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A Study on Treatment Defaulters in Tuberculosis Patients on Dots Therapy


Affiliations
1 Department of Pharmacy Practice, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka, India
2 Department of Pulmonary Medicine, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka,, India
3 Department of Pharmacology, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka, India
     

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Tuberculosis is an infectious airborne, chronic granulomatous bacterial disease which requires a prolonged treatment to get a complete cure and prevent death, relapse, resistance to drugs and spreading it to the community. Present study was focused on treatment defaulters among tuberculosis patients receiving dots therapy. A prospective observational study was carried out in the in-patient and outpatient department of pulmonary medicine and other departments with dots referral in a hospital setting for a period of eight months from September 2017- April 2018. During the study period all the patients who was administered with dots therapy for the treatment of tuberculosis were enrolled as per the study criteria. All the patients were interviewed to know there treatment status and also monitored there ADR to check compliance with dots therapy. All the datas were analyzed using descriptive statistics. Out of 90 patients, 21 patients interrupted the treatment, of which 12 were defaulters. The overall percentage of the default to the treatment was 13.3%. The case fatality rate was 4.4%. The mean age of defaulting was found to be 53.3 years and the highest percentage were in the age group 50-65years. Male patients, rural domicile, patients pursuing primary education, pulmonary TB patients were high among the defaulters. Distance (58.3%) transportation (25%), staying alone (16.7%), workload (25%) were the general problems felt by the defaulters. 41.7% were dissatisfied with the behavior of dots provider and 50% of them did not have family support. Patients interrupted treatment in there early phases (41.7% in intensive phase and 58% in early continuous phase). The reasons to default were feeling of wellbeing after the treatment (41.7%), side effects (25.0%). Migration, non-availability of medicines, affording transport charges, medical issues were the other reasons (8.3%). Out of 90 patients, 17 (18.9%) patients came out with a total of 24 ADRs. From this only 2 patients had defaulted from the treatment due to intolerance from the medicational Side effects. ADR monitoring improved the knowledge (from 4.9 to 8.2) and treatment (1.2 to 2.5) of the patient in the current study. From the study we came to conclude that Defaulting was seen mainly due to unawareness, carelessness, disbelief of the treatment method. This can be enhanced by patient education, interviewing them periodically, Monitoring the treatment condition and side effects. So the Clinical pharmacists is responsible in promoting the dots therapy to improve the patients adherence towards it, there by achieving a well treatment outcome.

Keywords

Tuberculosis, DOTS Therapy, Default, ADR Monitoring.
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  • Tuberculosis (TB) [Internet]. World Health Organization; 2018 [updated 2018Jan; cited 2018 Apr9]. Available from: http://www.who.int/mediacentre/factsheets/fs104/en/

  • Gorityala SB, Mateti UV, Venkateswarlu Konuru SM. Assessment of treatment interruption among pulmonary tuberculosis patients: A cross-sectional study. J Pharm Bioallied Sci. 2015 Jul; 7(3):226.

  • Tuberculosis (TB) [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2018 [Updated 2018 Jan 1 cited 2018 Apr 9]. Available from: https://www.cdc.gov/tb/default.htm

  • Tuberculosis Types [Internet]. Tuberculosis Types - Tuberculosis – Health Communities.com. Stanley J. Swierzewski, III, M.D.; 2015 [Updated 08 Oct 2015 cited 2018Apr9]. Available from: http://www.healthcommunities.com/tuberculosis/types.shtml

  • Ravigilone MC. Tuberculosis. In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J, editors. Harrison's Principles of Internal Medicine.19thed. New York: MC Graw Hill Education; 2015.p.1102- 1120.

  • Kays MB. Tuberculosis. In: Koda- Kimble MA, Young LY, Alldredge BK, Corelli RL, Guglielmo BJ, Kradjan WA, et al. Applied Therapeutics, the Clinical use of drugs.9thed.Philadelphia: Lippincott Williams and Wilkins; 2009.p. 61.1 - 61.20.

  • Namdar R, Lauzardo M, Peloquin CA. Tuberculosis. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, Editors. Pharamacotherapy, A Pathophysiologic Approach.9th ed. United States of America: MC Graw Hill Education; 2014.p. 1787- 1803.

  • Reid PT, Innes JA. Respiratory disease. In: Walker BR, College NR, Ralston SH, Penman ID, editors. Davidson's Principles and Practice of Medicine.22nd ed. Edinburgh: Churchill Livingstone Elsevier; 2014.p.688- 696.

  • Treatment of Tuberculosis: Guidelines. 4th edition. Geneva: World Health Organization;2010.Availablefrom: https://www.ncbi.nlm.nih.gov/books/NBK138748

  • Pandit N, Choudhary SK. A study of treatment compliance in directly observed therapy for tuberculosis. Indian J Community Med. 2006 Oct 1;31(4):241-3.

  • Gelmanova IY, Keshavjee S, Golubchikova VT, Berezina VI, Strelis AK, Yanova GV, Atwood S, Murray M. Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance. Bulletin of the World Health Organization. 2007 Sep; 85(9):703-11.

  • Al-Hajjaj MS, Al-Khatim IM. High rate of non-compliance with anti-tuberculosis treatment despite a retrieval system: a call for implementation of directly observed therapy in Saudi Arabia. Int J Tuberc Lung Dis. 2000 Apr 1; 4(4):345-9.

  • Muture BN, Keraka MN, Kimuu PK, Kabiru EW, Ombeka VO, Oguya F. Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: a case control study. BMC public health. 2011 Dec; 11(1):696.

  • 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 Apr 1;7(4):327-35.

  • Slama K, Tachfouti N, Obtel M, Nejjari C. Factors associated with treatment default by tuberculosis patients in Fez, Morocco. East Mediterr Health J. 2013; 19 (8), 687 – 693.

  • Balabanova Y, Drobniewski F, Fedorin I, Zakharova S, Nikolayevskyy V, Atun R, Coker R. The directly observed therapy short-course (DOTS) strategy in Samara Oblast, Russian Federation. Respiratory Research. 2006 Dec; 7(1):44.

  • Amoran OE, Osiyale OO, Lawal KM. Pattern of default among tuberculosis patients on directly observed therapy in rural primary health care centres in Ogun State, Nigeria.J. Infect. Dis. Immun. 2011 May 31;3(5):90-5.

  • Bhagat VM, Gattani PL. Factors affecting tuberculosis retreatment defaults in Nanded, India Southeast Asian J Trop Med Public Health. 2010 Sep 1; 41(5):1153.

  • Chee CB, Boudville IC, Chan SP, Zee YK, Wang YT. Patient and disease characteristics, and outcome of treatment defaulters from the Singapore TB control unit—a one-year retrospective survey. Int J Tuberc Lung Dis. 2000 Jun 1;4(6):496-503.

  • Jaggarajamma K, Sudha G, Chandrasekaran V, Nirupa C, Thomas A, Santha T, Muniyandi M, Narayanan PR. Reasons for non-compliance among patients treated under Revised National Tuberculosis Control Programme (RNTCP), Tiruvallur district, south India. Ind J Tub. 2007; 54(3):130-5.

  • Tekle B, Mariam D, Ali A. Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia.Int J Tuberc Lung Dis. 2002 Jul 1;6(7):573-9.

  • Daniel OJ, Oladapo OT, Alausa OK. Default from tuberculosis treatment programme in Sagamu, Nigeria. Niger J Med. 2006 Jan;15(1):63-7.

  • Kruyt ML, Kruyt ND, Boeree MJ, Harries AD, Salaniponi FM, Van Noord PA. True status of smear-positive pulmonary tuberculosis defaulters in Malawi. Bulletin of the World Health Organization. 1999; 77(5):386.

  • Kruk ME, Schwalbe NR, Aguiar CA. Timing of default from tuberculosis treatment: a systematic review. Trop. Med. Int. Health. 2008 May 1; 13(5):703-12.

  • Sanchez-Padilla E, Marquer C, Kalon S, Qayyum S, Hayrapetyan A, Varaine F, Bastard M, Bonnet M. Reasons for defaulting from drug-resistant tuberculosis treatment in Armenia: a quantitative and qualitative study. Int J Tuberc Lung Dis. 2014 Feb 1; 18(2):160-7.

  • Jaiswal A, Singh V, Ogden JA, Porter JD, Sharma PP, Sarin R, Arora VK, Jain RC. Adherence to tuberculosis treatment: lessons from the urban setting of Delhi, India. Trop. Med. Int. Health. 2003 Jul 1; 8(7):625-33.

  • Castelnuovo B. Review of compliance to anti-tuberculosis treatment and risk factors for defaulting treatment in Sub Saharan Africa. African health sciences. 2010; 10(4).

  • Oboyle S, Power J, Ibrahim MY, Watson J. Factors affecting patient compliance with anti-tuberculosis chemotherapy using the directly observed treatment, short-course strategy (DOTS). Int J Tuberc Lung Dis. 2002 Apr 1; 6(4):307-12.

  • Sagbakken M, Frich JC, Bjune G. Barriers and enablers in the management of tuberculosis treatment in Addis Ababa, Ethiopia: a qualitative study. BMC Public health. 2008 Dec;8(1):11.


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  • A Study on Treatment Defaulters in Tuberculosis Patients on Dots Therapy

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Authors

Mohammed Shabil
Department of Pharmacy Practice, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka, India
V. Rajesh
Department of Pulmonary Medicine, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka,, India
K. C. Bharath Raj
Department of Pharmacy Practice, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka, India
K. S. Rajesh
Department of Pharmacy Practice, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka, India
K. Prasanna Shama
Department of Pharmacology, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka, India
M. P. Gururaja
Department of Pharmacology, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka, India
Himanshu Joshi
Department of Pharmacology, NITTE (Deemed to be University), Mangaluru - 575018 Karnataka, India

Abstract


Tuberculosis is an infectious airborne, chronic granulomatous bacterial disease which requires a prolonged treatment to get a complete cure and prevent death, relapse, resistance to drugs and spreading it to the community. Present study was focused on treatment defaulters among tuberculosis patients receiving dots therapy. A prospective observational study was carried out in the in-patient and outpatient department of pulmonary medicine and other departments with dots referral in a hospital setting for a period of eight months from September 2017- April 2018. During the study period all the patients who was administered with dots therapy for the treatment of tuberculosis were enrolled as per the study criteria. All the patients were interviewed to know there treatment status and also monitored there ADR to check compliance with dots therapy. All the datas were analyzed using descriptive statistics. Out of 90 patients, 21 patients interrupted the treatment, of which 12 were defaulters. The overall percentage of the default to the treatment was 13.3%. The case fatality rate was 4.4%. The mean age of defaulting was found to be 53.3 years and the highest percentage were in the age group 50-65years. Male patients, rural domicile, patients pursuing primary education, pulmonary TB patients were high among the defaulters. Distance (58.3%) transportation (25%), staying alone (16.7%), workload (25%) were the general problems felt by the defaulters. 41.7% were dissatisfied with the behavior of dots provider and 50% of them did not have family support. Patients interrupted treatment in there early phases (41.7% in intensive phase and 58% in early continuous phase). The reasons to default were feeling of wellbeing after the treatment (41.7%), side effects (25.0%). Migration, non-availability of medicines, affording transport charges, medical issues were the other reasons (8.3%). Out of 90 patients, 17 (18.9%) patients came out with a total of 24 ADRs. From this only 2 patients had defaulted from the treatment due to intolerance from the medicational Side effects. ADR monitoring improved the knowledge (from 4.9 to 8.2) and treatment (1.2 to 2.5) of the patient in the current study. From the study we came to conclude that Defaulting was seen mainly due to unawareness, carelessness, disbelief of the treatment method. This can be enhanced by patient education, interviewing them periodically, Monitoring the treatment condition and side effects. So the Clinical pharmacists is responsible in promoting the dots therapy to improve the patients adherence towards it, there by achieving a well treatment outcome.

Keywords


Tuberculosis, DOTS Therapy, Default, ADR Monitoring.

References