Randomized Control Trial Study On The Effect Of Health Education In Promoting Adherence To Treatment Among The Urban And Rural Tuberculosis Patients In Kenya
Authors: Mbuti Humphrey Kimani , Oguya Francis Ochieng , Mwaniki Elizabeth , Warutere Peterson 
Published: November 2020

Abstract
Background: Tuberculosis is a global health concern and the incident rate in Kenya remains high. Because of the long duration of standard treatment (six months), there is a risk of treatment default by patients. Low adherence to treatment may result in the emergence of resistant strains of the Mycobacterium Tuberculosis in turn increasing mortality and prolonging the treatment duration. The rising TB cases in Kenya have been associated with poor adherence and low cure rate arising from inappropriate health education. Directly Observed Therapy, Short-course (DOTS) Strategy, in combination with patient education have proved to be more effective in reducing TB incident than the DOTS Strategy alone. However, there is lack of Evidence Based Protocol to guide Medical Professionals through the implementation of health education for TB patients. Objective: The main objective of this study was to determine the effect of health education in promoting adherence to treatment among the urban and rural tuberculosis patients in Kenya. The study used the PRECEDE-PROCEED model. Design: The study adopted Randomized Controlled Trial Design with pre-and post-test assessment. The Multi-Stage Sampling Technique was applied to select the study respondents. Random sampling was adopted to select the hospitals, health centers and dispensaries. Simple random sampling method was also used to assign the patients into experimental and control groups.Setting: The study was conducted in fourteen public health facilities in Nairobi and Murang’a Counties; 2 Hospitals, 7 health centers, 5 dispensaries. Participants: A total of 450 patients were recruited from the selected health facilities by random sampling according to probability proportionate to TB patient’s population. Only 373 met the eligibility criteria for the study. Intervention: Health Education Program for 10-15 minutes on average, twice a month for the next 6+ months as the Patient went for the weekly drug ration.Main measurement outcome: Level of adherence to TB treatment in patients.Methods: The study was conducted between September 2019 and February 2020. Only patients aged 18 years and above who had been on DOTS for at least two weeks were selected. Health education was given to those in the experimental group while those in the control group did not receive the intervention. After the six months of treatment the two groups were compared. Standard Questionnaire was used to collect data. Multivariate Analysis of Variance, Odds Ratio and Chi-square tests were used to evaluate the association between health education and adherence to TB treatment. Results: 450 patients were recruited (experimental group=225, control group=225). 77 patients did not meet the eligibility criteria leaving 373 patients (experimental group=186, control group=187). 83.3% of patients in the experimental group had high level adherence after intervention in the post- test phase compared to 60.4% of patients who had high level adherence in the control group in the post-test phase. Wilk’s Λ had an F value of 18.540, p<0.001, Odds Ratio was 3.274 and χ²= 24.189, p<0.001, indicating that the health education intervention improved adherence to medication. Gender, levels of education, marital status and primary occupation were also found to be significantly associated with adherence to medication (p<0.05). Conclusions: Health education enhanced patients’ adherence to TB treatment regime. A health education program should be adopted and rolled out to health facilities and health care settings that provide TB services in Kenya.