Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study

Abstract

BackgroundThe directly observed therapy-short course (DOTS) strategy was introduced in Shaanxi province, China to improve tuberculosis (TB) control by means of improved case detection (target: > = 70%) and treatment success rates (target: > = 85%) in new smear positive (SS+) TB patients. At a provincial level the targets were both reached in 2005. However in 30 (28%) out of 107 counties of Shaanxi province the cure rate was below 85%. This study aimed to investigate patient and treatment characteristics associated with non-cure after tuberculosis (TB) treatment in these counties.MethodsIn this case-control study, new smear positive TB cases in 30 counties with a cure rate <85% were included. Cured patients were compared to non-cured patients using logistic regression analysis to assess determinants for non-cure.ResultsOf the 659 patients included, 153 (23.2%) did not have cure as treatment outcome. Interruption of treatment was most strongly associated with non-cure (OR = 8.7, 95% CI 3.9-18.4). Other independent risk factors were co-morbidity, low education level, lack of appetite as an initial symptom of TB disease, diagnosis of TB outside of the government TB control institutes, missing sputum re-examinations during treatment, and not having a treatment observer. Twenty-six percent of patients did not have a treatment observer. The non-cure rate was better for those with a doctor (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17-0.88) as treatment observer than for those with a family member (OR 0.62, 95%CI 0.37-1.03). The main reason for interrupted treatment mentioned by patients was presence of adverse effects during treatment (46.5%).ConclusionsInterruption of treatment was most strongly associated with non-cure. Although treatment observation by medical staff is preferred, in order to diminish the proportion of patients who do not have a treatment observer and thereby reduce the proportion of patients who interrupt treatment, we suggest making it possible for family members, after sufficient training, to be treatment observers in remote areas where it is logistically difficult to have village doctors observe treatment for all patients.

Factors Associated with Outcomes of Treatment among Pulmonary Tuberculosis Patients in Plateau State, Nigeria, 2011

“…Karim et al in Bangladesh and Salami and Olubayo in Ilorin Nigeria reported that male were less likely to adhere to treatment leading to poorer outcomes [23,24]. Similarly, the study of WU et al in Taiwan and a case control study in China by Ai et al revealed that elderly patients and those above 60 years had poorer treatment outcomes respectively [25,26]. These findings were in contrast to our finding which showed that the sex and age of the patients were not significantly associated with the outcome of treatment.…”

Treatment Outcomes of Tuberculosis and Associated Factors in an Ethiopian University Hospital

“…The burden of TB in these finding accounts for defaulted treatment 5.1%, dead subjects 2.4%, failure 0.3%, and transfer-out 0.5% of all patients and among smear positive pulmonary TB there were defaulted treatment 5.4%, dead subjects 2.9%, failure 0.4%, and transfer-out 0.7% cases [11]. Similarly in different parts of the world defaulted treatment, death, failure and transferout cases are the real challenges for TB treatment [12][13][14][15][16].…”

“…High age, male sex, low income, no or limited access to transport, distance from home to the treatment center, incomplete treatment compliance, limited interest in information about the disease and its treatment, limited social support, multidrug resistance, and Advances in Public Health 3 comorbidity have all been found to be related to unsuccessful treatment outcomes [13,[19][20][21][22][23][24].…”

Treatment Outcome of Tuberculosis Patients and Associated Risk Factors at Dessie and Woldiya Town Health Institutions, Northeast Ethiopia: A Retrospective Cross Sectional Study

“…There are several influential risk factors for treatment outcome of TB patients which have been identified so far. The following are among the recognized factors that lead to poor treatment outcome of the patients: male sex [7][8][9][10][11][12][13], old age [7,8,[14][15][16][17], unemployment [14,18], distance or travel cost to a healthcare facility [10,[18][19][20], being on retreatment [7,14,16,[21][22][23][24], TB/HIV co infection [9,10,22,[25][26][27], side effects of anti-TB drugs [10,[28][29][30][31], family size greater than 5 persons [14], having smearnegative pulmonary TB [7,8]. In addition, illiteracy [20,30,32], low educational level [27,31], substance abuse [10,…”