title: Risk factors associated with default among new smear positive TB patients treated under DOTS in India.
abstract: BACKGROUND
  Poor treatment adherence leading to risk of drug resistance, treatment failure, relapse, death and persistent infectiousness remains an impediment to the tuberculosis control programmes. The objective of the study was to identify predictors of default among new smear positive TB patients registered for treatment to suggest possible interventions to set right the problems to sustain and enhance the programme performance.
  
  
  RESULTS
  Twenty districts selected from six states were assigned to six strata formed, considering the geographic, socio-cultural and demographic setup of the area. New smear positive patients registered for treatment in two consecutive quarters during III quarter 2004 to III quarter 2005 formed the retrospective study cohort. Case control analysis was done including defaulted patients as "cases" and equal number of age and sex matched patients completing treatment as "controls". The presence and degree of association between default and determinant factors was computed through univariate and multivariate logistic regression analysis. Data collection was through patient interviews using pre-tested semi structured questionnaire and review of treatment related records. Information on a wide range of socio demographic and patient related factors was obtained. Among the 687 defaulted and equal numbers of patients in completed group, 389 and 540 patients respectively were satisfactorily interviewed. In the logistic regression analysis, factors independently associated with default were alcoholism [AOR-1.72 (1.23-2.44)], illiteracy [AOR-1.40 (1.03-1.92)], having other commitments during treatment [AOR-3.22 (1.1-9.09)], inadequate knowledge of TB [AOR-1.88(1.35-2.63)], poor patient provider interaction [AOR-1.72(1.23-2.44)], lack of support from health staff [AOR-1.93(1.41-2.64)], having instances of missed doses [AOR-2.56(1.82-3.57)], side effects to anti TB drugs [AOR-2.55 (1.87-3.47)] and dissatisfaction with services provided [AOR-1.73 (1.14-2.6)].
  
  
  CONCLUSIONS
  Majority of risk factors for default were treatment and provider oriented and rectifiable with appropriate interventions, which would help in sustaining the good programme performance.
authors.affiliation: National Tuberculosis Institute, Bangalore, India. nti@ntiindia.org.in
authors.forename: Sophia
authors.initials: S
authors.lastname: Vijay
authors.forename: Prahlad
authors.initials: P
authors.lastname: Kumar
authors.forename: Lakbir Singh
authors.initials: LS
authors.lastname: Chauhan
authors.forename: Balasangameshwara Hanumanthappa
authors.initials: BH
authors.lastname: Vollepore
authors.forename: Unnikrishnan Pallikkara
authors.initials: UP
authors.lastname: Kizhakkethil
authors.forename: Sumathi Govinda
authors.initials: SG
authors.lastname: Rao
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003625:Data Collection; D023801:Directly Observed Therapy / Q000379:methods*; D006801:Humans; D007194:India; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult
references.citation: Chest. 1997 May;111(5):1168-73
references.pmid: 9149565
references.citation: Int J Tuberc Lung Dis. 2007 Jan;11(1):46-53
references.pmid: 17217129
references.citation: Int J Tuberc Lung Dis. 2007 May;11(5):539-43
references.pmid: 17439678
references.citation: Natl Med J India. 2004 Nov-Dec;17(6):292-9
references.pmid: 15736548
references.citation: Soc Sci Med. 1992 Feb;34(3):291-306
references.pmid: 1557670
references.citation: Am Rev Respir Dis. 1991 Oct;144(4):745-9
references.pmid: 1928942
references.citation: Southeast Asian J Trop Med Public Health. 2008 Nov;39(6):1076-82
references.pmid: 19062698
references.citation: PLoS Med. 2007 Feb;4(2):e37
references.pmid: 17298164
references.citation: Int J Tuberc Lung Dis. 2002 Jul;6(7):573-9
references.pmid: 12102295
references.citation: Int J Tuberc Lung Dis. 1999 Apr;3(4):300-9
references.pmid: 10206500
references.citation: Int J Tuberc Lung Dis. 2003 Sep;7(9 Suppl 1):S5-13
references.pmid: 12971649
references.citation: Ir Med J. 1986 Apr;79(4):87-90
references.pmid: 3710760
references.citation: Int J Tuberc Lung Dis. 2003 Sep;7(9 Suppl 1):S21-8
references.pmid: 12971651
references.citation: BMC Public Health. 2005 Jun 06;5:62
references.pmid: 15938746
references.citation: Ethiop Med J. 1994 Apr;32(2):97-106
references.pmid: 8033883
references.citation: Int J Tuberc Lung Dis. 2002 Sep;6(9):780-8
references.pmid: 12234133
references.citation: Int J Tuberc Lung Dis. 2004 Dec;8(12):1492-8
references.pmid: 15636497
references.citation: Bol Oficina Sanit Panam. 1991 Nov;111(5):423-31
references.pmid: 1837720
references.citation: Int J Tuberc Lung Dis. 1998 Nov;2(11):891-7
references.pmid: 9848609
references.citation: Indian J Tuberc. 2007 Apr;54(2):66-70
references.pmid: 17575677
references.citation: Bull Int Union Tuberc. 1982 Sep-Dec;57(3-4):255-60
references.pmid: 7168813
references.citation: JAMA. 2007 Jan 24;297(4):380-6
references.pmid: 17244834
references.citation: Trop Med Int Health. 2003 Jul;8(7):625-33
references.pmid: 12828545
references.citation: Kekkaku. 2008 Dec;83(12):765-72
references.pmid: 19172821
references.citation: Bull World Health Organ. 1999;77(5):386-91
references.pmid: 10361755
references.citation: Am Rev Respir Dis. 1993 May;147(5):1311-20
references.pmid: 8484650