Abandono del tratamiento de la tuberculosis en Nicaragua: resultados de un estudio comparativo / Dropout from tuberculosis treatment in Nicaragua: the results of a comparative study

ABSTRACT

Objective. To identify factors related to dropping out from tuberculosis treatment in health centers in the departments of Managua and Matagalpa, in Nicaragua. Methods. This study matched cases and controls (11 ratio) by age and by municipality of treatment. The 251 cases were patients over 15 years of age who had dropped out of tuberculosis treatment, and the 251 controls were patients who had completed pharmacotherapy, during the period of January 1998 to December 2001. Data were obtained on demographic and socioeconomic characteristics, lifestyle habits, and treatment characteristics. The variables were chosen and grouped using a hierarchical theoretical model. Conditional logistic regression analysis was used to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs). Results. The risk factors for dropping out of tuberculosis drug treatment were male gender (OR, 2.51; 95% CI, 1.63 to 3.94), an unstable living situation or being homeless (OR, 3.08; 95% CI, 1.57 to 6.49), changing residence during the treatment period (OR, 4.22; 95% CI, 2.06 to 9.93), consuming alcoholic beverages (OR, 5.25; 95% CI, 2.43 to 12.94), using illegal drugs (OR, 5.25; 95% CI, 2.43 to 12.94), difficulty in access to the health services (OR, 2.64; 95% CI, 1.39 to 5.29), and a negative opinion of the health care received (OR, 5.33; 95% CI, 1.52 to 28.56). Conclusions. It is essential for the health services in Nicaragua to develop measures to reduce the risk of dropout from treatment. In particular, it is important for the health sector to work with community groups that can support the health sector's activities

RESUMEN

Objetivo. Identificar factores relacionados con el abandono (deserción) del tratamiento de la tuberculosis en centros de salud de los departamentos de Managua y Matagalpa, en Nicaragua. Métodos. Se diseñó un estudio de casos y testigos pareados por edad y por municipio de tratamiento. Se seleccionaron como casos 251 pacientes mayores de 15 años que abandonaron el tratamiento antituberculoso y como testigos pacientes que concluyeron la farmacoterapia (razón 11) durante el periodo de enero de 1998 a diciembre de 2001. Se obtuvieron datos de aspectos demográficos y socioeconómicos, hábitos de vida y características de la atención. Las variables se seleccionaron y agruparon utilizando un modelo teórico jerarquizado. Por medio de un análisis de regresión logística condicional, se estimó la razón de posibilidades (odds ratio, OR), con un intervalo de confianza de 95% (IC95%). Resultados. Son factores de riesgo de abandono de la farmacoterapia antituberculosa sexomasculino (OR 2,51; IC 95% 1,63 a 3,94), residencia inestable o en la calle (OR 3,08; IC95% 1,57 a 6,49), cambio de domicilio durante el tratamiento (OR 4,22; IC95% 2,06 a 9,93), consumo de bebidas alcohólicas (OR 5,25; IC95% 2,43 a 12,94), uso de drogas ilícitas (OR 5,25; IC95% 2,43 a 12,94), dificultad de acceso a los servicios de salud (OR 2,64; IC95% 1,39 a 5,29) y un concepto negativo de la atención recibida (OR 5,33; IC95% 1,52 a 28,56). Conclusión. Es indispensable establecer en los servicios de salud medidas que contribuyan a abatir el riesgo de abandono. Es importante recuperar la participación social del sector de la salud mediante acciones comunitarias