Factors associated with default from treatment among tuberculosis patients in nairobi province, Kenya: A case control study

Abstract

BackgroundSuccessful treatment of tuberculosis (TB) involves taking anti-tuberculosis drugs for at least six months. Poor adherence to treatment means patients remain infectious for longer, are more likely to relapse or succumb to tuberculosis and could result in treatment failure as well as foster emergence of drug resistant tuberculosis. Kenya is among countries with high tuberculosis burden globally. The purpose of this study was to determine the duration tuberculosis patients stay in treatment before defaulting and factors associated with default in Nairobi.MethodsA Case-Control study; Cases were those who defaulted from treatment and Controls those who completed treatment course between January 2006 and March 2008. All (945) defaulters and 1033 randomly selected controls from among 5659 patients who completed treatment course in 30 high volume sites were enrolled. Secondary data was collected using a facility questionnaire. From among the enrolled, 120 cases and 154 controls were randomly selected and interviewed to obtain primary data not routinely collected. Data was analyzed using SPSS and Epi Info statistical software. Univariate and multivariate logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied.ResultsOf 945 defaulters, 22.7% (215) and 20.4% (193) abandoned treatment within first and second months (intensive phase) of treatment respectively. Among 120 defaulters interviewed, 16.7% (20) attributed their default to ignorance, 12.5% (15) to traveling away from treatment site, 11.7% (14) to feeling better and 10.8% (13) to side-effects. On multivariate analysis, inadequate knowledge on tuberculosis (OR 8.67; 95% CI 1.47-51.3), herbal medication use (OR 5.7; 95% CI 1.37-23.7), low income (OR 5.57, CI 1.07-30.0), alcohol abuse (OR 4.97; 95% CI 1.56-15.9), previous default (OR 2.33; 95% CI 1.16-4.68), co-infection with Human immune-deficient Virus (HIV) (OR 1.56; 95% CI 1.25-1.94) and male gender (OR 1.43; 95% CI 1.15-1.78) were independently associated with default.ConclusionThe rate of defaulting was highest during initial two months, the intensive phase of treatment. Multiple factors were attributed by defaulting patients as cause for abandoning treatment whereas several were independently associated with default. Enhanced patient pre-treatment counseling and education about TB is recommended.

Factors associated with non-adherence during tuberculosis treatment among patients treated with DOTS strategy in Jayapura, Papua Province, Indonesia

“…This association was also observed in the Indian and Moroccan studies [7,19]. Other studies showed that older age was significantly related to the risk of LTFU [22,23]. The studies in Bandung, Indonesia and Sub-Saharan Africa did not find any difference between age groups [13,24].…”

“…Previous studies examining risk factors for LTFU reported that low knowledge about the cause of TB, TB transmission and the consequences of incomplete treatment played a role in lower treatment compliance [14,19]. Many studies also demonstrated that inadequate knowledge of TB was associated with poor adherence [7,22–24,27,28]. In contrast to our finding, a similar case-control study conducted in urban Morocco found that TB knowledge (duration, causes, transmission, and consequence of stopping TB treatment) was not associated with compliance during TB treatment [7].…”

Reasons for defaulting from drug-resistant tuberculosis treatment in Armenia: a quantitative and qualitative study

“…The relationship between sex and default, shown previously for drug-susceptible TB, 15,[25][26][27][28] was close to signifi cance. This association may be explained by the fact that in Armenia males are more likely to work outside the home; presumably, once their health improves they seek employment, sometimes outside the country.…”

Factors that contribute to treatment defaulting amongst tuberculosis patients in Windhoek District, Namibia

“…Alcohol is considered a social problem which predisposes patients to malnutrition and increasing the chances of contracting TB. [35] It was found that TB patients who have a problem with alcoholism do not collect their treatment regularly and were found to default treatment more than the non-alcoholic patients. [7] One health service related factor that can cause stigma is the integration of the TB and HIV departments as well as having this combined department separate from the main health centre.…”