monthly income US$ 152 (SD±110) and average family size 5 (range: 1–15) living in very poor housing condition. At the time of diagnosis 59% of the patients were smear +ve. Fifty-two per cent respondents took drug at centre and 48% at home. Adherence rate at clinic was 100% and at home 66%—overall 84% (95% CI 79.1 to 88.9) had adhered to DOT. Association was found between adherence and smear type at start, clinic type (govt or private) and family history of TB (p<0.05). Binary logistic regression suggests type of smear and family history of TB as correlates of adherence.

Conclusion Although respondents belong to low socio-demographic status, adherence rate seems satisfactory. But home level adherence was low. Creation of awareness and appropriate monitoring might improve the situation.

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