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WHO guidelines for treatment of tuberculosis: the missing links

Atif M, Sulaiman SA, Shafie AA, Ali I, Hassali MA, Saleem F

Int J Clin Pharm, 2012 Aug;34(4):506-9.
PMID: 22706597 DOI: 10.1007/s11096-012-9657-8

Worldwide, the treatment of tuberculosis is based on evidence-based guidelines developed by the World Health Organization (WHO) for national tuberculosis programs. However, the importance of health related quality of life, the adequate management of side effects associated with antituberculosis drugs and the elaboration of tuberculosis treatment outcome categories are a few issues that need to be addressed in forthcoming WHO guidelines for the treatment of tuberculosis.

Matched MeSH terms: Tuberculosis/psychology*
Fulltext Evaluation of Health-Related Quality of Life among Tuberculosis Patients in Two Cities in Yemen

Jaber AA, Khan AH, Syed Sulaiman SA, Ahmad N, Anaam MS

PLoS One, 2016;11(6):e0156258.
PMID: 27257990 DOI: 10.1371/journal.pone.0156258

BACKGROUND: The health-related quality of life (HRQoL) of Tuberculosis (TB) patients is important because it directly influences the outcome of TB patients in several aspects. The current study aims to evaluate and to find the factors influencing the HRQoL of TB patients in two major TB-prevalent cities (Taiz and Alhodidah) in Yemen.
METHODS: A prospective study was conducted, and all TB patients meeting the HRQoL criteria were asked to complete the HRQoL SF-36 survey. The records of TB patients were examined for disease confirmation, and a follow-up was consequently performed for patients during treatment between March 2013 and February 2014 in Taiz and Alhodidah Cities. HRQol scores were calculated by using QM scoring software version 4.5, in which the physical component score (PCS) and mental component score (MCS) were obtained. The scores obtained between 47-53 normal based score (NBS) were considered equivalent to the US normal score. Low scores indicate the poor health situation of TB patients.
RESULTS: A total of 243 TB patients enrolled in the study at the beginning of the treatment. A total of 235 and 197 TB patients completed the questionnaire at the end of the intensive phase (I.P.) and continuation phase (C.P.), respectively. The final dropout rate was 16.2%. The mean PCS and MCS scores at the beginning of treatment were low, thus showing the poor health situation of TB patients. The mean PCS scores at the beginning of treatment, end of I.P., and end of treatment were (36.1), (44.9), and (48), respectively. Moreover, the mean MCS score at the beginning of treatment, end of I.P., and end of treatment were (35.1), (42.2), and (44.3), respectively. The result shows that significant increases are observed at the end of I.P. for PCS and MCS because of the treatment and slight changes at the end of C.P. Despite this finding, the MCS score remains below the normal range (47), thus indicating a significant risk of depression among TB patients. Furthermore, general linear repeated measure ANOVA was performed for selected variables, to examine the changes of PCS and MCS over time. It was found that Alhodiah city, chewing khat habit, stigmatization, and duration of treatment more than six months were greatly associated with low mean MCS score of TB patient, indicating great risk of depression which may result in poor treatment outcome.
CONCLUSION: TB patients in Yemen were found to have poor QoL, with a significant likelihood of depression. Highly risk depression was found among TB patients in Alhodiah city, khat chewers, stigmatization and having a duration of treatment more than 6 months. Therefore, additional efforts should be made to improve their QoL because it may affect the final clinical outcome of patients.

Matched MeSH terms: Tuberculosis/psychology
Fulltext Factors affecting patient compliance with anti-tuberculosis chemotherapy using the directly observed treatment, short-course strategy (DOTS)

O'Boyle SJ, Power JJ, Ibrahim MY, Watson JP

Int J Tuberc Lung Dis, 2002 Apr;6(4):307-12.
PMID: 11936739

SETTING: Kota Kinabalu and surrounding communities in Sabah, Malaysia.
OBJECTIVES: To establish factors affecting compliance of patients with anti-tuberculosis chemotherapy, their knowledge of the disease, and views on improving the DOTS strategy.
DESIGN: Interviews with compliant patients attending clinics for DOTS treatment and with non-compliant patients in their homes, in August and September 2000.
RESULTS: A total of 63 compliant and 23 non-compliant patients were interviewed. For non-compliant patients, reaching the treatment centre entailed greater cost (P < 0.005) and travel time (P < 0.005) compared to compliant patients. Cost of transport was the reason most frequently given for non-attendance. Non-compliant patients were more likely to have completed secondary education (P < 0.05), and to be working (P < 0.01). More non-compliant patients had family members who had had the disease (P < 0.01). There was no difference between the groups for overall tuberculosis knowledge scores; however, non-compliant patients were more likely to think that treatment could be stopped once they were symptom free (P < 0.01). Most patients (73%) felt that the DOTS system could be improved by provision of more information about tuberculosis.
CONCLUSION: Compliance with DOTS in the Kota Kinabalu area is affected by travel expenses, time spent travelling to treatment centres, and having family members who have had the disease. Patients would like more information on tuberculosis.
Study site: Tuberculosis clinics, Kota Kinabalu, Malaysia

Matched MeSH terms: Tuberculosis/psychology*
Fulltext An exploration of disease awareness among tuberculosis patients: The empirical link between attitude and self-preventive care

Mokhtar KS, Rahman NA, Haron MS, Rahman NHA

J Infect Dev Ctries, 2020 04 30;14(4):349-359.
PMID: 32379711 DOI: 10.3855/jidc.11583

INTRODUCTION: The prevalence of tuberculosis (TB) remains alarmingly high in developing countries, including Malaysia. Recognised as the leading global infectious disease, untreated TB can be fatal. TB is easily spread through the air, and any close contact with a TB patient can put others at risk. This study therefore aimed to investigate the level of awareness of TB among TB patients and how their attitudes affect self-preventive healthcare.
METHODOLOGY: This cross-sectional study was conducted using a validated self-administered questionnaire at 18 hospitals in six states of Malaysia, namely, Selangor, Kuala Lumpur, Penang, Kelantan, Sabah, and Sarawak in 2015. The study sample comprised 1600 TB patients who were randomly selected using data obtained from the Disease Control Division, Ministry of Health Malaysia. A total of 1368 of the completed questionnaires were considered usable and included in the statistical analysis.
RESULTS: Overall, the level of TB awareness was found to be high, and the respondents possessed positive attitudes towards TB and health-seeking behaviours. Self-preventive care among the TB patients was determined as being at a moderate level. With regard to contact with others, the patients were more comfortable around their families than their friends and neighbours.
CONCLUSIONS: More health education programmes are recommended to cultivate positive attitudes towards TB, to encourage communities to have a better understanding of TB, and to create awareness among patients of the proper ways to practice self-preventive care.

Matched MeSH terms: Tuberculosis/psychology*
SF-36v2 norms and its' discriminative properties among healthy households of tuberculosis patients in Malaysia

Atif M, Sulaiman SA, Shafie AA, Asif M, Ahmad N

Qual Life Res, 2013 Oct;22(8):1955-64.
PMID: 23239084 DOI: 10.1007/s11136-012-0337-x

BACKGROUND: The aim of the study was to obtain norms of the SF-36v2 health survey and the association of summary component scores with socio-demographic variables in healthy households of tuberculosis (TB) patients.
DESIGN: All household members (18 years and above; healthy; literate) of registered tuberculosis patients who came for contact tracing during March 2010 to February 2011 at the respiratory clinic of Penang General Hospital were invited to complete the SF-36v2 health survey using the official translation of the questionnaire in Malay, Mandarin, Tamil and English. Scoring of the questionnaire was done using Quality Metric's QM Certified Scoring Software version 4. Multivariate analysis was conducted to uncover the predictors of physical and mental health.
RESULTS: A total of 649 eligible respondents were approached, while 525 agreed to participate in the study (response rate = 80.1 %). Out of consenting respondents, 46.5 % were male and only 5.3 % were over 75 years. Internal consistencies met the minimum criteria (α > 0.7). Reliability coefficients of the scales were always less than their own reliability coefficients. Mean physical component summary scale scores were equivalent to United States general population norms. However, there was a difference of more than three norm-based scoring points for mean mental component summary scores indicating poor mental health. A notable proportion of the respondents was at the risk of depression. Respondents aged 75 years and above (p = 0.001; OR 32.847), widow (p = 0.013; OR 2.599) and postgraduates (p < 0.001; OR 7.865) were predictors of poor physical health while unemployment (p = 0.033; OR 1.721) was the only predictor of poor mental health.
CONCLUSION: The SF-36v2 is a valid instrument to assess HRQoL among the households of TB patients. Study findings indicate the existence of poor mental health and risk of depression among family caregivers of TB patients. We therefore recommend that caregivers of TB patients to be offered intensive support and special attention to cope with these emotional problems.
Study site: Respiratory clinic, Hospital Pulau Pinang, Malaysia

Matched MeSH terms: Tuberculosis/psychology*
Fulltext Attitudes and knowledge of newly diagnosed tuberculosis patients regarding the disease, and factors affecting treatment compliance

Liam CK, Lim KH, Wong CM, Tang BG

Int J Tuberc Lung Dis, 1999 Apr;3(4):300-9.
PMID: 10206500

SETTING: An urban university teaching hospital.
OBJECTIVES: To determine patients' attitudes to tuberculosis and their knowledge of the disease, and factors associated with treatment compliance.
DESIGN: All adult patients commenced on treatment for tuberculosis from September 1994 to February 1996 were interviewed on initiation of treatment. To assess patient compliance with treatment, hospital clinical records were reviewed retrospectively.
RESULTS: A total of 135 patients with a mean age (±SD) of 41.9 (±17.4) years (range 15–84 years) were interviewed. The patients had limited understanding and knowledge about tuberculosis. There was a negative correlation between patient age and tuberculosis knowledge score (r = −0.18, P = 0.038). Patients with tertiary education had better knowledge than the others. Of 118 patients who were followed-up in our chest clinic, 80 (67.8%) completed the prescribed treatment. Compliance with treatment and follow-up was not affected by age, sex, ethnic group, educational level, occupation, extent of knowledge, tuberculosis symptoms, hospitalisation for tuberculosis or duration of the prescribed treatment regimen. There was a trend toward poorer compliance among patients who equated disappearance of tuberculosis symptoms with cure of the disease.
CONCLUSIONS: Malaysian patients with newly diagnosed tuberculosis attending a university teaching hospital had misconceptions and limited knowledge about the disease and its treatment. Educational background was an important determinant of a patient's level of knowledge about tuberculosis. Compliance was not affected by patient characteristics. Adequate counselling and education of patients and close relatives on tuberculosis and the necessity for prolonged treatment may help to improve treatment compliance.
Study site: Chest clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Tuberculosis/psychology*
Fulltext The SCIDOTS Project: evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

Awaisu A, Nik Mohamed MH, Mohamad Noordin N, Abd Aziz N, Syed Sulaiman SA, Muttalif AR, et al.

Subst Abuse Treat Prev Policy, 2011;6:26.
PMID: 21943384 DOI: 10.1186/1747-597X-6-26

There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.

Matched MeSH terms: Tuberculosis/psychology*