Risk factors for non-cure among new sputum smear positive tuberculosis patients treated in tuberculosis dispensaries in Yunnan, China

Abstract

BackgroundYunnan province in China has a high tuberculosis (TB) burden. Cure rates in general are high, but they were below the target of 85% in 26 out of 129 counties in 2005. In these 26 counties we assessed which patient-related and treatment-related factors were associated with non-cure.MethodsWe conducted a prospective cohort study. Smear positive pulmonary TB patients treated at the local Center for Disease Control and Prevention (CDC) were interviewed before start of treatment and during the fifth month of treatment using structured questionnaires. Information on treatment outcome was extracted from patient records. Patients cured at the end of treatment were compared to patients with unsuccessful treatment outcomes (failure, default, and death).ResultsA total of 841 patients were registered between January-June 2007 of which 792 (94%) were cured. Independent risk factors for non-cure were having a low income (<3000 RMB per year), not having medical insurance, a delay in health care seeking >30 days, a positive smear test result two months after start of treatment, not being aware of the need to go to the CDC for medical follow up during treatment, and not seeing the need for treatment observation.ConclusionReducing the financial burden of TB disease and providing health education to improve compliance with treatment could increase the proportion of patients with successful treatment outcomes.

Factors Associated with Treatment Failure among Smear Positive TB Patients in Khorasan-e-Razavi and Sistan-Baluchistan Provinces, Iran

“…This finding is in line with the results of the researches conducted in southern Delhi [7], Yunnan province of China [8] as well as a study performed in Uganda [9].…”

“…Inconsistent with the findings of the study by Jianzhao et al in China [8], monthly income of the families was also not significant in our study. However, it is worth mentioning that in Jianzhao et al's study the number of people with low, medium and high incomes were similar.…”

“…In a study by Narayanan et al [2], about the factors associated with failure and absence from treatment in southern India, the chance of treatment failure in patients to which DOTS was presented irregularly was 4.3 more than the chance for treatment failure in patients who had received complete DOTS from the healthcare system. In another study by Jianzho et al [8], conducted in China, a significant difference in treatment related to DOTS was observed. In this study, the chance for treatment failure in a group on which the DOTS was implemented in cooperation with the patient's family was 3.1 times higher than the group which DOTS was provided by the healthcare staff.…”

“…In studies conducted in Uganda [9] and China [8], no significant difference was shown between patients with upper-intermediate level of education and the reference group (elementary and uneducated ones). However, in the Uganda study the ratio of educated people in the case and control groups was exactly the same.…”

Prevalence and associated factors of tuberculosis treatment outcome among hazardous or harmful alcohol users in public primary health care in South Africa

“…12,14 TB patients with an unsuccessful treatment outcome, especially due to treatment failure and default, are a public health concern as they are at risk for clinical deterioration and complications, can continue to be infectious to others, and are at risk of premature death from TB. 9,12 TB treatment default, defined by the World Health Organization (WHO) as a treatment interruption of two consecutive months or more after at least one month on treatment, 13 is among the factors that has been linked to TB related mortality, 45% in Vietnam, 27% in Mexico, 28% in South Africa and 54% in the USA. 14 Various studies conducted in West Asia, Australia, Canada, Russia, Switzerland, and the USA had identified potential risk factors for TB treatment default.…”