After a week, she stopped taking the medication because she “felt better”. A week later, she presented to Mulago hospital’s emergency department with a classic asthma attack. Likewise, Mugisha (not real name), an HIV patient, decided to skip some of his anti-tuberculosis medication.
Within a matter of months, his condition had derailed and he was readmitted at Mbarara regional referral hospital. This time after sputum analysis and a chest examination the doctor explained that the infection had spread from the lungs to the liver.
He cited failure to comply with treatment as the cause, and that Mugisha had now become resistant to the former regimen. A new regimen had to be executed. By now, Mugisha was emaciated, breathless and hanging on for dear life using an oxygen cylinder.
Compliance (or adherence) is the extent to which a person’s behaviour – taking medication, following a diet, etc, corresponds with agreed recommendations from a healthcare provider. Non-adherence can be intentional or unintentional.
A 2010 research to understand factors contributing to tuberculosis treatment adherence in Morocco found that patients with multiple medicines to swallow in most cases failed to comply.
Also, socio-economic factors like age, poverty, cultural beliefs and level of education affected drug adherence.
It was found that most patients stopped taking the medication as soon as they started feeling better, while others stopped as soon as they started experiencing unbearable side effects.
Consequences of non-adherence:
According to Dr Abdallah Kateregga of Mulago hospital, dissemination of the infection may occur in many patients who default on treatment, resulting into further complications.
Resistance, especially with antibiotics, may occur. For instance, if Mugisha had taken his entire course of treatment, he would have been cured of TB. The treatment regimen was changed most probably because of resistance.
Other effects include further financial burden, and at worst death.
Some of the strategies to improve patient adherence, according to Kateregga, include adequate patient counselling, emphasizing the cons of defaulting, plus highlighting the side effects to be expected.
For example, among HIVAids patients, defaulting on one’s ARVs can be fatal. Kateregga also aises that elderly patients have caretakers in position to administer the right dose of medication at the appropriate time.
While Simon Peter Sseguya, principal pharmacist at Mulago hospital, recommends the use of multi-compliance aids, which can help patients remember to take their medication. For instance, elderly patients can be aised to take their medications with other routine daily activities such as meals.
Devising once-a-day regimens could also make swallowing medication easier. Most importantly, the healthcare professionals should do a regular follow-up (such as phone calls) to the patient to ascertain whether or not the patient is compliant.
However, this is almost unachievable in Uganda due to the ridiculous doctor-to-patient ratio.
Source : The Observer