Determinants of default from pulmonary tuberculosis treatment in kuwait

ABSTRACT

To determine the prevalence and risk factors of default from pulmonary tuberculosis treatment in Kuwait. Retrospective study. We studied all patients who were registered for pulmonary tuberculosis treatment between 1[st] January 2004 and 31[st] December 2006 and admitted in TB wards in El Rashid Center or treated in the outpatient clinic in TB Control Unit. To examine the determinants and risk factors of default from treatment, we used a nested case control study design. For each case of default [110 cases], three controls were randomly selected [330 controls] from cases that cured or completed treatment, using computer-generated random numbers. Data were obtained from programme forms completed by physicians and from medical records. Patients who defaulted treatment were defined as those ho had failed to collect medication for more than 2 consecutive months after the date of the last attendance during the course of treatment. Demographic and clinical characteristics, including history, treatment and outcome, were compared between defaulters and non-defaulters. There were 110 [11.5%] patients who defaulted from treatment. Fifty six percent of those who defaulted did so in the first 2 months of treatment and 86.4% of them were still bacteriologically positive at the time of default. Key risk actors associated with non-compliance were male sex, low educational level, non Kuwaiti nations, history of default and history of concomitant diabetes mellitus, liver disease or lung cancer. Multiple drug resistance was also associated with default from treatment. Default from treatment may be partially responsible for the persistent relatively high rates of tuberculosis in Kuwait. Health professionals and policy makers should ensure that all barriers to treatment be removed and that incentives be used to encourage treatment compliance