A comparative study of factors for interruption of antitubercular treatment among defaulters in urban and rural areas of Kamrup District, Assam

Abstract

Background: Defaulting from treatment is an important challenge for tuberculosis (TB) control. As per the Revised National Tuberculosis Control Programme quarterly reports of Kamrup District (Assam), among the registered cases default rate was 13.3%(2008) & 13.1 % (2009). Objectives: To elicit reasons & factors responsible for interruption of treatment from a cohort of TB defaulters of urban & rural areas in Kamrup District. Methods: The cross-sectional study was conducted among 1/3rd of all defaulters who were put on Directly Observed Treatment Short-course chemotherapy in 2011 under 1 urban Tuberculosis Unit (TU) & 2 rural TUs of Kamrup District. From these 3 TUs, total 210 patients interrupted treatment in 2011; so 70 defaulters (35 from 1 urban TU & 35 from 2 rural TUs) were interviewed in their residences by using a pretested and predesigned schedule. Study was conducted in January - June, 2012. Results: Majority of the defaulters was illiterate (51.4%) in rural areas but in urban areas majority studied upto high school level (37.1%). Maximum defaulters were in the age group 25-44 years (55.7% in urban areas & 62.9% in rural areas). The number of defaulters decreased uniformly with increasing income in the rural areas & but not so in urban areas. More number of new cases defaulted in rural areas (82.8%) compared to urban areas (57.1%). Improvement in symptoms was found to be the most common reason (45.7% in urban areas & 40 % in rural areas), leading to treatment interruption. Conclusions: Early improvement in symptom was the most common reason leading to treatment interruption. Continuous health education should be provided to TB patients emphasizing the need to continue treatment despite early improvement in symptoms.

Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies

“…Across 15 studies surveying people who experienced loss to follow-up or medication nonadherence during treatment, clinical reasons included medication side effects (reported by 7% [1/14] [ 112 ] to 47% [15/32] [ 92 ] of people across 15 studies [ 87 , 92 , 102 , 106 , 112 – 122 ]), long treatment duration (reported by 11% [8/70] [ 121 ] to 16% [5/32] [ 92 ] of people in 2 studies), early symptom improvement (reported by 4% [1/28] [ 119 ] to 55% [110/201] [ 114 ] across 11 studies [ 87 , 92 , 106 , 113 – 117 , 119 – 121 ]), and lack of symptom improvement (reported by 1% [1/150] [ 117 ] to 34% [11/32] [ 92 ] across 8 studies [ 92 , 113 – 115 , 117 , 120 – 122 ]) (Fig L in the S6 Appendix ).…”

“…Across 15 studies surveying people who experienced loss to follow-up or medication nonadherence, reported reasons included: work constraints (reported by 1% [1/82] [ 106 ] to 38% [12/32] [ 92 ] of people across 8 studies [ 92 , 106 , 113 – 115 , 118 – 120 ]); migration or travel (reported by 1% [2/201] [ 114 ] to 91% [20/22] [ 103 ] of people across 9 studies [ 87 , 103 , 106 , 113 , 114 , 116 , 118 , 120 , 121 ]); lack of knowledge of treatment duration or of the risks of treatment interruption (reported by 7% [5/70] [ 121 ] to 25% [14/55] [ 122 ] of people in 4 studies [ 114 , 115 , 121 , 122 ]); TB stigma (reported by 3% [4/141] [ 113 ] to 81% [26/32] [ 92 ] of people across 3 studies [ 87 , 92 , 113 ]); alcohol use (reported by 3% [5/150] [ 117 ] to 35% [29/82] [ 106 ] of people across 5 studies [ 92 , 106 , 113 , 114 , 117 ]); forgetfulness in dose-taking (reported by 19% [15/78] [ 118 ] to 43% [6/14] [ 112 ] of people across 4 studies [ 87 , 112 , 118 , 122 ]); and depression (reported by 7% [27/377] [ 112 ] to 23% [39/167] [ …”

“…Across 15 studies surveying people who experienced loss to follow-up or medication nonadherence, health system-related reasons included lack of faith in treatment (reported by 5% [10/201] [ 114 ] to 25% [8/32] [ 92 ] in 2 studies), long distance to the clinic (reported by 1% [2/150] [ 117 ] to 21% [35/167] [ 87 ] across 6 studies [ 87 , 112 , 114 , 116 , 117 , 119 , 121 ]), and high treatment costs (reported by 17% [25/150] [ 117 ] to 30% [60/201] [ 114 ] across 3 studies [ 114 , 117 , 120 ]) ( Fig 8 ). Healthcare provider barriers (reported by 1% [2/150] [ 117 ] to 21% [6/28] [ 119 ] across 3 studies [ 114 , 117 , 119 ]) included providers refusing treatment, advising people to stop treatment, or not cooperating with care.…”