Effect of health education on treatment adherence among drug-sensitive pulmonary tuberculosis patients in selected DOTS facilities in Ebonyi State, Nigeria

Nneka Immaculata Nwali; Constance Chioma Oko; Nelson Chidinma Okpua; Stanley Njaka

doi:10.53730/ijhs.v10n1.15891

Authors

Nneka Immaculata Nwali
nwalinneka200@gmail.com
Ebonyi State University, Abakaliki, Ebonyi State
Constance Chioma Oko Ebonyi State University, Abakaliki, Ebonyi State
Nelson Chidinma Okpua Alex Ekwueme Federal University, Ndufu Alike Ikwo, Ebonyi State
Stanley Njaka Ebonyi State University Abakaliki Ebonyi State and Ebonyi State University, Abakaliki, Ebonyi State & David Umahi Federal University of Health Science, Uburu, Ebonyi State

Keywords:

adherence, directly observed therapy short course, health education, pulmonary tuberculosis patients, Tuberculosis

Abstract

Background: Adherence to Tuberculosis (TB) therapy is critical to achieving a cure. Effective patient education could influence treatment-related attitudes and behaviors, thereby enhancing therapeutic compliance and optimal health outcomes. Aim: To assess the effect of health education on treatment adherence among drug-sensitive pulmonary TB patients in ten DOTS facilities in Ebonyi State. Method: A quasi-experimental design was employed to recruit 248 respondents drawn from a population of 487 patients using a multi-stage sampling approach. The intervention and control groups consisted of 129 and 119 respondents, respectively, with the intervention group receiving a two-month health education package and the WHO standard routine care, while the control group received only the WHO standard routine care. A validated questionnaire was administered to the respondents before and after the intervention. Result: The intervention group achieved 99.2% TB knowledge, 97.7% attitude, and 88.3% treatment adherence after the intervention. However, the control group showed 83.2%, 73.9%, and 68.1% for knowledge, attitude, and treatment adherence, respectively. There was a statistically significant difference between sex and level of treatment adherence in the intervention group, with females showing higher adherence (p<0.049). Conclusion: The study showed that regular health education improves patients’ knowledge, attitude, and adherence to TB treatment.

Downloads

Download data is not yet available.

References

Ajayi, R. F., Zezi, A. U., Ya'u, J., & Wanche, E. M. (2025). Evaluation of Pharmacist Interventions on Treatment Outcomes of Pulmonary Tuberculosis Patients in Secondary Health Facilities Abuja. The Nigerian Journal of Pharmacy, 59(1), 19-30. DOI: https://doi.org/10.51412/psnnjp.2025.03

Alinaitwe, B., Shariff, N. J., & Madhavi Boddupalli, B. (2025). Treatment adherence and its association with family support among pulmonary tuberculosis patients in Jinja, Eastern Uganda. Scientific Reports, 15(1), 11150. DOI: https://doi.org/10.1038/s41598-025-96260-8

Anochie, P. I., Onyeneke, E. C., Onyeozirila, A. C., Igbolekwu, L. C., Onyeneke, B. C., & Ogu, A. C. (2013). Evaluation of public awareness and attitude to pulmonary tuberculosis in a Nigerian rural community. Germs, 3(2), 52. DOI: https://doi.org/10.11599/germs.2013.1037

Yeti, E., & Usman, A. N. (2021). Risk factors analysis of non-compliance of Tuberculosis (TB) patients taking medicine in Puskesmas Polonia, Medan, 2021. Gaceta Sanitaria, 35, S227-S230. https://doi.org/10.1016/j.gaceta.2021.10.027

Bhattad, P. B., & Pacifico, L. (2022). Empowering patients: promoting patient education and health literacy. Cureus, 14(7). DOI: https://doi.org/10.7759/cureus.27336

Chen, E. C., Owaisi, R., Goldschmidt, L., Maimets, I. K., & Daftary, A. (2024). Patient perceptions of video directly observed therapy for tuberculosis: a systematic review. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 35, 100406. https://doi.org/10.1016/j.jctube.2023.100406 DOI: https://doi.org/10.1016/j.jctube.2023.100406

Daniel, A. A., Adogo, B., Gamde, M.S & Agwom, K. (2025). Impact of Stigma on Diagnosis, Treatment, and Quality of Care for Patients with Tuberculosis: A Review. International Journal of Biological & Medical Research. 16(4): 8292-8296. DOI: https://doi.org/10.65048/ijbmr.2025.16.4.8292.0440

Edeh, G. C., Ezenyeaku, C. A., Ifeadike, C. O., Awugosi, M. C., Ekwebene, O. C., & Chiekezie, C. F. (2023). Tuberculosis medication adherence in a secondary care center in South-Eastern Nigeria. J Clin Med Images, 3, 1522. DOI: https://doi.org/10.55920/2771-019X/1522

Fasoranti, A. J. (2016). Effect of Health Education Intervention on Treatment Adherence in Patients with Pulmonary Tuberculosis Lagos State, Nigeria. International Journal of Human Kinetics, Health and Education, 2(2).

Hickmann, E., Richter, P., & Schlieter, H. (2022). All together now–patient engagement, patient empowerment, and associated terms in personal healthcare. BMC health services research, 22(1), 1116. DOI: https://doi.org/10.1186/s12913-022-08501-5

Iweama, C. N., Agbaje, O. S., Umoke, P. C. I., Igbokwe, C. C., Ozoemena, E. L., Omaka-Amari, N. L., & Idache, B. M. (2021). Nonadherence to tuberculosis treatment and associated factors among patients using directly observed treatment short-course in north-west Nigeria: A cross-sectional study. SAGE open medicine, 9, 2050312121989497. DOI: https://doi.org/10.1177/2050312121989497

John, S., Lawan, B., Ahmad, A. A, & Abdulkarim, S. (2024). Effect of Health Education Program on Knowledge, Attitude, and Practice Towards Tuberculosis among Nomads in Adamawa State, Nigeria. Texila International Journal of Public Health. DOI: https://doi.org/10.21522/TIJPH.2013.12.01.Art028

Katende-Kyenda, L. N. (2025). Determinants of non-adherence to anti-tuberculosis treatment in a public primary healthcare clinic in South Africa: Improving the quality of long-term care. International journal of environmental research and public health, 22(8), 1209. DOI: https://doi.org/10.3390/ijerph22081209

KNCV Tuberculosis Foundation in Nigeria (2024). TB in Nigeria

Netto, T.A.L., Diniz, B. D., Odutola, P., Dantas, C. R., de Freitas, M. C. F. L. C., Hefford, P. M., & Bes, T. M. (2024). Video-observed therapy (VOT) vs directly observed therapy (DOT) for tuberculosis treatment: A systematic review on adherence, cost of treatment observation, time spent observing treatment and patient satisfaction. PLoS neglected tropical diseases, 18(10), e0012565. DOI: https://doi.org/10.1371/journal.pntd.0012565

Nwali, N.I., Umoke, P.C.I., Nwali, M.I., Umoke, M., Mbaocha, B.O., Egede, J.O., et al. (2024). Treatment outscomes of multi-drug resistant tuberculosis patients managed in Ebonyi State from October 2017 - September 2020. Kasmera, 52(2).

Onyango, P. A., Ter Goon, D., & Rala, N. M. D. (2020). Knowledge, attitudes and health-seeking behaviour among patients with tuberculosis: a cross-sectional study. The Open Public Health Journal, 13(1). DOI: https://doi.org/10.2174/1874944502013010739

Sile, I., Teterovska, R., Onzevs, O., & Ardava, E. (2023). Safety concerns related to the simultaneous use of prescription or over-the-counter medications and herbal medicinal products: survey results among Latvian citizens. International journal of environmental research and public health, 20(16), 6551. DOI: https://doi.org/10.3390/ijerph20166551

Umeokonkwo, C. D., Okedo-Alex, I. N., Azuogu, B. N., Utulu, R., Adeke, A. S., & Disu, Y. O. (2020). Trend and determinants of tuberculosis treatment outcome in a tertiary hospital in Southeast Nigeria. Journal of infection and public health, 13(7), 1029-1033. https://doi.org/10.1016/j.jiph.2019.10.012 DOI: https://doi.org/10.1016/j.jiph.2019.10.012

Worgu, G. O., Onotai, L. O., & Asuquo, E. O. (2022). Medication Adherence among Pulmanory Tuberculosis Patients in Treatment Centers in a Southern Nigerian Local Government Area: Question Mark on Performance of DOTS Services. Nigerian Medical Journal, 63(5), 418-424.

World Health Organization (2008). Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys. WHO/HTM/STB/2008.46

World Health Organization (2024). Treatment supporter. WHO TB Knowledge Sharing Platform.

World Health Organization (2025). Tuberculosis and gender. Global Tuberculosis Report. Geneva, Switzerland.

World Health Organization. Global tuberculosis report 2021. World Health Organization

Yadav, R. K., Kaphle, H. P., Yadav, D. K., Gurung, S. C., Khatri, E., & Baral, S. (2020). Factors associated with treatment adherence among tuberculosis patients in gandaki province of Nepal. SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, 18(1), 8-21. DOI: https://doi.org/10.3126/saarctb.v18i1.34128

Zhang, J., Yang, Y., Qiao, X., Wang, L., Bai, J., Yangchen, T., & Chodron, P. (2020). Factors influencing medication nonadherence to pulmonary tuberculosis treatment in Tibet, China: a qualitative study from the patient perspective. Patient preference and adherence, 1149-1158. DOI: https://doi.org/10.2147/PPA.S252448