IntroductionNigeria has one of the highest tuberculosis (TB) burdens in the world with estimated incidence of 133 per 100,000 populations. Multi-drug resistant TB (MDR-TB) is an emerging threat of the TB control in Nigeria caused mainly by incomplete treatment. This study explored factors that affect adherence to treatment among patients undergoing direct observation of TB treatment in Plateau state, Nigeria.MethodsBetween June and July 2011, we reviewed medical records and interviewed randomly selected pulmonary TB patients in their eighth month of treatment. Information on patients? clinical, socio-demographic and behavioral characteristics was collected using checklist and structured questionnaire for knowledge of treatment duration and reasons for interruption of treatment. We conducted focus group discussions with patients about barriers to treatment adherence. Data were analyzed with Epi Info software.ResultsOf 378 records reviewed, 229 (61%) patients were male; mean age 37.6 ±13.5 years and 71 (19%) interrupted their treatment. Interruption of treatment was associated with living > 5 km from TB treatment site (AOR: 11.3; CI 95%: 5.7-22.2), lack of knowledge of duration of treatment (AOR: 6.1; CI 95%: 2.8-13.2) and cigarette smoking (AOR: 3.4; CI 95%: 1.5- 8.0). Major reasons for the interruption were lack of transport fare (40%) and feeling well (25%). Focused group discussions revealed unfriendly attitudes of health care workers as barriers to adherence to treatment.ConclusionThis study revealed knowledge of the patients on the duration of treatment, distance and health workers attitude as the major determinants of adherent to TB treatment. Training for health care workers on patient education was conducted during routine supportive supervision.

SETTING: Plateau state is in north central Nigeria with population of 3.7 million people in 2011. Treatment of patient using the Directly Observed Treatment Short Course (DOTS) started since 2001. The cured rate had remained below expected target of ≥ 85%. OBJECTIVE: To identify the factors associated with the outcomes of the treatment. DESIGN: We conducted a cross sectional study among pulmonary TB patients aged ≥ 15 years. We reviewed their medical records, interviewed patients with structured questionnaires and conducted focus group discussions (FGD) about factors that affect TB treatment. Data were analyzed with epiInfo software. RESULTS: Of the 378 respondents, 178 (47%) were smear positive. Cured, failure and default rates were 112 (62.8%), 5 (2.8%) and 5 (2.8%), respectively. Knowledge of duration of treatment and previous medication for TB were associated higher (AOR: 9.62, 95%CI: 2.28-40.68) and lower (AOR: 0.03, 95% CI: 0.01-0.17) cured rates, respectively. FGD identified unfriendly attitude of health care workers, long distance and transport cost to health facility for DOT as the major barriers to treatment. CONCLUSION: Treatment interruption prevention, patients' education, decentralization of services to reduce distance and positive attitude of health care workers towards the patients will improve outcomes of treatment.