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

BMC Public Health

Research Article

Ephantus W Kabiru¹  Francis Oguya²  Margaret N Keraka²  Peter K Kimuu³  Victor O Ombeka³  Bernard N Muture⁴ 

[1] Department of Pathology, Kenyatta University, P.O Box 43844, Nairobi, Kenya;Department of Public Health, Kenyatta University, P.O Box 43844, Nairobi, Kenya;National Leprosy and Tuberculosis Program (NLTP), Ministry of Health, P.O. Box 19265-00202, Nairobi, Kenya;National Public Health Laboratory Services, Ministry of Health, P.O. Box 20750-00202, Nairobi, Kenya;

关键词: Inadequate Knowledge;    Intensive Phase;    Herbal Medication;    Directly Observe Treatment Short;    Treatment Default;   

DOI  :  10.1186/1471-2458-11-696

 received in 2011-02-17, accepted in 2011-09-09,  发布年份 2011

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Muture et al; licensee BioMed Central Ltd. 2011