Biological and Social Economic Determinants of Adherence and Cure of Tuberculosis Treatment: Path Analysis Evidence from Yogyakarta

Abstract

Background: Tuberculosis (TB) was an infectious disease which was still a health problem worldwide , including in Indonesia, which only had a population of around 261 million. The purpose of this study was to analyze biological and social economic determinants of adherence and cure of TB treatment. Subjects and Method: This was an analytic observational study with a case control design. The study was conducted in Bantul, Yogyakarta, from April to May 2019. A sample of 225 TB patients was selected by random sampling. The dependent variable was adherence and cure of TB treatment. The independent variables were age, gender, education, family income, nutritional status, healthy behavior, complication, family support, drug taking supervisor, drug taking adherence, environment, and smoking. The data were collected by questionnaire and analyzed by path analysis. Results: Adherence and cure of TB treatment was directly increased with good nutritional status (b= 076; 95% CI= 0.03 to 1.49; p= 0.042), drug taking adherence (b= 3.67; 95% CI= 1.47 to 5.92; p= 0.001), drug taking supervisor (b= 3.64; 95% CI= 1.26 to 6.02; p= 0.003), strong family support (b= 2.03; 95% CI=-3.85 to-0.21; p= 0.029), and healthy physical environment (b= 4.05; 95% CI=-0.09 to 8.20; p= 0.056). Adherence and cure of TB treatment was directly decreased with age ≥65 years old (b=-0.54; 95% CI=-1.85 to 0.75; p= 0.411), female gender (b=-0.05; 95% CI=-0.86 to 0.76; p= 0.900), unhealthy behavior (b=-3.20; 95% CI=-5.02 to-1.36; p= 0.001), smoking (b=-1.50; 95% CI=-2.56 to-0.43; p= 0.006), complication (b=-1.41; 95% CI=-2.60 to-0.23; p= 0.019). It was indirectly affected by nutritional status, education, family income, and healthy environment. Conclusions: Adherence and cure of TB treatment is directly increased with good nutritional status, drug taking adherence, drug taking supervisor, strong family support, and healthy physical environment. Adherence and cure of TB treatment is directly decreased with age ≥65 years old, female gender, unhealthy behavior, smoking, complication. It is indirectly affected by nutritional status, education, family income, and healthy environment.