- Title
- Impact of dietary factors on drug adherence and the nutritional status of tuberculosis patients in the Nelson Mandela Bay Health District
- Creator
- Human, Wieda
- Subject
- Patients -- Nutritional aspects -- South Africa -- Nelson Mandela Bay Municipality
- Subject
- Tuberculosis -- Patients -- Nutritional aspects -- South Africa -- Nelson Mandela Bay Municipality Drug-nutrient interactions Appetite -- Effect of drugs on
- Date Issued
- 2018
- Date
- 2018
- Type
- Thesis
- Type
- Masters
- Type
- MSc
- Identifier
- http://hdl.handle.net/10948/22265
- Identifier
- vital:29929
- Description
- The prevalence of poor adherence by Tuberculosis (TB) patients to their drug regimens poses a major public health problem in South Africa. Many South Africans are the victims of poverty and unemployment and, as a result, may face food insecurity, hunger and have diets lacking diversity. Malnutrition is commonly noted in patients with TB. Poor immunity as a result of TB further compromises the nutritional status of the patient and thus the prognosis. Chronic hunger together with food insecurity and inadequate dietary diversity can lead to poor drug adherence amongst patients. This highlights the fact that dietary factors may pose a threat to TB drug adherence. There is limited information available regarding the impact of dietary factors on drug adherence and the nutritional status in patients with TB, especially in the Eastern Cape. This emphasises the need for more research focusing on the impact that dietary factors have on drug adherence and nutritional status of patients with TB from underprivileged areas. The aim of the study was to describe the impact of dietary factors on drug adherence and the nutritional status of patients with TB from underprivileged areas in the Nelson Mandela Bay Health District (NMBHD) in order to revise current guidelines to standardise the nutrition management in patients with TB who are initiated on treatment. A descriptive, cross-sectional study was conducted using a quantitative approach. Ethical approval was obtained from the Research Ethics Committee (NMU) and the Eastern Cape Department of Health Provincial Research Committee. All participants provided written, informed consent prior to participation. A representative sample was drawn from each of the three sub-districts in the NMBHD to include a total of 256 participants. The following clinics were randomly selected: Max Madlingozi, Tshangana, Soweto clinic (sub-district A), Laetitia Bam, Middle Street, Rosedale (sub-district B) while clinics in sub-district C included Korsten, Walmer, Gelvandale and Helenvale. The population for the study included patients with TB older than 18 years treated at these specific clinics. Patients with Drug- Resistant TB were excluded. A structured interview was conducted by the researcher and three fieldworkers to obtain information on socio-demographics, drug adherence, food insecurity and dietary diversity. Anthropometric measurements (weight and height) were also obtained to determine the nutritional status of participants. The majority of participants were male (59%; n=150). The mean age of participants was 35,03 years (SD=11.97). Of the total sample, 70% (n=179) reported being currently unemployed, while 59% of the total sample were also unemployed prior to TB diagnosis. Fifty percent of participants (n=127) were HIV co-infected, while only a marginal percentage (3%; n=7) had Diabetes Mellitus. Treatment adherence was considered 'good' as 94% (n=240) reported taking their TB treatment daily while 92% (n=121) reported taking their antiretroviral therapy (ART) daily. About a third (32%; n=81) of the total sample experienced low appetite, followed by nausea (21%; n=53) and vomiting (20%; n=50). A large percentage (48%; n=123) of participants experienced severe hunger. The mean individual dietary diversity score (DDS) for this sample was below 3 (2.81/9) and could be classified as being moderately diverse. Forty-three percent (n=110) had a low DDS of 2 or less food groups. Only 2% (n=5) had a high DDS of more than 7 food groups. A statistically significant association was found between employment status and food insecurity and poor DDS. Previous TB infection was also significantly associated with food insecurity and poor DDS. Although so many participants were food insecure, 74% (n=188) reported taking their TB treatment with food. Regarding substance use, 24% (n=88) consumed alcohol weekly, whereas 31% (n=80) of participants smoked cigarettes. The mean BMI value for males was 20.93 kg/m2 (SD=4.19) and for females at 20.91 kg/m2 (SD=5.10). However, 30% (n=76) had BMI values below 18.5 kg/m2 and 16% (n=40) had BMI values above 25 kg/m2. Majority of the participants (91%; n=233) had lost weight prior to data collection. Furthermore, 75% (n=175) reported having experienced involuntary weight loss in the preceding 3 months, while 17% (n=43) reported having lost more than 10% of their body weight in the last 3 months. Almost all participants reported taking their TB treatment as prescribed. However, the study results echo the findings of other studies that a large cohort of participants are currently unemployed and food insecure. Many participants were consuming monotonous diets, consisting primarily of starch with little vegetables and fruits. As a result, the nutritional status of the sample population was compromised. This sample also reflected unhealthy lifestyle habits which included substance use (alcohol and cigarette smoking). As so many participants self-reported adhering to TB treatment, it was challenging to determine the impact that dietary factors have on TB drug adherence. Government, NGO's and other private stakeholders should make nutrition a priority especially in vulnerable groups such as patients with TB. Dietitians and nutritionists should be involved in the care of all patients with TB by providing relevant nutrition counselling. Although malnourished patients with TB are currently receiving nutrition supplementation, the amount and sustainability thereof should be revised. Food gardens may further be a safety net against food insecurity, hunger and inadequate dietary diversity.
- Format
- xviii, 162 leaves
- Format
- Publisher
- Nelson Mandela University
- Publisher
- Faculty of Health Sciences
- Language
- English
- Rights
- Nelson Mandela University
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