Effect of mobile health intervention to medication dosage adherence among people with tuberculosis in selected hospitals in Imo State, Nigeria

Abstract

Tuberculosis (TB) remains a significant contributor to the global burden of disease, drawing considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Non-adherence to treatment can result in therapeutic failure, sustained infectiousness, and the emergence of drug-resistant strains. This study aimed to assess the effect of mobile health interventions on medication adherence among people with tuberculosis in Imo State, Nigeria. A quasi-experimental study design was employed, involving adults aged 18 years and above diagnosed with pulmonary tuberculosis and undergoing first-line treatment at the Federal University Teaching Hospital (FUTH), Owerri, and the Imo State Specialist Hospital (ISSH), Umuguma, between June and November 2024. Participants included those who had been diagnosed with tuberculosis within the past month and had commenced treatment within two weeks prior to the onset of the study. A total of 128 participants from ISSH and 134 from FUTH were enrolled. Simple random sampling, via coin toss, assigned FUTH as the intervention group and ISSH as the control group. Adherence was measured using questionnaire, video-observed therapy, and pill counts. Data were analyzed using regression analysis, with associations and statistical significance determined by odds ratios at a 95% confidence interval and a p -value threshold of less than 0.05. At the completion of the study, one death was reported in the intervention group and five in the control group. Adherence rates were significantly higher in the intervention group (86.6%) compared to the control group (41.4%). After adjusting for socio-demographic characteristics, participants at FUTH were found to be 12.9 times more likely to adhere to their anti-TB medication than those at ISSH (AOR = 12.91, 95% CI: 5.55–30.05, p < 0.001). Among all socio-demographic variables assessed, only occupation demonstrated a statistically significant association with non-adherence between the two hospitals. Non-adherence was significantly more among those employed in private firms (AOR = 0.09, p = 0.001) and traders (AOR = 0.17, p = 0.017). Mobile health interventions; including SMS, voice calls, video-assisted therapy, and WhatsApp audio messages, were found to be effective in improving medication adherence among individuals with tuberculosis. There was a marked increase in adherence among the intervention group compared to the control group following the six-month study. Policy makers should consider incorporating Mhealth as part of TB management.