Analysing Sociodemographic Factors: Highlighting Gender in Tuberculosis Treatment and Defaulters

@#Introduction: : Current tuberculosis (TB) eradication strategies have shifted away from the medical sphere, focusing on a more holistic approach that encompasses both healthcare and social support. This means a greater emphasis on TB prevention strategies, particularly on social determinants of TB. Using a locality in Malaysia as a case study, a research was carried out among 844 TB cases in Pasir Mas, Kelantan (2013 to 2017) to identify the socioeconomic distributions of TB defaulters and its implications for current TB prevention strategies. Methods: TB patients’ sociodemographic characteristics and treatment outcomes were extracted and analyzed from the Malaysian registry. Pearson’s chi-square test was used to determine sociodemographic factors associated with TB defaulters. Results: Gender, age and education levels were significantly associated with default treatment (p<0.05), highlighting the need to focus on adult male patients with low educational background. Conclusion: Results indicate that current national TB management needs to focus on targeting those at increased risk of defaulting by understanding gender-specific challenges to treatment. While more research is needed to explore the gender associated issues related to treatment defaulting, we are also calling for a change in current TB management practices to one that focuses on gender-specific intervention that addresses personal and societal challenges to TB treatment.

Patterns of radiation treatment default and its evaluation in a cancer center in the Southern part of Odisha: a retrospective study

Background: The incidence of cancer in India is alarming. However, many patients discontinued their treatment protocols resulting in higher mortality rate. This study aims to find out different patterns of treatment defaults in cancer patients receiving external beam radiation in the radiotherapy department of a cancer center in the southern part of Odisha state.Methods: It is a retrospective epidemiological study carried out in cancer patients receiving external beam radiotherapy for their cancer treatment but had not completed the full course of treatment during the study period from January 2018 to May 2019. Patterns of failure in relation to various demographic and socio-economic statuses were analyzed.Results: One hundred seven defaulter patients were included in this study. The mean age of the patients was 50.93±14.3 years (range 12 to 90 years) and 66(61.7%) were being females. Out of 107 patients, 53.2% patients were receiving treatment in curative intent, 28.0% patients were treated in adjuvant intent and 18.2% in palliative intent. Forty-two (39.2%) patients were from a distance >50 km from the study center, 74.7% of patients belong to low socio-economic status and 60.7% patients were illiterate. Only 33.3% of patients completed more than 15 fractions of radiation excluding the palliative cases. The comparison of various factors such as distance from study center (p=0.759), education (p=0.2428), socio-economic status (p=0.6628) and acute radiation toxicity (p=0.9359) among the groups of patients receiving more or less than 15 fractions of radiation did not showed any statistical significant differences.Conclusions: Radiation induced acute toxicity, distance from study center, education and socio-economic status might be responsible for the treatment discontinuation. There is no particular association of age, disease site and intent of treatment with default among patients.

Reasons for the delay in the initiation of treatment and initial default among drug-resistant tuberculosis patients in Ahmedabad corporation area

The emergence of drug-resistant tuberculosis (DR-TB) has become a significant health problem in India. Delays in diagnosis and treatment initiation are frequently observed among patients with DR-TB, resulting in an increased risk of disease complications and high mortality and pretreatment lost to follow-up rates. To understand the factors associated with delays between the diagnosis and treatment, the study was carried out in Ahmedabad Municipal Corporation Area. A total of 177 DR-TB patients diagnosed in the year 2014 who had a delay in the initiation of treatment, and 23 initial defaulters were studied using a structured questionnaire. Fifty-four DOTS providers were also interviewed. Of 177 patients, 62.15% initiated treatment between 7 and 15 days and nearly 12% of them started the treatment after a month. The median duration of delay was 12 days (range: 8–144 days and interquartile range: 9–20 days). The most common reason for the delay in the initiation and initial default was the social and personal factors (48.80%), and in 34 (20%) of the patients, the delay was attributed to the effect of the previous treatment.

A cross-sectional study among defaulters of DOTS under RNTCP in tuberculosis units of Solapur city

Background: Tuberculosis (TB) is a specific infectious disease caused by mycobacterium tuberculosis affecting pulmonary and extra-pulmonary organs. Default is one of the unfavorable outcomes for patients on DOTS and represents an important challenge for the control programme. Inadequate treatment adherence is considered as a potential cause of drug resistance. This study was conducted ascertain causes of defaults & to study socio-demographic corelates of defaulters.Methods: A cross-sectional study was conducted from 1st January 2014 to 31st December 2014. All default patients registered from 1st January 2014 to 31st December 2014 under RNTCP in both Tuberculosis Units of Municipal Corporation are considered for this study.Results: Total 104 cases of defaulters were registered under RNTCP in both TB units; 83 (79.8%) defaulters were males and remaining 21 (21.2%) were females and difference was statistically significant. Side effects of DOTS drugs were the most common reason of defaulting the treatment. Default of DOTS was significantly associated with socioeconomic status, educational status, addiction, religion and marital status of the patients.Conclusions: Poverty has effect on illness and completion of treatment.

Assessing the Effectiveness of House-to-House Visits on Routine Oral Polio Immunization Completion and Tracking of Defaulters.

Strengthening routine immunization is one of the four prongs of the Global Polio Eradication Initiative. Using data collected through 30-cluster sample household surveys of caretakers of children aged 12-23 months, this paper assessed the effectiveness of house-to-house visits on routine oral polio immunization completion, using simple frequency tables, bivariate and multivariate logistic regression analyses. Logistic regression results demonstrated that children in households where the caregivers reported receiving a household visit by health workers were more likely to be fully immunized for polio through routine immunization than other children, although results were significant only after correcting for confounders. In Ethiopia and India, children of caregivers who remembered a house-to-house visit were significantly and positively associated with routine polio vaccination completion (OR=2.2 and OR=2.2 respectively). In Angola, the association was positive, though not significant (OR=1.3). The evidence suggests that targeting high-risk areas for house-to-house visits played a role in increasing routine polio vaccination.

A qualitative study to determine factors to ART default in Zambia / 国際保健医療

<B>Objectives</B><BR>The objective of this study is to identify barriers and facilitators of anti-retroviral treatment (ART) continuation among ART patients in Zambia. It also aims to explore ART scale-up approach while reducing defaulters.<BR><B>Methods</B><BR>In October 2009, we obtained ART statistics, interviewed District Health Management Team (DHMT) in Livingstone, Zambia, and conducted Focus Group Discussion (FGD) with 27 ART defaulters who were traceable, where participants shared experience in relation to why they gave up and how they resumed treatment.<BR><B>Results</B><BR>Although ART facilities have been increased in Livingstone, half of the facilities are not equipped with CD4 count machine, which affects timely commencement of treatment. Anti-retrovirals (ARV) and consultation are basically offered free of charge to ART patients, yet patients have to pay X-ray and co-morbidity treatment. On average, 22.7% of ART patients stopped visiting ART facilities. Especially in large-scale ART centre, defaulters were not followed up. FGD revealed the process of how defaulters developed hopelessness and pill burden, which were triggered and influenced by several factors including hunger, poverty, stigma, side-effects and co-morbidities. Some stopped medication as they thought being cured after condition recovered. Others attributed discontinuation to the accessibility of service and the attitude of ART centre staff. Default was attributed by internal (inadequate knowledge, weak motivation) and also external (hunger, medical service system) factors. It is inevitable to empower patients with adherence management by strong motivation to treatment and supportive environment.<BR><B>Conclusion</B><BR>Financial empowerment of patients, free-service of co-morbidity treatment and side effect mitigation are desirable for sustainable ART scale-up. Defaulter follow-up, continuous regular adherence counseling and ART roll-out to small-scale clinics are inevitable to reduce defaulters.

Defaulter rate of follow-up of patients with gonorrhoea at the Genitourinary Medicine Clinic

Backround Gonorrhoea is the third most common sexually transmitted infection (STI) in the Genitourinary Medicine Clinic. Despite high cure rates achieved with the use of intramuscular ceftriaxone, all patients with gonorrhoea are followed up with one test of cure (gonococcal culture) after treatment. This is essential to ensure success of cure hence preventing complications, to screen for and treat concomitant STIs, and to reduce the possibility of re-infection through repeated patient education. A defaulter is defined as a patient who fails to attend follow-up and undergo test of cure within a period of 2 weeks after completion of treatment. Previous studies showed high defaulter rates of 41.1% and 43.8% in 1996 and 1997 respectively. This study aims to determine the defaulter rate of follow-up of patients with gonorrhoea, and to formulate remedial measures to reduce defaulter rate and thereby improve the management of gonorrhoea specifically and all sexually transmitted infections in general. Materials and Methods An audit of defaulter rate of patients diagnosed as gonorrhoea was performed from January 1998 to December 2005 in the Genitourinary Medicine Clinic, Department of Dermatology, Kuala Lumpur Hospital. All patients who failed to attend follow-up visit within 2 weeks after treatment were recorded as defaulters. An analysis was performed on all defaulters from January to December 2005. Results Defaulter rates for patients with gonorrhoea were generally high throughout the years studied, ranging from 35.0% to 48.2%, the highest being in year 2001. Despite continuous and relentless efforts in patient education and counseling, there has been no decreasing trend. In the year 2005, all defaulters were males. Majority (72.1%) of the defaulters were young adults aged between 21 and 40 years. 67.4% of the defaulters were Malay, followed by Indian 14.0%, Chinese 7.0% and other ethnic groups 11.6%. Among the defaulters, 30.2% had repeated gonococcal infection and 38.5% had concomitant STIs. Conclusions More effort is necessary in educating patients to attend follow-up visit after treatment of gonorrhoea. Emphasis has to be made on the importance of confirming cure and thereby preventing complications and transmission to sexual partners. Counseling should also be given to all patients regarding practice of safe sex to prevent gonococcal re-infection and other STIs.

Failure to initiate treatment for tuberculosis patients diagnosed in a community survey and at health facilities under a dots programme in a district of south India.

We studied the proportion and fate of tuberculosis patients who were not initiated on treatment (initial defaulters) in Tiruvallur district of Tamilnadu, where DOTS strategy was implemented. These patients were visited to find out the reason for default. Treatment was not initiated in 57 (23.5%) of the 243 sputum positive cases diagnosed in a community survey and 156 (14.9%) of 1049 patients diagnosed in health facility. Men were more likely not to have treatment initiated. The common reasons stated for initial default were unwillingness, symptoms being mild, personal reasons and dissatisfaction. There is an urgent need to improve the patient’s perception of treatment and strengthen the health systems’ capabilities to reduce initial default.