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

Type of Adherence

Age

Gender

Operational
Definition

Categories of
Variable

The completion to a. adherent

the whole duration b. non-adherent
of
treatment
regardless of the
factors
Length of time from Code as is
birth measured in
months or age in
years
at
last
birthday
during
treatment
Biological sex of the a. male
participant
b. female

Method of Data
Collection

Source of
Data

Potential error in
measuring the variable

Review
records
documents

of Secondary
or

Faulty
procedure
adopted by the observer

Face-to-face
Interview

Primary

Recall bias of respondent

and personal error of
faulty procedure adopted
by the observer

Face-to-face
Interview

Primary

Personal error of faulty

procedure adopted by
the observer

Operational Definition
Variable

Operational
Definition

Categories of
Variable

Method of Data
Collection

Source of
Data

Employment
The kind of work a. Employed
During Treatment that the subject had b. Unemployed
when he/ she was c. Self-Employed
on treatment

Face-to-face
Interview

Primary

Monthly income Monthly salary of Code as is

during treatment the family of the
subject

Face-to-face
Interview

Primary

Potential error in
measuring the
variable
Response bias to
please interviewer
and personal error
of
faulty
procedure
adopted by the
observer
Response bias to
please interviewer
and personal error
of
faulty
procedure
adopted by the
observer

Operational Definition
Variable

Operational
Definition

Level of Education The

educational
attainment
subject.

Categories of Variable

Method of Data
Collection

highest a. Never Went to School Face-to-face

b. Elementary
Interview
by the c. High School
d. Vocational
e. College
f. Post-Graduate

Source of
Data

Primary

Potential error in
measuring the
variable

Response bias to
please interviewer
and personal error
of
faulty
procedure
adopted by the
observer

Operational Definition
Variable

Smoking

Operational
Definition
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.

Categories of Variable

Method of Data
Collection

Non-Smoker: No history Face-to-face

of smoking.
Interview
Current Smoker:
- Light Smoker: 15 or
less
cigarette
sticks/day
- Moderate Smoker: 1624
cigarette
sticks/day
- Heavy Smoker: 25 or
more
cigarette
sticks/day

Reference:
JAMA Sept 16,1988_Vol
260, No. 11

Source of
Data
Primary

Potential error in
measuring the
variable
Response bias to
please interviewer
and personal error
of faulty procedure
adopted by the
observer

Operational Definition
Variable

Operational
Definition

Categories of Variable

Method of Data
Collection

Source of
Data

Alcohol Intake

Self-reported alcohol- a. Yes

drinking status of the
participant which is b. No
based on the number
of units of alcohol
consumed per day.

Face-to-face
Interview

Primary

Drug Abuse

Self-reported if the a.
subject
is
taking b.
prohibited drugs

Face-to-face
Interview

Primary

Yes
No

Potential error in
measuring the
variable
Response bias to
please interviewer
and personal error
of
faulty
procedure
adopted by the
observer

Response bias to
please interviewer
and personal error
of
faulty
procedure
adopted by the
observer

Operational Definition
Variable

Relief
Symptoms

Operational
Definition

Categories of
Variable

of During treatment in a. Yes

which the subject b. No
feel
relief
of
symptoms

Method of Data
Collection
Face-to-face
Interview

Source of
Data
Primary

Potential error
in measuring
the variable
Subjective
bias
which
involves
evaluation
based
on
personal,
poorly
measurable,
and
unverifiable
data or feelings

Operational Definition
Variable

Side effects

Operational
Definition

Categories of
Variable

A peripheral or a. Yes
secondary effect, b. No
especially
an
undesirable
secondary effect of
a drug or therapy

Method of Data
Collection

Source of
Data

Review of records Secondary

or documents

Potential error
in measuring
the variable
Personal
bias
and
faulty
procedure
adopted by the
observer

Operational Definition
Variable

Operational
Definition

Categories of Variable

Method of Data
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

Secondary

Faulty procedure
adopted by the
observer

Co-morbidities

Is the presence of
one or more
additional disorders
(or diseases) cooccurring 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

Secondary

Faulty procedure
adopted by the
observer

Operational Definition
Variable

Operational
Definition

Categories of Variable

Method of Data
Collection

Source of
Data

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

Types of TB
patient

Categorization of
TB patient
according to history
of TB disease of the
subject

a. New
b. Relapse
c. Treatment failured.Transfer-in
e.Return-after-default
f. Others

Review of records
or documents

Secondary

Potential error in
measuring the
variable
Personal error of
faulty procedure
adopted by the
observer

Personal error of
faulty procedure
adopted by the
observer

Operational Definition
Variable

Operational
Definition

Categories of Variable

Method of Data
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

Secondary

Faulty procedure
adopted by the
observer

Stigma

Disgrace felt which

is associated with
having a disease of
TB

a.

Face-to-face
Interview

Primary

Response bias to
please
interviewer and
personal error of

b.

no stigma- the
subject did not
feel the stigma
with stigma - the
subject did feel
the stigma

faulty procedure
adopted by the
observer

Operational Definition
Variable

Family support

History of antiTB drug intake

Operational
Definition

Categories of Variable

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

Previous anti-TB
drug intake of the
subject before
he/she started
treatment in the
DOTS facility

a.
b.

Method of Data
Collection

Face-to-face
Interview

Source of
Data

Primary

Potential error in
measuring the
variable

Response bias to
please
interviewer and
personal error of
faulty procedure
adopted by the
observer

c.

no history
one history of
drug intake
two or more
history of drug
intake

Review of records
or documents

Secondary

Faulty procedure
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

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

List of TB patients who were

enrolled and included in TB
Register in the year 20082010
with
treatment
outcome of default, cured
and treatment completed

Adherent

Non-Adherent

Factors Associated with

Adherent to TB Treatment

Factors Associated with NonAdherent to TB Treatment

Research Study

Past

(2008 2010)

Present

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

Data Collection Tools

Data Collection Tools

16 DOTS Facility

Assess the DOTS facility

Pool subjects from TB Register in the year of 20082010:

Note inclusion/exclusion criteria.

Note inclusion/exclusion criteria.

Review inventory of medicine in the time

of treatment

Review of medical history

Assess knowledge on DOT staff (Nurse and

midwife)

Note address and contact number

Informed Consent

Informed Consent

Self-administered questionnaire

Knowledge assessment exam on DOT staff

Data collection

DATA ANALYSIS
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

Mode of transportation

Nominal

Smoking

Nominal

Alcohol Intake

Nominal

Drug Abuse

Nominal

Side effects

Nominal

Relief of Symptoms

Nominal

Frequency, Relative Frequency

Frequency, Relative Frequency

Frequency, Relative Frequency

Frequency, Relative Frequency
Frequency, Relative Frequency
Frequency, Relative Frequency
Frequency, Relative Frequency

Multiple Logistic Regression

Multiple Logistic Regression

Multiple Logistic Regression

Multiple Logistic Regression
Multiple Logistic Regression
Multiple Logistic Regression
Multiple Logistic Regression

Plan for Data Analysis

Variable

Type of Variable

Co-morbidities

Nominal

Types of TB patient

Nominal

History of anti-TB drug

Nominal

Descriptive Statistics
Relative Frequency
Relative Frequency

Relative Frequency

Inferential Statistics
Multiple Logistic Regression
Multiple Logistic Regression

Multiple Logistic Regression

intake
Category of Treatment

Nominal

Availability of drugs and Ordinal

Relative Frequency

Multiple Logistic Regression

Median, Mode

Hierarchical Logistic
Regression

Median, Mode

Hierarchical Logistic
Regression

supplies
Knowledge of DOT

Ordinal

provider
Family Support

Nominal

Relative Frequency

Hierarchical Logistic
Regression

Attitude of DOT Provider

Nominal

Frequency, Relative Frequency

Hierarchical Logistic Regression

The End