Uzma Saleem, Bashir Ahmad
Keywords: non-compliance, tuberculosis, global epidemic

Objective: Thestudy objective was to find out the cause of non-compliance towards tuberculosis therapy in patients. Method:A self-designed questionnaire containing all the anticipated causes of non-compliance with anti-TB therapy and demographic information (age, gender) was prepared as study tool and tested by interviewing the patients. Results: The major cause of non-compliance towards DOTS is less awareness that adherence with therapy is very important for complete cure (34.38%). Other causes in descending order are as follows: big size of tablets (31.25 %), side effects of the drugs (18.75 %), and use of complementary and alternative medicines (15.62 %). Conclusion: Lack of patient’s awareness regarding complete adherence with DOTS therapy is one of the major cause of failure of giving T.B. free zone to the population. It is concluded that patients education regarding strict adherence with therapy is compulsory in order to control the epidemic of tuberculosis.

Article Information

Identifiers and Pagination:
First Page:106
Last Page:108
Publisher Id:19204159.7:2.2015
Article History:
Received:January 20, 2015
Accepted:March 1, 2015
Collection year:2015
First Published:April 1, 2015


Tuberculosis (TB) is one of the most serious health issues worldwide, almost one third of the population has been infected with Mycobacterium tuberculosis (Marinac et al., 1998). Pakistan ranks 6th globally among 22 high burden Tuberculosis (TB) countries in the world and harbors 63 % of Tuberculosis burden in the Eastern Mediterranean Region of WHO (WHO, 2012). In Pakistan 420,000 new TB cases reported annually. Government of Pakistan endorsed the Directly Observed Treatment, Short course (DOTS) strategy, following WHO’s declaration of TB, as a global emergency and adopted DOTS strategy in 1995(WHO, 2012). 

Patients compliance with therapy depends on many psychological and sociological factor including age, patients own idea regarding disease and level of education (Bakke et al., 1995). Patient compliance is one of the most important factors that affect the outcome of the therapy. Compliance can be defined as the extent to which the patient obeys the medical advice. Tuberculosis treatment comprised of three to four tablets. Non-compliance to the self- administration of these drugs is the main cause of initial therapy failure, development of multi drug resistance and relapses (Globe et al., 1993). Poor patients’ compliance with TB treatment is one of the main difficulties to get the goals of National TB Control Program (Riley et al., 1989).

To understand various causes of non-compliance with anti-TB therapy, we conducted cross sectional study among pulmonary TB patients under treatment.


This cross sectional study was conducted in anti-tuberculosis unit in Independent medical university teaching hospital; Faisalabad. 80 patients (study subjects) aged 15-60 currently under treatment in the hospital were included in this study. Patients were interviewed in the hospital at the time of receiving anti-TB medicines from the hospital. A written consent was taken from all patients included in the study. A self-designed questionnaire containing all the anticipated causes of non-compliance with anti-TB therapy and demographic information (age, gender) was prepared as study tool and tested. Each interview lasted for about 30 minutes. Results were presented as frequency and percentage.


In this study 29 females and 51 males participated (Table 1). 40% (n=32) of the under study subjects showed non-compliance with therapy (Table 2). Highest percentage (62.5%) of non-compliant cases was noted in the first month of therapy and 94% non-compliant cases were appeared in first three months of therapy (Table 3). Different causes of non-compliance were discussed with the patients, Out of 32 non-compliant cases, 11 (34.38%) patients didn’t adhere with therapy due to less awareness that how important it is to take drug on daily basis for nine months. 31.25% showed non-compliance due to big size of tablets, 18.75% gave gap in taking drug due to side effects on skin, eyes, liver and kidney, and 15.62% stop taking allopathic medicine because of use of complementary and alternative medicines but they have to revisit allopathic TB center to get relief from TB symptoms (Table 4).

Table 1: Age and Sex distribution of the study

Table 2: Subjects showed non-compliance with DOTS

Table 3: Duration after which Patients showed non-compliance

Table 4: Causes for non-compliance among TB Patients


Tuberculosis was declared as global emergency epidemic in 1993 by WHO (Pioet al., 1998). Imran et al., (2009) had discussed few reasons of patient noncompliance with anti TB therapy in Pakistan.This study explained some other causes of patients non-compliance with anti TB therapy non-compliance was maximum within first three months due to less awareness that adherence with therapy is very important for complete cure (38.34%), big size of tablets (31.25%), side effects of the drug (18.75%), use of complementary and alternative medicines (15.62%). Ali et al.(2003) study is consistent with our study that the biggest cause of non-compliance in patience is lack of knowledge and awareness regarding disease and it treatment protocol. Outcome of anti-tuberculosis therapy depends on patient compliance (Globe et al., 1993). Non-compliance to therapy can cause drug resistance and relapse of disease (Weis et al., 1994) and this leads to raise the burden of tuberculosis globally.


Less awareness about adherence with therapy is very important for complete cure is the major cause of non-compliance to tuberculosis therapy in this cross sectional study. So, Patients’ education and awareness relating to side effects of therapy and importance of complete adherence with therapy is mandatory to get TB free zone nationally.


1         Ali SS, Rabbani S, Siddiqui UN, Zaidi AH, Sophie A, Virani SJ (2007). Tuberculosis: do we know enough? A study of patients andtheir families in an out'patient hospital setting in Karachi, Pakistan.Int J Tuberc Lung Dis.7, 1052-1058.

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4         Marian G, Michael DI, Lorie AM, Dennis W, Lynn A, Robert HJr (1993). Treatment of 171patients with pulmonary tuberculosis resistance to isoniazid and rifampicin.N England J Med. 328, 527-32.

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6.     WHO, Pakistan, tuberculosis programme.Accessed on 11th march

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Welcome to the research group of Prof. Dr. Cornelia M. Keck in Marburg. Cornelia M. Keck is a pharmacist and obtained her PhD in 2006 from the Freie Universität (FU) in Berlin. In 2009 she was appointed as Adjunct Professor for Pharmaceutical and Nutritional Nanotechnology at the University Putra Malaysia (UPM) and in 2011 she obtained her Venia legendi (Habilitation) at the Freie Universität Berlin and was appointed as a Professor for Pharmacology and Pharmaceutics at the University of Applied Sciences Kaiserslautern. Since 2016 she is Professor of Pharmaceutics and Biopharmaceutics at the Philipps-Universität Marburg. Her field of research is the development and characterization of innovative nanocarriers for improved delivery of poorly soluble actives for healthcare and cosmetics. Prof. Keck is executive board member of the German Association of Nanotechnology (Deutscher Verband Nanotechnologie), Vize-chairman of the unit „Dermocosmetics“ at the German Society of Dermopharmacy, active member in many pharmaceutical societies and member of the BfR Committee for Cosmetics at the Federal Institute for Risk Assessment (BfR).

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