Initial default among sputum-positive pulmonary TB patients at a referral hospital in Uttarakhand, India.
BACKGROUND
Initial default is a serious issue which can enhance the transmission of TB. We determined the magnitude of and the causative factors for initial default among sputum-positive pulmonary TB (PTB) patients.


METHODS
In this prospective study, 2310 patients attending a referral hospital in Uttarakhand state, north India, with presumptive TB were investigated and 555 patients with sputum-positive PTB were followed-up for initiation of anti-TB treatment (ATT) during 2010-2012. The patients not confirmed as having started ATT were considered initial defaulters.


RESULTS
Initial default was seen in 120 (21.6%) patients comprising 22 (18.3%) defaulters during diagnosis and 98 (81.6%) defaulters after referral for directly observed treatment, short-course (DOTS). The initial default rate was significantly higher among patients from rural areas than urban areas, illiterate patients than literate patients and smokeless tobacco-users than non-users (p<0.05 for all). The main reasons for initial default among patients referred for DOTS were limited trust in DOTS (n = 44, 44.8%), adverse effects of previous ATT (n = 41, 41.8%), dissatisfaction with health services (n = 38, 38.7%), local deaths while taking DOTS (n = 28, 28.5%), advice by others against DOTS (n = 25, 25.5%), disbelief in the diagnosis (n = 18, 18.3%) and patient death before starting treatment (n = 4, 4.0%).


CONCLUSIONS
A high initial default rate was seen among patients with PTB. There is an urgent need to promote public awareness to lower the initial default rate.
Department of Medicine, Himalayan Institute of Medical Sciences, HIHT University, Swami Ram Nagar, Dehradun 248140, Uttarakhand, India.
Darshan
D
Mehra
Rajeev M
RM
Kaushik
Reshma
R
Kaushik
Jagdish
J
Rawat
Rajesh
R
Kakkar
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D023801:Directly Observed Therapy; D004522:Educational Status; D005260:Female; D005843:Geography; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
D000995:Antitubercular Agents
DOTS; India; Initial default; Loss to follow-up; Pulmonary tuberculosis