European Journal of Cardiovascular Medicine

Tuberculosis (TB) remains one of India’s most persistent publichealth challengesespecially in rural districts where poverty, distance to care and stigma can erode the effectiveness of the National TB Elimination Programme (NTEP). Uttar Pradesh contributes roughly one‑fifth of the country’s annual caseload, yet granular evidence on patient behaviour from its interior districts is scarce. Jalaun district is predominantly rural (75 % rural population) and served by nine Tuberculosis Units (TUs); until now, no study had quantified how reliably patients there take their medicines or what programme outcomes they achieve. Understanding these issues is critical because sub‑optimal adherence not only jeopardises individual cure but also drives drug resistance and continued transmission. [1]

In India, the majority of those who contract tuberculosis are poor people and its victims are migrant laborers, slum dwellers, residents of backward areas and tribal pockets. Poor living conditions, malnutrition, shanty housing and overcrowding are the primary causes of the spread of the disease. It accounts for 26 per cent of the estimated global incident tuberculosis cases in 2019.[3]Even though many national and international efforts have been implemented against TB prevention and control, currently, the world as a whole, are not on track to reach the 2030 milestones of the End TB Strategy.[1-2]

Moreover, no such study had been taken place in District Jalaun especially in rural area to know the status of the tuberculosis patients and their compliance, so that appropriated measures can be taken and on the basis of findings recommendation may be suggested to the district level for betterment of the services of TB patients in the respective district. Therefore, this study was undertaken to assess the treatment compliance and outcome among tuberculosis patients in rural area of district Jalaun.

Study design and setting. A descriptive cross‑sectional survey was conducted in Jalaun Block, selected by simple random sampling from nine rural blocks in the district. The block contains one TU with two Designated Microscopy Centres—Community Health Centre (CHC) Jalaun and Primary Health Centre (PHC) Chiriya—together serving an agrarian catchment of about 0.17 million people.

Study participants. All drug‑sensitive TB patients who were (i) notified to the NI‑KSHAY portal between 1 January and 30 June 2023, (ii) resided in the block for at least six months, and (iii) consented to interview, were included. Drug‑resistant cases and patients who refused consent were excluded, yielding a final sample of 134.

Study Duration:The study was for the duration 18 months from November 2022 to April 2024. Extended up to July 2024 due to 3-month DRP posting. Pilot study was done from November 2022 to December 2022 to observe feasibility of study and validation of study questionnaire.

Sampling and recruitment. Eligible names were extracted from NI‑KSHAY and treatment registers. Patients were contacted via telephone or through their DOTS provider; those consenting were interviewed at home or a convenient facility within four weeks of treatment initiation.

Data collection tools. A pre‑tested interviewer‑administered questionnaire captured socio‑demographics, clinical details, health‑system factors, perceived stigma and self‑reported pill‑taking in the preceding 30 days. Compliance was defined as taking ⩾ 90 % of prescribed doses in the previous month.

Ethical consideration. Verbal informed consent was obtained from every participant, and confidentiality assured. Approval was granted by the Institutional Ethical committee and District TuberculosisOfficer.

Statistical analysis. Data were coded in Excel and analysed with SPSS v23. Categorical variables were described with mean and compared using the χ² test or Fisher’s exact test and continuous variables with independent‑sample t‑tests; with p < 0.05 was considered significant at 95% Confidence Interval.

Table 1: Distribution of the Socio-demographic profile among study participant

Table 1 showing the cohort was relatively young (mean age 34.7 ± 15.2 years); nearly 60 % were 15–44 years old. Males marginally out‑numbered females (55 % vs 45 %). Two‑thirds were married and the majority were Hindu (86.6 %). Using the Modified B.G. Prasad scale, most patients belonged to socio‑economic classes IV (47.8 %) and III (38.0 %). Over one‑third were illiterate and more than half of them were unemployed.

Table 2: Treatment compliance of the TB patients

Overall compliance was 92.5 % (124 / 134); ten patients (7.5 %) were non‑compliant. This signifies that treatment monitoring services was better as expected.

Table 3: Treatment outcomes of the Tuberculosis among the study participants

Table 3 shows that at the treatment completion rate of around 86.6 %, were cured or had completed treatment; deaths, default and treatment failure accounted for 5.2 %, 3.8 % and 4.4 % respectively.

Table 4: Determinants of non‑compliance in association with Socio-demographics profile

Table 4 inferenced that non‑compliant patients were more likely to be unmarried, illiterate, report stigma, experience side‑effects, and live farther from the treatment facility. Waiting times at the TU were likewise longer among non‑compliant patients. Moreover, all these variables are statistically significant associated with the non-compliance of the patients (p-value<0.05).

Table 5. Association of Compliance status among Tuberculosis patients with Age (in years), weight (in kg) and BMI (kg/m²) (n=134)

Table 5 is showing, the Mean ± SD of mean age in the compliant group and non-compliant group was 38.15±18.16 and 49.10±19.26, respectively. However, there was no notable distinction between the two groups in terms of mean age (t=2.48, p=0.789); although the mean age being higher among non-compliant group. With reference to the Mean ± SD of mean weight (kilograms) in the compliant group and non-compliant group was 44.30±11.66 and 43.07±10.65, respectively. There was no major difference between the two groups in terms of mean weight (t=0.127, p=0.390); although the mean weight being higher among compliant group.

Concerning the Mean ± SD of mean BMI (kg/m²) in the compliant group and non-compliant group was17.36±3.46 and17.80±3.66, respectively. There was no significant difference between the two groups in terms of mean BMI (t=1.48, p=0.100); nevertheless, the mean BMI being higher among non-compliant group

Figure 1. Bar graph showing distribution of Tuberculosis patients showing reasons for stigma

Figure 1 indicated that, nearly one-third of those experiencing stigma worried most about social isolation from family, while much smaller proportions cited lack of trusted confidants or assorted other factors.

This study provides the first systematic snapshot of treatment adherence and outcomes for drug‑sensitive TB patients in rural Jalaun. With 92.5 % of patients taking at least 90 % of doses, adherence exceeded WHO recommendations and compared favourably with urban studies in India and Ethiopia. The cure plus completion rate of 86.6 % also edged past the national average of 85 %.However, the small minority of non‑compliant patients accounted for a disproportionate share of deaths and defaults, underscoring non‑adherence as a potent predictor of poor outcomes. Social vulnerability—unmarried status, illiteracy and stigma—proved more decisive than biomedical variables, mirroring earlier findings from other regions. [3-4]

In the current research found the rate of noncompliance to anti TB treatment to be at 7.47%, while majority of the participants were compliant (92.53%) to the treatment.Similar to our study, majority participants were compliant in a study carried out by Das R et al. [5] where majority (84.50%) were adherent to the DOTS regimen. The compliance rate of our study was in line with studies conducted in developed areas of Mumbai (84.00%) [6] and Kerala (88.00%). [7] The study's compliance rate is higher than a study carryout in Ethiopia, which had a rate of 80.00%. [8]

In a study conducted by Kulkarni P et al., [9] the researchers discovered that the treatment compliance rate was significantly lower at 50%. -n the study carried out by Mittal C et al., [8] 15.1% patients were non-compliant which were higher than observed in our study.

The present study revealed that 93.50% of TB cases were effectively treated through the NTEP program. In the cases of non-compliant TB patients, there was an unfortunate outcome where 50% of the individuals lost their lives, while the other 50% failed to complete their treatment.The results of this study were consistent with previous research conducted in India. In the present study found that a significantly higher proportion of participants who were compliant with the TB treatment had a successful TB treatment completion compared to the non-compliant TB population who either died or did not complete their treatment successfully (p = 0.0001).

Our study, 42.34% of the patients showed signs of stigma related to their TB diagnosis, whereas 80% of the patients who was not comply with TB treatment also displayed stigma. This association between stigma and non-compliance in present study was observed to be significant.The findings of a study carried out by Shivapujimath R et al. [10] indicate that 51.02% of the participants have experienced stigma, which is higher than observed. This was shown to be lower than the results of the studies carried out in Nepal by Aryal et al. [11] (63.3% of respondents were stigmatized) and Thailand by Jittimanee et al. (65% of respondents were stigmatized). [12] In a study carried out in North 24 Parganas in West Bengal in 2015, the researchers found that stigma had a significant impact on the adherence to DOTS. [13]

The reasons for feeling stigma around TB diagnosis in our study were mostly due to fear of being isolated by relatives (65.21%), followed by having no one to trust (21.73%), and some participants gave various other reasons (13.04%) for feeling stigma. In their study Zaman FA et al. [14] also found that more women experiencing the stigma around the diagnosis of TB were non -compliant to the treatment of TB.

In the study conducted by Ravi N et al. [15] a higher percentage of patients (19.9%) did not comply in contrast to our study. Jaggarajamma et al. also noted a higher non-compliance rate of 20% in their study conducted in the Tiruvallur district of Tamil Nadu, which differs from our findings.[16] In a study conducted by Mahesh Kumar et al. [17], a compliance rate of 89.4% was reported. Similarly, Neeraj Pandit et al [18] observed a non-compliance rate of 7% in 2006, which aligns with the default rate results of our investigation.

The rural TUs of Jalaun have achieved commendably high treatment adherence and cure rates. Still, a vulnerable subsetmarked by social disadvantage, stigma and logistical hurdles; experiences disproportionate mortality and default. Targeted social‑support interventions, streamlined drug access and stigma mitigation could propel the district closer to End‑TB targets before 2025.

FINACIAL SUPPORT: NIL

CONFLICT OF INTEREST: NIL

SPONSORSHIP: NIL

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