Risk factors associated with default among tuberculosis patients in Darjeeling district of West Bengal, India.
BACKGROUND
The treatment outcome "default" under Revised National Tuberculosis Control Program (RNTCP) is a patient who after treatment initiation has interrupted treatment consecutively for more than 2 months.


OBJECTIVE
To assess the timing, characteristics and distribution of the reasons for default with relation to some sociodemographic variables among new sputum-positive (NSP) tuberculosis (TB) patients in Darjeeling District, West Bengal.


METHODS
A case-control study was conducted in three tuberculosis units (TUs) of Darjeeling from August'2011 to December'2011 among NSP TB patients enrolled for treatment in the TB register from 1(st) Qtr'09 to 2(nd) Qtr'10. Patients defaulted from treatment were considered as "cases" and those completed treatment as "controls" (79 cases and 79 controls).


METHODS
The enrolled cases and controls were interviewed by the health workers using a predesigned structured pro-forma.


METHODS
Logistic regression analysis, odds ratios (OR), adjusted odds ratios (AOR).


RESULTS
75% of the default occurred in the intensive phase (IP); 54.24% retrieval action was done within 1 day during IP and 75% within 1 week during continuation phase (CP); cent percent of the documented retrieval actions were undertaken by the contractual TB program staffs. Most commonly cited reasons for default were alcohol consumption (29.11%), adverse effects of drugs (25.32%), and long distance of DOT center (21.52%). In the logistic regression analysis, the factors independently associated were consumption of alcohol, inadequate knowledge about TB, inadequate patient provider interaction, instances of missed doses, adverse reactions of anti-TB drugs, Government Directly Observed Treatment (DOT) provider and smoking.


CONCLUSIONS
Most defaults occurred in the intensive phase; pre-treatment counseling and initial home visit play very important role in this regard. Proper counseling by health care workers in patient provider meeting is needed.
West Bengal Health Service, Burdwan District, India.
Nirmalya
N
Roy
Department of Community Medicine, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India.
Mausumi
M
Basu
Super Speciality Wing, (Anamoy Hospital) Burdwan Medical College & Hospital, Burdwan District, India.
Sibasis
S
Das
West Bengal Health Service, Maldah, India.
Amitava
A
Mandal
Department of Epidemiology, All India Institute of Hygiene and Public Health, Kolkata, India.
Debashis
D
Dutt
Department of Community Medicine, North Bengal Medical College, Darjeeling District, West Bengal, India.
Samir
S
Dasgupta
Alcohol drinking; case-control study; smoking; treatment outcome; tuberculosis