Factors Contributing to Tuberculosis Relapse Among Patients on Treatment Completion
DOI:
https://doi.org/10.5281/zenodo.15208460Keywords:
Tuberculosis, Tuberculosis Relapse, Treatment Adherence, Lifestyle, Social SupportAbstract
Tuberculosis (TB) is a continuing major public health concern, and relapse is the most challenging determinant of treatment success and disease management. This study is descriptive research and determined the predictors of relapse of tuberculosis among patients once they have already undergone treatment. The respondent-population targets included TB DOTS enrollees who are covered exclusively for 2024 who are also facing recurrence of TB. Data were collected from 177 respondents, classified by age, sex, socio-economic status, comorbidities, treatment duration, and locality of residence. Findings suggest the greatest number of respondents lay within the 30-64 age bracket, with a largely male population. The largest percentage was in the lowest income category, highlighting economic vulnerability as a key determinant of TB recurrence. The most common comorbidities were hypertension and diabetes, conditions which are common to affect TB treatment outcomes. The majority of the respondents received the regular six-month TB treatment. The researcher used the adapted and modified questionnaire. Treatment adherence, lifestyle, and social support were rated as being most frequently experienced, followed by awareness of TB recurrence as the highest-rated factor. Statistical analysis also reflected important differences in treatment adherence according to comorbidities and residential area. Lifestyle was significantly affected by age, comorbidities, and residential area. Social support differed significantly with age, while knowledge of TB recurrence differed significantly according to residential areas. These results emphasize the influence of socio-economic and environmental determinants on TB recurrence and identify the potential importance of targeted interventions. This research suggested healthcare policies from the findings of the study to minimize the probability of tuberculosis recurrence.
References
Agarwal, N., & Sarthi, P. (2020). The necessity of psychological interventions to improve compliance with Tuberculosis treatment and reduce psychological distress. Journal of Family Medicine and Primary Care, 9(8), 4174. https://doi.org/10.4103/jfmpc.jfmpc_1404_20
Agbeko, C. K., Mallah, M. A., He, B., Liu, Q., Song, H., & Wang, J. (2022). Mental Health Status and its Impact on TB Treatment and its Outcomes: A Scoping Literature review. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.855515
Ahmad, S., Wasim, S., Irfan, S., Gogoi, S., Srivastava, A., & Farheen, Z. (2019). Qualitative v/s. quantitative research-a summarized review. population, 1(2), 2828-2832.
Aibana, O., Dauria, E., Kiriazova, T., Makarenko, O., Bachmaha, M., Rybak, N., Flanigan, T. P., Petrenko, V., Becker, A. E., & Murray, M. B. (2020). Patients’ perspectives of tuberculosis treatment challenges and barriers to treatment adherence in Ukraine: a qualitative study. BMJ Open, 10(1), e032027. https://doi.org/10.1136/bmjopen-2019-032027
Al-Sayyad, A., Alshehabi, F., Alabd, D., & Marzooq, A. (2020b). Medication Adherence among Patients with Chronic Diseases in Primary Health Care Centers in Bahrain. Journal of the Bahrain Medical Society, 32(3). https://doi.org/10.26715/jbms.32_2020_3_2
Ali, A. O. A., & Prins, M. H. (2020). Patient Characteristics Associated with Non-Adherence to Tuberculosis Treatment: A Systematic Review. Journal of Tuberculosis Research, 08(02), 73–92. https://doi.org/10.4236/jtr.2020.82008
Alsharani, F., Zafar, M., Omar, E.O., & Muzaheed (2021). Lifestyle Risk Factors Associated with Tuberculosis Patients in Asir Region of Saudi Arabia. International Journal of Preventive Medicine, 12.
Anaam, M. S., & Alrasheedy, A. A. (2023). Recurrence Rate of Pulmonary Tuberculosis in Patients Treated with the Standard 6-Month Regimen: Findings and Implications from a Prospective Observational Multicenter Study. Tropical medicine and infectious disease, 8(2), 110. https://doi.org/10.3390/tropicalmed8020110
Appiah, M. A., Arthur, J. A., Gborgblorvor, D., Asampong, E., Kye-Duodu, G., Kamau, E. M., & Dako-Gyeke, P. (2023). Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient’s perspective. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16259-6
Baluku, J. B., Namiiro, S. M., Nabwana, M., Muttamba, W., & Kirenga, B. (2021). Undernutrition and treatment success in Drug-Resistant tuberculosis in Uganda. Infection and Drug Resistance, Volume 14, 3673–3681. https://doi.org/10.2147/idr.s332148
Barik, A. L., Indarwati, R., & Sulistiawati, S. (2020). THE ROLE OF SOCIAL SUPPORT ON TREATMENT ADHERENCE IN TB PATIENTS: A SYSTEMATIC REVIEW. Nurse and Health Jurnal Keperawatan, 9(2), 201–210. https://doi.org/10.36720/nhjk.v9i2.186
Bouchrika, I. (2024). Types of Research Design in 2024: Perspective and Methodological Approaches. https://research.com/research/types-of-research-design
Carwile, M. E., Hochberg, N. S., & Sinha, P. (2022). Undernutrition is feeding the tuberculosis pandemic: A perspective. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 27, 100311. https://doi.org/10.1016/j.jctube.2022.100311
Chimeh, R. A., Gafar, F., Pradipta, I. S., Akkerman, O. W., Hak, E., Alffenaar, J. C., & Van Boven, J. F. M. (2020). Clinical and economic impact of medication non-adherence in drug-susceptible tuberculosis: a systematic review. The International Journal of Tuberculosis and Lung Disease, 24(8), 811–819. https://doi.org/10.5588/ijtld.19.0754
Chung, C., Jeong, D., Sohn, H., Choi, H., & Kang, Y. (2023). Low household income increases the risk of tuberculosis recurrence: a retrospective nationwide cohort study in South Korea. Public Health, 226, 228–236. https://doi.org/10.1016/j.puhe.2023.11.014
Cox, S. E., Edwards, T., Faguer, B. N., Ferrer, J. P., Suzuki, S. J., Koh, M., Ferdous, F., Saludar, N. R., Garfin, A. C. G., Castro, M. C., & Solon, J. A. (2021). Patterns of non-communicable comorbidities at start of tuberculosis treatment in three regions of the Philippines: The St-ATT cohort. PLOS global public health, 1(11), e0000011. https://doi.org/10.1371/journal.pgph.0000011
Craciun, O. M., Del Rosario Torres, M., Llanes, A. B., & Romay-Barja, M. (2023). Tuberculosis Knowledge, Attitudes, and Practice in Middle- and Low-Income Countries: A Systematic review. Journal of Tropical Medicine, 2023, 1–15. https://doi.org/10.1155/2023/1014666
Daniels, J., Medina-Marino, A., Glockner, K., Grew, E., Ngcelwane, N., & Kipp, A. (2021). Masculinity, resources, and retention in care: South African men’s behaviors and experiences while engaged in TB care and treatment. Social Science & Medicine, 270, 113639. https://doi.org/10.1016/j.socscimed.2020.113639
Dauphinais, M. R., Koura, K. G., Narasimhan, P. B., Mehta, S., Finkelstein, J. L., Heysell, S. K., & Sinha, P. (2024). Nutritionally acquired immunodeficiency must be addressed with the same urgency as HIV to end tuberculosis. BMC Global and Public Health, 2(1). https://doi.org/10.1186/s44263-023-00035-0
Dave, J. D., & Rupani, M. P. (2022). Does direct benefit transfer improve outcomes among people with tuberculosis? – A Mixed-Methods study on the need for a review of the cash transfer policy in India. International Journal of Health Policy and Management. https://doi.org/10.34172/ijhpm.2022.5784
Dlangalala, T., Musekiwa, A., Mckelly, D., Baloyi, E., & Mashamba-Thompson, T. P. (2024). Accessibility of TB diagnostic services at primary healthcare clinics in the eThekwini district, South Africa: a geospatial analysis. BMJ Open, 14(9), e082129. https://doi.org/10.1136/bmjopen- 2023-082129
Ehntholt, A., Frimpong, E. Y., Compton, M. T., Rowan, G. A., Ferdousi, W., Swetnam, H., Chaudhry, S., Radigan, M., Smith, T. E., & Rotter, M. (2022). Prevalence and correlates of four social determinants in a statewide survey of licensed mental health services. Psychiatric Services, 73(11), 1282–1285. https://doi.org/10.1176/appi.ps.202100380
Elmuttalut, M. (2024). The key factors influencing tuberculosis treatment outcomes: A literature review. Deleted Journal, 6(3), 76–79. https://doi.org/10.18231/j.ijrimcr.2024.054
Farooq, S., Tunmore, J., & Comber, R. (2021). Pharmacological or non-pharmacological interventions for treatment of common mental disorders associated with Tuberculosis: A systematic review. Chronic Respiratory Disease, 18. https://doi.org/10.1177/14799731211003937
Florentino, J. L., Arao, R. M. L., Garfin, A. M. C., Gaviola, D. M. G., Tan, C. R., Yadav, R. P., ... & Nishikiori, N. (2022). Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first national TB patient cost survey in the Philippines. PLoS One, 17(2), e0264689.
Flores, G. P., Alberto, I. R. I., Eala, M. a. B., & Cañal, J. P. A. (2021). The social determinants of tuberculosis in the Philippines. The Lancet Global Health, 10(1), e38. https://doi.org/10.1016/s2214-109x(21)00516-7
Fuady, A., Fitriangga, A., Sugiharto, A., Arifin, B., Yunita, F., Yani, F. F., Nasution, H. S., Putra, I. W. G. a. E., Rauf, S., Mansyur, M., & Wingfield, T. (2022). Characterising and Addressing the Psychosocial Impact of Tuberculosis in Indonesia (CAPITA): A study protocol. Wellcome Open Research, 7, 42. https://doi.org/10.12688/wellcomeopenres.17645.2
Goletti, D., Pisapia, R., Fusco, F. M., Aiello, A., & Van Crevel, R. (2023). Epidemiology, pathogenesis, clinical presentation and management of TB in patients with HIV and diabetes. The International Journal of Tuberculosis and Lung Disease, 27(4), 284–290. https://doi.org/10.5588/ijtld.22.0685
Halloran, E. C. (2024). Adult development and associated health risks. Journal of Patient-centered Research and Reviews, 11(1), 63–67. https://doi.org/10.17294/2330-0698.2050
Hossain, M. M., Flora, M. S., Shahidullah, M., Amin, M. N., Mosharref, M., & Wahab, M. A. (2020). Socio-demographic and Economic Factors Associated with Adherence to Anti-Tuberculosis Treatment. Journal of Armed Forces Medical College Bangladesh, 15(1), 39–41. https://doi.org/10.3329/jafmc.v15i1.48639
Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2015). The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation. Health communication, 30(6), 566–576. https://doi.org/10.1080/10410236.2013.873363
Kaufmann, S. H. E. (2021). Vaccine development against tuberculosis over the last 140 years: Failure as part of success. Frontiers in Microbiology, 12. https://doi.org/10.3389/fmicb.2021.750124
Kerkhoff, A. D., Mwamba, C., Pry, J. M., Kagujje, M., Nyangu, S., Mateyo, K., Sanjase, N., Chilukutu, L., Christopoulos, K. A., Muyoyeta, M., & Sharma, A. (2023). A mixed methods study on men’s and women’s tuberculosis care journeys in Lusaka, Zambia—Implications for gender-tailored tuberculosis health promotion and case finding strategies. PLOS Global Public Health, 3(6), e0001372. https://doi.org/10.1371/journal.pgph.0001372
Lee, G., Scuffell, J., Galea, J. T., Shin, S. S., Magill, E., Jaramillo, E., & Sweetland, A. C. (2020). Impact of mental disorders on active TB treatment outcomes: a systematic review and meta-analysis. The International Journal of Tuberculosis and Lung Disease, 24(12), 1279–1284. https://doi.org/10.5588/ijtld.20.0458
Lisboa, M., Fronteira, I., Mason, P. H., & Martins, M. D. R. O. (2020). National TB program shortages as potential factor for poor-quality TB care cascade: Healthcare workers’ perspective from Beira, Mozambique. PLoS ONE, 15(2), e0228927. https://doi.org/10.1371/journal.pone.0228927
Lutfian, L., Azizah, A., Wardika, I. J., Wildana, F., Maulana, S., & Wartakusumah, R. (2024). The role of family support in medication adherence and quality of life among tuberculosis patients: A scoping review. Japan Journal of Nursing Science, 22(1). https://doi.org/10.1111/jjns.12629
Marahatta, S. B., Yadav, R. K., Giri, D., Lama, S., Rijal, K. R., Mishra, S. R., Shrestha, A., Bhattrai, P. R., Mahato, R. K., & Adhikari, B. (2020). Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers. PLoS ONE, 15(1), e0227293. https://doi.org/10.1371/journal.pone.0227293
Mohammed, H., Oljira, L., Roba, K. T., Ngadaya, E., Ajeme, T., Haile, T., Kidane, A., Manyazewal, T., Fekadu, A., & Yimer, G. (2020). Burden of tuberculosis and challenges related to screening and diagnosis in Ethiopia. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 19, 100158. https://doi.org/10.1016/j.jctube.2020.100158
Muniyandi, M., Thomas, B. E., Karikalan, N., Kannan, T., Rajendran, K., Saravanan, B., Vohra, V., Okorosobo, T., Lönnroth, K., & Tripathy, S. P. (2020). Association of tuberculosis with household catastrophic expenditure in South India. JAMA Network Open, 3(2), e1920973. https://doi.org/10.1001/jamanetworkopen.2019.20973
Musiimenta, A., Tumuhimbise, W., Atukunda, E. C., Mugaba, A. T., Muzoora, C., Armstrong-Hough, M., Bangsberg, D., Davis, J. L., & Haberer, J. E. (2020). Mobile health technologies may be acceptable tools for providing social support to tuberculosis patients in rural Uganda: a Parallel Mixed-Method study. Tuberculosis Research and Treatment, 2020, 1–8. https://doi.org/10.1155/2020/7401045
Oladele, D. A., Balogun, M. R., Odeyemi, K., & Salako, B. L. (2020). A comparative study of knowledge, attitude, and determinants of Tuberculosis-Associated stigma in rural and urban communities of Lagos State, Nigeria. Tuberculosis Research and Treatment, 2020, 1–14. https://doi.org/10.1155/2020/1964759
Pasha, A., Siddiqui, H., Ali, S., Brooks, M. B., Maqbool, N. R., & Khan, A. J. (2021). Impact of integrating mental health services within existing tuberculosis treatment facilities. Medicine Access Point of Care, 5, 239920262110113. https://doi.org/10.1177/23992026211011314
Puentes-Markides (2007). Strategic Health Development Area PAHO/WHO on Policy Analysis and Decision with Emphasis on Chronic Non-communicable Diseases. Retrieved from: /english/ad/dpc/nc/cmn- po-bar-7-5-gen-pol-options.pdf
Pradipta, I. S., Houtsma, D., Van Boven, J. F. M., Alffenaar, J. C., & Hak, E. (2020). Interventions to improve medication adherence in tuberculosis patients: a systematic review of randomized controlled studies. Npj Primary Care Respiratory Medicine, 30(1). https://doi.org/10.1038/s41533-020-0179-x
Ragan, E. J., Kleinman, M. B., Sweigart, B., Gnatienko, N., Parry, C. D., Horsburgh, C. R., LaValley, M. P., Myers, B., & Jacobson, K. R. (2020). The impact of alcohol use on tuberculosis treatment outcomes: a systematic review and meta-analysis. The International Journal of Tuberculosis and Lung Disease, 24(1), 73–82. https://doi.org/10.5588/ijtld.19.0080
Rui, J. R., & Du, Y. (2023). The more the better? How social support predicted perceived barriers to tuberculosis treatment across groups of different socioeconomic statuses. Patient Education and Counseling, 115, 107874. https://doi.org/10.1016/j.pec.2023.107874
Shao, Y., Song, H., Li, G., Li, Y., Li, Y., Zhu, L., ... & Chen, C. (2021). Relapse or re-infection, the situation of recurrent tuberculosis in eastern China. Frontiers in cellular and infection microbiology, 11, 638990.
Singh, H., & Ramamohan, V. (2020). A model-based investigation into urban-rural disparities in tuberculosis treatment outcomes under the Revised National Tuberculosis Control Programme in India. PLoS ONE, 15(2), e0228712. https://doi.org/10.1371/journal.pone.0228712
Sriratih, E. A., Suhartono, S., & Nurjazuli, N. (2021). ANALISIS FAKTOR LINGKUNGAN FISIK DALAM RUANG YANG BERHUBUNGAN DENGAN KEJADIAN TUBERKULOSIS PARU DI NEGARA BERKEMBANG. Jurnal Kesehatan Masyarakat, 9(4), 473–482. https://doi.org/10.14710/jkm.v9i4.29741
Suarnianti, S., Selan, C. H., & Sumi, S. S. (2021). Literature Review : Evaluasi Peer Group Support dan Family Support Terhadap Kepatuhan Pengobatan Pada Pasien Tuberkulosis Paru. 2-TRIK TUNAS-TUNAS RISET KESEHATAN, 11(1), 51. https://doi.org/10.33846/2trik11111
Suparjo, N. F. M., Purnomo, S. E. C., & Indriyawati, N. (2020). Literature Review: Relationship of Family Support with the Medication Adherence in Tuberculosis Patients (TB). JENDELA NURSING JOURNAL, 4(2), 54–70. https://doi.org/10.31983/jnj.v4i2.6259
Tarafdar, S.S. (2019). Despite being a dim memory in some parts of the world, TB grinds on in many low and middle income countries. BMJ, 367.
Thungana, Y., Wilkinson, R., & Zingela, Z. (2022). Comorbidity of mental ill-health in tuberculosis patients under treatment in a rural province of South Africa: a cross-sectional survey. BMJ Open, 12(11), e058013. https://doi.org/10.1136/bmjopen-2021-058013
World Health Organization (2022). Global Tuberculosis Report 2022. World Health Organization. https://www.who.int/publications/i/item/9789240061729
World heath Organization (2022). Drug-resistant TB.https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023/tb-disease-burden/1-3-drug-resistant-tb
World heath Organization (2022). Tuberulosis Data.https://www.who.int/teams/global-tuberculosis-programme/data
Yosua, M. I., Ningsih, F., & Ovany, R. (2022). Hubungan Kondisi Lingkungan Rumah dengan Kejadian Tuberkulosis (TB) Paru. Jurnal Surya Medika, 8(1), 136–141. https://doi.org/10.33084/jsm.v8i1.3455
Yousif, K., Maki, M. E., Babikir, R. K., & Abuaisha, H. (2020). The effect of an educational intervention on awareness of various aspects of pulmonary tuberculosis in patients with the disease. Eastern Mediterranean Health Journal, 27(3), 287–292. https://doi.org/10.26719/emhj.20.102
Zegeye, A., Dessie, G., Wagnew, F., Gebrie, A., Islam, S. M. S., Tesfaye, B., & Kiross, D. (2019). Prevalence and determinants of anti-tuberculosis treatment non-adherence in Ethiopia: A systematic review and meta-analysis. PLoS ONE, 14(1), e0210422. https://doi.org/10.1371/journal.pone.0210422
Zeitoune, R. C. G., Dias, J. R., Nascimento, F. P. B., Da Motta, M. C. S., Sousa, M. H. N., Cardoso, M. D., Lira, S. C. C., Pereira, A. A., Rodrigues, I. L. A., Nogueira, L. M. V., Mocelin, H. J. S., Prado, T. N. D., Maciel, E. L. N., Savoy, C. a. A., & Gonçalves, C. C. M. (2022). Access to government social programs and the tuberculosis control program: a multicenter study. Revista Brasileira De Enfermagem, 75(suppl 2). https://doi.org/10.1590/0034-7167-2021-0454
Zhang, Y., Wu, J., Hui, X., Zhang, P., & Xue, F. (2024). Knowledge, attitude, and practice toward tuberculosis prevention and management among household contacts in Suzhou Hospital, Jiangsu province, China. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1249971
Downloads
Published
Issue
Section
License
Copyright (c) 2025 ERNALYN E. JAMON, XERXES G. MALAGA (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
