Group 1 Plenary 4

Plenary 4

BIOSTAT 206 GROUP 1

Adrianne C. Ablola

Bernadette C. Bautista

Renz Annika B. Daquioag

Ivy P. Roxas

Faye C. Rubico

Chapter I: Introduction Background of the Research Question Pulmonary Tuberculosis (PTB)

caused by Mycobacterium tuberculosis

easily spread from person to person via sneezing, coughing, and talking second to HIV/AIDS as the greatest killer worldwide due to a single infectious agent (WHO)

TB Burden: Worldwide

TB Burden: Philippine Mortality

TB Burden: Philippine Morbidity

What is DOTS? Directly Observed Treatment Short-Course (DOTS)

Efforts by the Philippine Government to control TB started in 1996 contribute significantly on the increase in case detection and cure rate of PTB in the country

locally implemented in health centers by medical staff composed of physicians, nurses, medical technologists, and barangay health workers

Research Objectives

General Objective: To determine the different factors associated with adherence of TB patients to DOTS treatment in health facilities of Paranaque City from the year 2008 to 2010

Research Objectives Specific Objectives: 1. To identify socio economic factors, clinical status, health system

related factors, behavioral and other external factors that contributed to TB DOTS treatment non-adherence

2. To determine socio economic factors, clinical status, health system related factors, behavioral and other external factors that promoted adherence with TB DOTS treatment

3. To compare the factors affecting adherence and non-adherence among TB DOTS patients

Significance of the Study Provide an evidence of the factors that associates with adherence of TB patients in the DOTS facilities in city of Paranaque Gathered data may be used to improve and develop the service delivery of the DOTS Program Prevention of non-ahherence to treatment may eliminate or decrease prolifiretion of MDR-TB cases

Chapter II. Theoretical Background

Figure 1: Conceptual Framework

Operational Definition Variable Operational

Definition

Categories of

Variable

Method of Data

Collection

Source of

Data

Potential error in

measuring the variable

Type of Adherence The completion to

the whole duration

of treatment

regardless of the

factors

a. adherent

b. non-adherent

Review of

records or

documents

Secondary Faulty procedure

adopted by the observer

Age Length of time from

birth measured in

months or age in

years at last

birthday during

treatment

Code as is Face-to-face

Interview

Primary Recall bias of respondent

and personal error of

faulty procedure adopted

by the observer

Gender Biological sex of the

participant

a. male

b. female

Face-to-face

Interview

Primary Personal error of faulty

procedure adopted by

the observer

Variable Operational

Definition

Categories of

Variable

Method of Data

Collection

Source of

Data

Potential error in

measuring the

variable

Employment

During Treatment

The kind of work

that the subject had

when he/ she was

on treatment

a. Employed

b. Unemployed

c. Self-Employed

Face-to-face

Interview

Primary Response bias to

please interviewer

and personal error

of faulty

procedure

adopted by the

observer

Monthly income

during treatment

Monthly salary of

the family of the

subject

Code as is Face-to-face

Interview


please interviewer

and personal error

of faulty

procedure

adopted by the

observer

Operational Definition


Definition

Categories of Variable Method of Data

Collection

Source of

Data

Potential error in

measuring the

variable

Level of Education The highest

educational

attainment by the

subject.

a. Never Went to School

b. Elementary

c. High School

d. Vocational

e. College

f. Post-Graduate

Face-to-face

Interview


please interviewer

and personal error

of faulty

procedure

adopted by the

observer



Definition


Collection

Source of

Data

Potential error in

measuring the

variable

Smoking Self-reported

smoking status of the

participant which is

based on the number

of cigarette sticks

consumed per day

which will be

computed based on

pack years in the

analysis.

Non-Smoker: No history

of smoking.

Current Smoker:

- Light Smoker: 15 or

less cigarette

sticks/day

- Moderate Smoker: 16-

24 cigarette

sticks/day

- Heavy Smoker: 25 or

more cigarette

sticks/day

Reference:

JAMA Sept 16,1988_Vol

260, No. 11

Face-to-face

Interview


please interviewer

and personal error

of faulty procedure

adopted by the

observer



Definition


Collection

Source of

Data

Potential error in

measuring the

variable

Alcohol Intake Self-reported alcohol-

drinking status of the

participant which is

based on the number

of units of alcohol

consumed per day.

a. Yes

b. No

Face-to-face

Interview


please interviewer

and personal error

of faulty

procedure

adopted by the

observer

Drug Abuse Self-reported if the

subject is taking

prohibited drugs

a. Yes

b. No

Face-to-face

Interview


please interviewer

and personal error

of faulty

procedure

adopted by the

observer



Definition

Categories of

Variable

Method of Data

Collection

Source of

Data

Potential error

in measuring

the variable

Relief of

Symptoms

During treatment in

which the subject

feel relief of

symptoms

a. Yes

b. No

Face-to-face

Interview

Primary Subjective

bias which

involves

evaluation

based on

personal,

poorly

measurable,

and

unverifiable

data or feelings



Definition

Categories of

Variable

Method of Data

Collection

Source of

Data

Potential error

in measuring

the variable

Side effects A peripheral or

secondary effect,

especially an

undesirable

secondary effect of

a drug or therapy

a. Yes

b. No

Review of records

or documents

Secondary Personal bias

and faulty

procedure

adopted by the

observer



Definition


Collection

Source of

Data

Potential error in

measuring the

variable

Availability of

drugs and

supplies

Adequacy of

supplies and drugs

and other logistics

in the DOTS facility

at the time of study

a. Poor

b. Satisfactory

c. Good

d. Excellent

Review of records

or documents


adopted by the

observer

Co-morbidities Is the presence of

one or more

additional disorders

(or diseases) co-

occurring with PTB

or the effect of such

additional disorders

or diseases at the

time of study

a. Diabetes

b. HCVD

c. Other pulmonary

disease

d. Arthritis

e. Cancer

f. HIV

g. Other diease

Review of records

or documents


adopted by the

observer



Definition


Collection

Source of

Data

Potential error in

measuring the

variable

Category of

Treatment

A class of treatment

in which the subject

belonged during

treatment.

a. Category I

b. Category II

c. Category III

Review of records

or documents

Secondary Personal error of

faulty procedure

adopted by the

observer

Types of TB

patient

Categorization of

TB patient

according to history

of TB disease of the

subject

a. New

b. Relapse

c. Treatment failure-

d.Transfer-in

e.Return-after-default

f. Others

Review of records

or documents

Secondary Personal error of

faulty procedure

adopted by the

observer



Definition


Collection

Source of

Data

Potential error in

measuring the

variable

Level of

knowledge of

DOT provider

Trainings and

seminars acquired

by the DOT staff.

a. Poor

b. Satisfactory

c. Good

d. Excellent

Review of records

or documents


adopted by the

observer

Stigma Disgrace felt which

is associated with

having a disease of

TB

a. no stigma- the

subject did not

feel the stigma

b. with stigma - the

subject did feel

the stigma

Face-to-face

Interview


please

interviewer and

personal error of

faulty procedure

adopted by the

observer



Definition


Collection

Source of

Data

Potential error in

measuring the

variable

Family support The emotional,

psychological and

monetary support

that was given to

the subject by their

family during

treatment

a. With family support

b. No family support

Face-to-face

Interview


please

interviewer and

personal error of

faulty procedure

adopted by the

observer

History of anti-

TB drug intake

Previous anti-TB

drug intake of the

subject before

he/she started

treatment in the

DOTS facility

a. no history

b. one history of

drug intake

c. two or more

history of drug

intake

Review of records

or documents


adopted by the

observer


Chapter III. Methodology Research Design Case Control Study Study Population TB Patients seeking treatment in the DOTS Facility of Paranaque City. Target population will include patients seeking treatment in the DOTS Facility of Paranaque City in the year 2008-2010 with treatment outcome of default, cured and treatment completed

Inclusion Criteria A. Subject

Subjects who were enrolled and included in the TB register in the year of 2008 to 2010 in the DOTS Facility of Paranaque City

Subjects with traceable address and contact number

Subjects who are still living in Paranaque City

Subjects who have ability to comprehend the true nature of the study

Inclusion Criteria

B. Facility

DOTS facility that have available record of the patients such as TB Register, treatment card, medical abstract and inventory of medicines DOTS Facility nurse and midwife who were supervising TB patients in the DOTS facility at the time of treatment

Exclusion Criteria

A. Subject

Subjects who have recurrent TB at the time of study

Patients with MDR-TB at the time of study

Subjects with neurologic and psychiatric disorder

Patients who have treatment outcome other than default, cured and treatment completed.

Exclusion Criteria B. Facility

Facilities which have had history of destruction or calamity destruction such as flood and fire that caused loss of patient files

Facilities which are under construction

Pretesting

constructed questionnaire was tested in one of the DOTS facility within Paranaque City

participants were selected to answer the questionnaire (SRS)

Cases -patients that were registered in the TB registry during the 2008 to 2010 with the treatment outcome of default

Controls - are those patients having a treatment outcome of cured and treatment

List of TB patients who were enrolled and included in TB Register in the year 2008-2010 with treatment outcome of default, cured and treatment completed

TB patients who were enrolled and included in TB Register in the year 2008-2010 with treatment outcome of default, cured and treatment completed

Adherent

Non-Adherent

Factors Associated with

Adherent to TB Treatment

Factors Associated with Non-

Adherent to TB Treatment

Research Study

Past Present (2008 2010)

Selection of Subjects

Figure 2. Selection of Subjects for determining the Factors Associated with Adherence to TB DOTS Treatment in the Health Facilities of Paraaque City from the year 2008 to 2010

Sample Size

Figure 3. Sample Size determination using EpiInfo to determine the factors associated with adherence to TB DOTS Treatment in the Health Facilities of Paraaque City from the year 2008 to 2010.

Data Collection Tools

16 DOTS Facility

Pool subjects from TB Register in the year of 2008-2010:

Note inclusion/exclusion criteria.

Review of medical history

Note address and contact number

Informed Consent

Self-administered questionnaire

Data collection

DATA ANALYSIS

Informed Consent

Assess the DOTS facility

Note inclusion/exclusion criteria.

Review inventory of medicine in the time of treatment

Assess knowledge on DOT staff (Nurse and midwife)

Knowledge assessment exam on DOT staff

Figure 2. Flowchart on the Process of Data Collection

Plan for Data Analysis Variable Type of Variable Descriptive Statistics Inferential Statistics

Age Ratio Mean, Standard Deviation Multiple Logistic Regression

Gender Nominal Frequency, Relative Frequency Multiple Logistic Regression

Employment Nominal Frequency, Relative Frequency Multiple Logistic Regression

Family Monthly Income Ratio Mean, Standard Deviation Multiple Logistic Regression

Level of Education Nominal Frequency, Relative Frequency

Multiple Logistic Regression

Mode of transportation Nominal Frequency, Relative Frequency


Smoking Nominal Frequency, Relative Frequency


Alcohol Intake Nominal Frequency, Relative Frequency


Drug Abuse Nominal Frequency, Relative Frequency


Side effects Nominal Frequency, Relative Frequency


Relief of Symptoms Nominal Frequency, Relative Frequency


Plan for Data Analysis Variable Type of Variable Descriptive Statistics

Inferential Statistics

Co-morbidities Nominal Relative Frequency


Types of TB patient Nominal Relative Frequency


History of anti-TB drug

intake

Nominal Relative Frequency


Category of Treatment Nominal Relative Frequency


Availability of drugs and

supplies

Ordinal Median, Mode Hierarchical Logistic

Regression

Knowledge of DOT

provider

Ordinal Median, Mode Hierarchical Logistic

Regression

Family Support Nominal Relative Frequency

Hierarchical Logistic

Regression

Attitude of DOT Provider Nominal Frequency, Relative Frequency Hierarchical Logistic Regression

The End

Documents

Group 1 Plenary 4