Study of various causes of defaulter among tuberculosis patients under revised national tuberculosis control programme: a prospective analysis of 5235 tuberculosis patients

B. B. Bhadke, R. Rathod, D. G. Deshmukh, A. Luniya


Background: The world health organization (WHO) declared tuberculosis (TB) a global public health emergency in 1993 and since then intensified its efforts to control the disease worldwide. Poor compliance with tuberculosis (TB) treatment has reportedly been cited as one of the major obstacles which have led to spread of TB and development of multi-drug resistant and extensively drug resistant tuberculosis. The objective is to investigate factors contributing to treatment non-adherence among patients on TB treatment, the results of which might help us to design intervention that would promote compliance.

Methods: All TB patients admitted to the Institute were interviewed regarding the past history of anti-tuberculosis treatment (AKT). As per the revised national tuberculosis control programme (RNTCP) guidelines, we defined defaulter as patient who had interrupted AKT for more than 2 months. All the interviewed patients had taken AKT at RNTCP DOT sites. Patient who has taken AKT from private institute were excluded. All the defaulted patients were then interviewed in details. In addition to the personal and socio-demographic data, treatment history was recorded in details along with reasons for stopping treatment.

Results: Among 5235 TB patients, 405 (7.7%) were found to have a past history of AKT interruption. The highest number of treatment interrupters were in the age group 21 to 50 years (n=309), constituting nearly 76.29% of all the patients studied. The most common reason stated was AKT-induced side effects (42.2%) a feeling of early improvement (33.3%) and followed by migration for work (9.6%).

Conclusions: Present study concludes that the most common cause of defaulters amongst tuberculosis patients are adverse effects, feeling of early improvement and migration.



Poor compliance, Tuberculosis, Default AKT

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TB India 2011: RNTCP status report. Central TB Division, DGHS, Govt. of lndia. Global tuberculosis control - Epidemiology, Strategy, Financing. World health organization, 2009.

World Health Organization. TB - A Global Emergence. World health organization, Geneva. 1994. WHO/TB/94.177.

Ganapathy S, Chandrasekaran V, Britto JJ, Jemima SF, Charles N, Santha T, et al. A study of patients ‘Lost’ from short course chemotherapy under the district tuberculosis programme in South India. Lung India. 1994;12(3):129-34.

Driver CR, Matus SP, Bayuga S, Winters AI, Munsiff SS. Factors associated with tuberculosis treatment interruption in New York City. J Public Health Manag Pract. 2005;11(4):361-8.

Emmanuel AD, Godwin YA. Factors associated with tuberculosis treatment default and completion at the Effia-Nkwanta Regional Hospital in Ghana. Trans R Soc Trop Med Hyg. 2005;99:827-32.

Jaiswal A, Singh V, Ogden JA, Porter JDH, Sharma PP, Sarin R, et al. Adherence to tuberculosis treatment: lessons from the urban setting of Delhi, India. Tropical medicine and international health. 2003;8:625-33.

Khanna BK, Srivastava AK, Mohd Ali. Drug default in Tuberculosis. Indian J Tuberc. 1977;24:121-6.

Vijay S, Balasangameshwara VH, Srikantaramu N. Treatment Dynamics and Profile of Tuberculosis Patients under the District Tuberculosis Programme (DTP) - A Prospective Cohort Study. Indian J Tuberc. 1999;46:239-49.

Vijay S, Balasangameshwara VH, Jagannatha PS, Saroja VN, Kumar P. Defaults among tuberculosis patients treated under DOTS in Bangalore city: A search for Solution. Indian J Tuberc. 2003;50:185-95

Jaggarajamma K, Sudha G, Chandrasekaran V, Nirupa C, Thomas A, Santha T et al. Reasons for non-compliance among patients treated under revised national tuberculosis control programme (RNTCP), Tiruvallur district, South India. Indian J Tuberc. 2007;54(3):130-5.

Wares DF, Singh S, Acharya AK, Dangi R. Non-adherence to tuberculosis treatment in the eastern Tarai of Nepal. Int J Tuberc. Lung Dis. 2003;7(4):327-35.

Kaona FA, Tuba M, Siziya S, Sikaona L. An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. BMC Public Health. 2004;4:68.

Demissie M, Kebede D. Defaulting from tuberculosis treatment at the Addis Ababa Tuberculosis Centre and factors associated with it. Ethiop Med J. 1994;32(2):97-106.

Tissera WAA. Non-Compliance with Anti-Tuberculous Treatment at Colombo Chest Clinic. NTI Bulletin. 2003;39:5-9.

Chatterjee C, Banerjee B, Dutt D, Pati RR, Mullick AK. A Comparative Evaluation of Factors & Reasons for Defaulting in Tuberculosis Treatment in the States of West Bengal, Jharkhand and Arunachal Pradesh. Indian J Tuberc. 2003;50:17-21.

Mishra P, Hansen EH, Sabroe S, Kafle KK. Adherence is associated with the quality of professional-patient interaction in Directly Observed Treatment Short-course, DOTS. Patient Educ Couns. 2006;63(1-2):29-37.

O'Boyle SJ, Power JJ, Ibrahim MY, Watson JP. Factors affecting patient compliance with anti-tuberculosis chemotherapy using the directly observed treatment, short• course strategy (DOTS). Int J Tuberc Lung Dis. 2002;6(4):307-12.

Hill PC, Stevens W, Hill S, Bah J, Donkor SA, Jallow A, et al. Risk factors for defaulting from tuberculosis treatment: a prospective cohort study of 301 cases in the Gambia. Int J Tuberc. Lung Dis. 2005;9(12):1349-54.

Jakubowiak WM, Bogorodskaya EM, Borisov SE, Danilova ID, Lomakina OB, et al. Social support and incentives programme for patients with tuberculosis: experience from the Russian Federation. Int J Tuberc. Lung Dis. 2007;11(11):1210-5.

Barn TS, Gunneberg C, Chamroonsawasdi K, Barn DS, Aalberg O, Kasland O, et al. Factors affecting patient adherence to DOTS in urban Kathmandu, Nepal. Int J Tuberc Lung Dis. 2006;10(3):270-6.