Characterization of Defaulters from Tuberculosis Treatment in a Tertiary Hospital in South Eastern Nigeria

Abstract

Background: Tuberculosis is second only to HIV/AIDS as the greatest killer worldwide, due to a single infectious agent. Directly Observed Treatment Short-Course (DOTS) is presently the WHO recommended programme to fight tuberculosis worldwide. There is a need to understand the characteristics of patients who default from treatment for tuberculosis. This will help modify the strategies to reduce such default to the barest minimum and achieve higher levels of adherence. Objective: The aim of this study was to describe the characteristics of patients that defaulted from treatment for TB at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi DOTS clinic for the period 1st January 2011 to 31st December 2012. Materials and Methods: This was a retrospective study conducted at the DOTS clinic at Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria. The records of patients who received treatment from the clinic from 1st January 2011 to 31st December 2012 (2 years) were reviewed. The data collected include patients' demographic characteristics, treatment category, patient type, baseline sputum smear result, and retroviral status. From the data, default rate was calculated and its relationship with other variables noted. Associations between patients' characteristics were determined using chi square test of independence. The significance level was set at p = 0.05. Results: A total of 765 patients enrolled for TB treatment in the DOTS clinic of the study area within the study period of 1 st January 2011 and December 31 st 2012. The mean age at commencement of the treatment was 33.14 years (±18.09). The outcome of treatment showed that 260 (34%) had treatment completed, 230 (30.1%) cured, 120 (15.7%) defaulted, 103 (13.5%) died, 40 (5.2%) were transferred-out, and 12 (1.6%) failed in the treatment, giving a treatment success rate of 64.1%. Among the 120 (15.7%) patients that defaulted from treatment, majority 80 (66.7%) were males, and most 30 (25.0%) were in the 30 -39 years age group. Conclusion: Defaulting starts with treatment interruption hence prompt management of interruption of treatment and default will largely help in prevent-* Corresponding author. E. D. Adinma et al. 2 ing drug-resistant TB.

Tuberculosis Treatment Outcomes and Determinants among Patients Treated in Hospitals in Imo State, Nigeria

“…This report was in line with findings from some of the reviewed works [5] [6] [19] [29] [52]. It has been globally reported that TB occurs mostly as pulmonary types in greater than 80% of all cases [5] [6].…”

“…It was also lower than figures reported from studies in Ekiti state Nigeria, (93.0%) [55], Turkey (94.7%) [43], India, (84.6%) [7] and also below the national recommended target of June 2016 | Volume 3 | e2754 85% [14]. Nevertheless, the treatment success found in this study was higher than figures reported in studies from, Nnewi, (61.3%) [19] Owo Ondo state, (75.5%) [51] Ibadan (76.6%) [17], Ebonyi state, (65.8%) [40], Abuja, (65.8%) [39] all from Nigeria and in Limpopo South Africa, (74.4%) [25]. Yet our findings compares favorably with the treatment successes reported in some other studies; 82% from a study in Enugu state [49], 80% in another study from Ebonyi state [56], 83.4% in India [26] and 82.7% in Addis Ababa, Ethiopia [23].…”

“…Where n 1 = corrected minimum sample size required, Z = standard normal deviate set at 1.96, p = proportion of TB patients in previous study with successful treatment outcome (61.3%) [19], d = level of precision set at 0.05, q = 1 − p, N = estimate total number of TB cases in the state. The hospitals that were studied was purposively selected based on the patient load, availability of free TB and HIV services, presence of a chest clinic and availability of manpower for the clinics.…”

“…The default rate remained as high as 11% in the seven year period, while the death rate was as high as 6.7% [17] [18]. In a study in a tertiary hospital in Nnewi, Nigeria, 61.3% of the TB patients had successful treatment, 14.6% defaulted while 16.2% died [19]. In another study in private and public hospitals in Nnewi, Nigeria, the success rate was 57.3%, default rate was 28.2% while 4.1% of the TB patients' died [20].…”

“…Several factors have been reported in previous studies to influence the treatment outcome of tuberculosis. Socio demographic factors reported in previous studies were age of patients [27]- [32], sex of patients [17] [43], presence of co-morbidities [28], hospitalization [28], sputum smear positivity at 3 months of treatment [28] [37], pre-treatment sputum result status [32] [42] [43], delay in treatment 42, HIV status of TB patients [19] [39] [44]- [46], bilateral radiologic lesions and cavities [28] [43]. Other factors reported were those related to type of health facility and house patient lived in [25] [39].…”