title: Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting.
abstract: OBJECTIVE
  To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria.
  
  
  METHODS
  Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death.
  
  
  RESULTS
  Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6).
  
  
  CONCLUSIONS
  Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme.
authors.affiliation: National Tuberculosis and Leprosy Control Programme, Ministry of Health, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Isaac
authors.initials: I
authors.lastname: Alobu
authors.affiliation: Centre for Development and Reproductive Health, Enugu, Enugu State, Nigeria.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Oshi
authors.affiliation: Centre for Development and Reproductive Health, Enugu, Enugu State, Nigeria.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Oshi
authors.affiliation: Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. Electronic address: ukwajakingsley@yahoo.co.uk.
authors.forename: Kingsley N
authors.initials: KN
authors.lastname: Ukwaja
keywords: Epidemiology; Health services; Mortality; Nigeria; Treatment default; Treatment outcome; Tuberculosis