RESUMO
SETTING: Three districts of Oromia Region in Arzi Zone, Ethiopia. OBJECTIVES: To determine the rate of defaulting from directly observed treatment, short course (DOTS) for tuberculosis and identify associated factors. DESIGN: A case control study. Records of 1367 new tuberculosis patients put on DOTS during a period of 30 months (1 July 1997-31 December 1999) were reviewed to determine the defaulting rate. Cases were defaulters and controls were selected by paired matching of sex and age using the lottery method. All study subjects were actively traced and interviewed by trained interviewers using a pre-tested structured questionnaire. RESULTS: The overall rate of defaulting from DOTS was calculated to be 11.3%, while the rate in sputum smear-positive cases was 11.6%. Defaulting was highest (81%) during the continuation phase of treatment. Medication side effects were significantly associated with defaulting (OR = 4.20, 95% CI 1.51-11.66), while adequate knowledge and family support were found to be possible protective factors (OR = 0.04, 95% CI 0.02-0.1 and OR = 0.19, 95% CI 0.08-0.46, respectively). CONCLUSIONS: Major factors contributing to high rates of defaulting were found to be lack of family support, inadequate knowledge about treatment duration and medication side effects. Control programmes that take these factors into consideration should be successful in reducing defaulting.
Assuntos
Antituberculosos/uso terapêutico , Cooperação do Paciente/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Educação de Pacientes como Assunto , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tuberculose Pulmonar/epidemiologiaRESUMO
The clinical history and treatment outcome of a twenty-year old female patient (EN) with typhoid fever is presented. Laboratory examination showed that the etiological agent was a strain of Salmonella typhi which was simultaneously resistant to chloramphenicol (C), streptomycin (S), sulphonamides (Su) and tetracycline (T). Genetic and molecular analysis of this strain demonstrated that resistance to CSSuT was encoded in a plasmid which showed a thermosensitive (28 degrees C) transfer to an Escherichia coli K12 recipient, at a frequency of 4.0 x 10(-2). The R-plasmid had a molecular weight of 110 megadaltons and belonged to incompatibility group H1 plasmids. The present finding should warn medical personnel of the possible dissemination of this epidemic strain in Addis Abeba area.
