Τομέας Υγείας - Μητέρας - Παιδιού
Library of the School of Health Sciences

2013-02-27

2013

Βαλλιανάτου Γερασιμούλα

Αναπληρώτρια Καθηγήτρια Παιδιατρικής Μαρία Τσολιά (επιβλέπουσα) , Αναπληρωτής Καθηγητής Παν. Σπυρίδης , Καθηγητής Παιδιατρικής Ανδρ. Κωνσταντόπουλος.

Συμμόρφωση παιδιατρικών ασθενών στην αντιφυματική θεραπεία

Greek

Compliance to anti-tuberculosis treatment among children

Introduction. Tuberculosis remains an important public health problem both in
the developing and in the developed world despite the recent progress in the
disease control globally. According to the World Health Organization it is
estimated that more than 1/3 of the global population has been infected by the
Mycobacterium tuberculosis, approximately 9 million people develop tuberculosis
each year and about 2 million die of which about 450.000 are children. Factors
related to the maintenance of this epidemic include immigration because of
economical or political causes, overpopulation, poverty, deficiencies in public
health systems, multi-drug resistance and Human Immunodeficiency Virus (HIV)
infection. Due to the aforementioned factors, strategies for the treatment of
tuberculosis have become insufficient to halt this major epidemic although
considerable progress has been achieved recently. Although of great importance,
compliance to treatment for tuberculosis disease in children has not been
thoroughly investigated.
Aim of the study. The aim of the present study was to examine the association
between different epidemiological, demographic and clinical characteristics
with compliance to treatment among children with tuberculosis.
Material and Methods. The study was conducted in the tuberculosis outpatient
clinic of the “P. and A. Kyriakou” Children’s Hospital between November 2002
and November 2004. The study sample consisted of 199 children (108 girls ) who
were diagnosed with active tuberculosis or latent tuberculosis infection.
Children with tuberculosis disease were treated with two different 6-month
regimens with 2 drugs (isoniazid (INH) and rifampicin (RIF) or 3 drugs (INH-RIF
and pyrazinamide (PZM). Children with latent tuberculosis infection were
treated with three different chemoprophylactic regimens using two drugs
(INH-RIF) with different duration (3 or 4 months) or INH monotherapy for 6
months. Compliance with tuberculosis treatment was assessed by measuring
isoniazid metabolites in urine samples submitted monthly for the whole duration
of treatment.
Statistical analysis Chi-square test and Fisher’s exact test was applied for
the examination of the association between two categorical variables. , where
chi-square test’s assumptions were not applicable. Furthermore, the
association between the effect of the statistical significant factors in the
univariate analysis with the level of compliance to treatment was examined
using multinomial logistic regression, adjusting also for the effect of
originating from tuberculosis-endemic countries.
Results. Patients who followed a three or four months short treatment regimen
were more likely to have excellent compliance compared to children who received
longer treatments. Living in a residence with a larger number of rooms, as a
marker of higher socio-economic status, was also significantly associated with
better compliance to treatment.
Conclusions. Long duration of therapy has a negative effect in the compliance
of children under treatment for tuberculosis. Lower socio-economic status is
also a risk factor associated with patient compliance. Incomplete treatment is
a major obstacle in the fight against the disease and leads to the development
and spread of drug-resistant bacteria. There is a need for the development of
shorter, simpler and faster acting treatment regimens to improve compliance to
TB treatment and control of the disease.

Compliance, Tuberculosis, Children, Short course treatment, Pediatrics

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https://pergamos.lib.uoa.gr/uoa/dl/object/1308186