TABLE OF CONTENTS
ABSTRACT ......................................................................................................................................... i
COPYRIGHT © 2017 ........................................................................................................................ iii
AUTHORIZATION FOR THE STUDY .................................................................................................. iv
AUTHOR’S DECLARATION....................................................................................................... iv
SUPERVISORS’ APPROVAL ....................................................................................................... v
DEDICATION.................................................................................................................................... vi
ACKNOWLEDGEMENT.....................................................................................................................vii
LIST OF TABLES.................................................................................................................................xi
LIST OF FIGURES..............................................................................................................................xii
KEY TERMS .....................................................................................................................................xiii
LIST OF ABBREVIATION..................................................................................................................xiv
CHAPTER ONE: INTRODUCTION....................................................................................................... 1
1.0 Introduction............................................................................................................................... 1
1.1 Background of the study............................................................................................................ 1
1.2 Problem Statement.................................................................................................................... 4
1.3 Purpose of the study.................................................................................................................. 5
1.4 Specific objectives...................................................................................................................... 5
CHAPTER TWO: LITERATURE REVIEW.............................................................................................. 7
2.1 Introduction............................................................................................................................... 7
2.1 Factors contributing to non-adherence with treatment among TB patients............................ 7
2.2 Prevention and Treatment of drug-resistant TB........................................................................ 9
CHAPTER THREE: METHODOLOGY................................................................................................. 12
3.1 Introduction............................................................................................................................. 12
ix
3.2 Study design and rationale ...................................................................................................... 12
3.3 Study setting and rationale...................................................................................................... 12
3.4 Study Population...................................................................................................................... 13
3.4.1 Sample size determination ................................................................................................... 13
3.4.2 Sampling procedure.............................................................................................................. 14
3.4.3 Inclusion Criteria................................................................................................................... 14
3.4.4 Exclusion ............................................................................................................................... 14
3.5 Definitions of variables............................................................................................................ 15
3.5.1 Independent variable............................................................................................................ 15
3.6 Research instruments.............................................................................................................. 15
3.7 Data collection procedure ....................................................................................................... 15
3.7.1 Data management ................................................................................................................ 16
3.7.2 Data analysis......................................................................................................................... 16
3.8 Ethical consideration ............................................................................................................... 16
3.9 Limitations of the study ........................................................................................................... 17
3.10 Dissemination of the results.................................................................................................. 17
CHAPTER FOUR: RESULTS .............................................................................................................. 18
4.0 Description of the sample........................................................................................................ 18
4.1 Demographic characteristics ................................................................................................... 18
4.2.1 Factors contributing to non-adherence with treatment among TB patients in Mbarara
Regional Referral Hospital ............................................................................................................. 20
4.2.2 Challenges limiting TB Patients from regular access to treatment ...................................... 22
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4.3.1 The treatment and prevention measures put in place to control the prevalence of drug
resistance to TB in Mbarara Regional Referral Hospital................................................................ 23
4.3.2 How drug resistance to Tuberculosis treatment can be reduced ........................................ 24
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS TO THE STUDY FINDINGS
....................................................................................................................................................... 26
5.0 Introduction............................................................................................................................. 26
5.1 Discussion of the findings........................................................................................................ 26
5.1.1 Factors contributing to non-adherence to treatment among TB patients........................... 26
5.1.2 Treatment and prevention measures put in place to control the prevalence of drug resistance.
....................................................................................................................................................... 29
5.2 Conclusion................................................................................................................................ 30
5.3 Recommendations................................................................................................................... 31
5.4 Implications to Nursing Practice.............................................................................................. 32
REFERENCES................................................................................................................................... 33
APPENDICES................................................................................................................................... 36
APPENDIX I: CONSENT FORM ........................................................................................................ 36
APPENDIX II: EBARUHA YOKWIKIIRIZANA...................................................................................... 37
APPENDIX III: QUESTIONNIARE FOR PATIENTS.............................................................................. 38
APPENDIX IV: EBIBUUZO BYA ABARWAIRE.................................................................................... 41
APPENDIX V: MAP OF UGANDA SHOWING MBARARA DISTRICT .................................................. 45
APPENDIX VI: MAP OF MBARARA MUNICIPALITY SHOWING MBARARA REGIONAL REFERRAL
HOSPITAL ....................................................................................................................................... 46
APPENDIX VII: ACCEPTANCE LETTER.............................................................................................. 47
ABSTRACT Drug-resistant TB occurs when bacteria become resistant to the drugs used to treat TB. Drug resistance among tuberculosis patients is an increasing phenomenon worldwide. Although tuberculosis is a curable and preventable disease defaulting from treatment can prolong infectiousness leading to increased transmission, relapse and death. Uganda is one of the 22 high tuberculosis (TB) burden countries in the world. The multidrug resistance TB among previously treated patients is still high at 25.3% and raises concerns. This study therefore, focused on assessing the factors contributing to drug resistance to TB in Mbarara Regional Referral. The study covered a sample of 34 respondents out of the targeted 45 respondents. TB infected male and female adult patients were selected at random from the list of patients recorded in the patients’ record book at Mbarara Regional Referral hospital and acted as a representative sample for the study. Risk factors for non-adherence to TB resistance included; irregular supply of anti-TB drugs and laboratory reagents, shortage of trained health workers, poor commitment of health workers, lack of adherence to TB treatment guideline and lack of family support as well as alcohol consumption and smoking. While studying the TB control it was noted that TB diagnostic services and treatments were provided free of cost at Directly Observed Therapy especially at the hospitals run by the government like Mbarara Regional Referral Hospital. It was also noted that family support received by patients play important role in improving treatment adherence. However, there was still a problem of patient follow-up. Treatment providers should spend adequate time to follow-up, inform and educate TB patient regarding importance of regular treatment, correct ii duration of the treatment and laboratory diagnosis. Non-adherent patients need to be committed until the full course of therapy is completed.