An Empirical Investigation of Patient Knowledge, Perceptions, and Adherence to Tuberculosis Treatment in Adamawa State, North East Nigeria

Nigeria bears one of the highest tuberculosis burdens globally, and successful treatment outcomes depend critically on patient adherence to the six-month directly observed treatment short-course regimen. Knowledge gaps and negative perceptions of tuberculosis treatment continue to undermine adherence in high-burden states. This study empirically investigated patient knowledge, perceptions, and adherence to tuberculosis treatment in Adamawa State, North East Nigeria. A mixed-methods study was conducted, combining cross-sectional surveys with 240 tuberculosis patients enrolled at directly observed treatment short-course centres across four local government areas, and in-depth interviews with 20 purposively selected participants. The survey measured knowledge of tuberculosis transmission and treatment, using a validated 20-item tool, and adherence using treatment outcome records and the tablet count method. Qualitative data explored illness perceptions, treatment barriers, and social support structures. Overall knowledge was adequate in 51 percent of respondents. Successful treatment completion was recorded in 68 percent of patients, with non-adherence events in 29 percent. Poor knowledge was independently associated with non-adherence in multivariate analysis, along with distance to directly observed treatment short-course centres, stigma perception, and side effect burden. Qualitative themes revealed that fear of discrimination and belief in traditional medicine were prominent adherence barriers. The study recommends pharmacist integration into tuberculosis care teams to provide medication education, stigma reduction counseling, and side effect management. Community-level support systems in Adamawa are essential. Keywords: tuberculosis, treatment adherence, patient knowledge, Adamawa State, DOTS program