Sex Bias in Treatment Abandonment of Childhood Cancer in India.

OBJECTIVES: To explore the magnitude of sex bias and determinants of treatment abandonment (TA) in childhood cancer in India. METHODS: Individual data of children (0-19 y) registered between January 1, 2017 and July 31, 2022, was compiled. TA was defined as defaulting curative intent treatment ≥4 wk. Defaulting treatment irrespective of intent ≥4 wk was defined as Treatment Default (TD). The primary outcome was the proportion of male-to-female children with TA. Secondary outcomes included the proportion of male-to-female children with upfront TA, TA at relapse, TD, TD-p (TD only in the palliative setting). The impact of clinico-demographic factors on TA was analysed using multivariable regression and propensity score matching (PSM). RESULTS: Three thousand two hundred eighty four patients were analysed. The overall male-to-female ratio (MFR) was 2.08 (95% CI 1.94-2.24). Of 2906 patients treated with curative intent, 415 (14·3%) abandoned treatment. TA was higher in females than males (16·4% vs. 13·3%; p = 0·022) with adjusted MFR of 0·81 (0·66-0·98). The adjusted MFR of TA for treatment-naïve and relapsed patients and TD were 0·73 (0·59-0·91), 1·13 (0·65-1·96) and 0·84 (0·71-1·00) respectively. Sex independently predicted TA on multivariable analysis. However, on PSM analysis including socio-economic variables, lower maternal education predicted higher TA in children with cancer (10·1% vs. 6%, p = 0·015). CONCLUSIONS: Child sex predicted TA in childhood cancer in India with more females abandoning treatment. Maternal education is a more crucial factor predicting TA over child sex, when socio-economic factors were considered. Hence, policies promoting female education and gender equality may mitigate sex-based gaps in childhood cancer care.

The Psychosocial Profile of Women Who Defaulted Option B+ HIV Treatment: An Interpretive Phenomenological Analysis Study.

Purpose: The study explored the psychosocial profile of women who defaulted Option B+ HIV treatment at Chitungwiza Municipality clinics in Zimbabwe. Option B+ is a strategy to prevent mother-to-child transmission (PMTCT) of HIV to reduce MTCT rate to less than or equal to 5%. Methods: An interpretive phenomenological analysis (IPA) design was used. Data were collected from 04 September to 12 October 2020 on twelve purposively selected HIV-positive breastfeeding women aged 18 to 40 years, who defaulted Option B+ HIV treatment. Unstructured individual face-to-face interviews were utilised. Data were analysed thematically using the interpretive phenomenological analysis framework for data analysis. Results: The study findings revealed that participants experienced the following: psychosocial and emotional challenges due to HIV positive results, shown emotional distress and suicidal tendencies which affected their mental health. Their relationship was derailed due to abuse, infidelity, partner's high-risk behaviour and to lack of support stemming from their partners and family members. Conclusion: Strengthening adherence support interventions and effective counselling on HIV-positive status disclosure and male partner involvement is important for retaining women in care and for improving their quality of life. Comprehensive, integrated, and tailor-made interventions should be adopted. Couple HIV counselling and testing should be encouraged. Psychosocial and mental health should be encouraged. Furthermore, community sensitization, risk reduction behaviour, education on purpose and side effects of ART as well as the benefits of Option B+ to new enrolments should be intensified and strengthened to minimize defaulting of treatment and LTFUP. Vigorous patient tracing and visit reminders help retain women in care.

Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa.

Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.

Treatment default and its related factors among tuberculosis patients, a case-control study in Iran.

Introduction: Treatment default is one of the main challenges in tuberculosis (TB) control and is considered a major barrier to achieving the sustainable development goals (SDG). Identifying the factors associated with this outcome can help us provide appropriate strategies for decision making. This study investigates the determining factors of treatment default among TB patients. Methodology: In this case-control study, all 88 TB patients experiencing treatment default during an11-year-period in Mazandaran province, Iran, were compared with 176 randomly selected TB patients without a history of default. Cases and controls were matched based on the year of incidence as well as the treatment center. Related factors of treatment default were determined using multivariate logistic regression models. Results: For men, the odds ratio of experiencing treatment default was 1.67 (p=0.165). In addition, considering ages >64 years as the reference group, the odds ratios for 15- to 24- and 55- to 64-year-olds were 0.95 (p=0.940) and 0.37 (p=0.123), respectively. The corresponding odds ratios for patients 25-34, 35-44 and 45-54 years of age were 1.29 (p=0.547), 1.40 (p=0.472), and 1.39 (p=0.512) respectively. Moreover, the odds ratios for urban residents, patients with a history of imprisonment, a history of previous treatment, adverse treatment effects, previous exposure, non-Iranians and patients with smear-positive TB were 1.72 (p=0.070), 1.24 (p=0.657), 1.47 (p=0.756), 0.99 (p=0.998), 0.98 (p=0.960), 9.29 (p=0.010), and 2.27 (p=0.049) respectively. Conclusion: Non-Iranian nationality and smear-positive TB were detected as predictors of treatment default among patients with tuberculosis.

Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia.

BACKGROUND & OBJECTIVES: : Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. METHODS: : In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients' database. Modified Kuppuswamy scale was used to classify socio-economic status. RESULTS: : A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7±4.9 vs. 59±7.2 and 58.1±4.6 per cent in middle and lower strata (P =0.026). Five year overall survival was higher in the higher SE group; being 91.2±3.5, 78.3±5.6 and 78.8±3.9 per cent (P =0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 (P =0.015); 1.98 (P =0.027)]. INTERPRETATION & CONCLUSIONS: : Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.

Loss to follow-up among patients receiving anti-tuberculosis treatment, Haiti, 2011-2015.

Setting: Tuberculosis (TB) treatment facilities in Haiti. Objective: To assess factors associated with loss to follow-up (LTFU) among patients receiving treatment for tuberculosis (TB) in Haiti. Design: We analyzed Haiti's national surveillance data for patients started on anti-tuberculosis treatment from 2011 to 2015 to determine factors associated with LTFU using multivariable logistic regression and describe LTFU in terms of subnational units to target future intervention strategies. We also conducted a survival analysis to estimate hazard ratios of factors associated with time to LTFU. Results: Of 81 490 TB cases reported, 7423 (9.1%) were LTFU during anti-tuberculosis treatment, increasing from 7.1% in 2011 to 10.3% in 2015. Six high-volume facilities had significantly higher rates of LTFU (14.3-31.9%) than the rest of the country, accounting for 18.8% of all TB cases reported, but 41.7% of all LTFU patients. Male sex, previous treatment history, and human immunodeficiency virus infection were associated with higher rates of LTFU. The median time to LTFU was 94 days. Conclusion: A small number of facilities accounted for disproportionately high rates of LTFU. These results identify characteristics of facilities and individuals leading to concentrated interventions to reduce LTFU and improve treatment success.

Contexte : Structures de traitement de la tuberculose (TB) en Haïti.Objectif : Evaluer les facteurs associés à la perte de vue (LTFU) parmi les patients recevant un traitement de TB en Haïti.Schéma : Nous avons analysé les données de surveillance nationale de Haïti pour les patients mis sous traitement de TB entre 2011 et 2015, afin de déterminer les facteurs associés aux LTFU grâce à une régression logistique multivariée, et nous avons décrit les LTFU par unités sous-nationales afin de cibler les stratégies d'intervention futures. Nous avons également réalisé une analyse de survie afin d'estimer les ratios de risque des facteurs associés au délai de LTFU.Résultats : Sur 81 490 cas de TB rapportés, 7423 (9,1%) ont été perdus de vue pendant le traitement de TB, augmentant de 7,1% en 2011 à 10,3% en 2015. Six structures à haut débit de patients ont eu des taux de LFTU significativement plus élevés (14,3­31,9%) que le reste du pays, représentant 18,8% de tous les cas de TB rapportés, mais 41,7% de tous les patients perdus de vue. Le sexe masculin, des antécédents de traitement préalable, et une infection au virus de l'immunodéficience humaine ont été associés à des taux plus élevés de LTFU. Le délai médian de LTFU a été de 94 jours.Conclusion : Un petit nombre de structures ont des taux disproportionnellement élevés de LTFU. Ces résultats identifient les caractéristiques des structures et des individus aboutissant à des interventions ciblées afin de réduire les LTFU et d'améliorer le taux de succès du traitement.

Marco de referencia: Establecimientos de tratamiento de la tuberculosis (TB) en Haití.Objetivo: Evaluar los factores que se asocian con la pérdida durante el seguimiento (LTFU) de los pacientes que reciben tratamiento antituberculoso en Haití.Método: Se analizaron los datos nacionales de vigilancia de los pacientes que iniciaron tratamiento antituberculoso del 2011 al 2015 en Haití, con el objeto de determinar los factores asociados con la LTFU mediante modelos de regresión logística multivariante y se describieron estas pérdidas por unidades subnacionales, con el fin de orientar las futuras estrategias de intervención. Se practicó además un análisis de supervivencia con el fin de estimar los cocientes de riesgos instantáneos de los factores asociados con el tiempo transcurrido hasta la LTFU.Resultados: De los 81 490 casos de TB notificados, se perdieron durante el seguimiento del tratamiento antituberculoso 7423 (9,1%) y se observó un aumento del 7,1% en el 2011 al 10,3% en el 2015. En seis establecimientos con alta carga asistencial se encontraron tasas significativamente más altas de LTFU (14,3­31,9%) que en el resto del país y correspondieron al 18,8% de todos los casos de TB notificados, pero al 41,7% de todos los pacientes pérdidas. Los factores que se asociaron con tasas más altas de LTFU fueron el sexo masculino, el antecedente de tratamiento y la infección por el virus de la inmunodeficiencia humana. La mediana del lapso transcurrido hasta la LTFU fue 94 días.Conclusión: Un número pequeño de establecimientos contribuyó con tasas desproporcionadamente altas de LTFU. Estos resultados ponen de manifiesto las características de las instalaciones y de las personas que deben orientar las intervenciones dirigidas, encaminadas a disminuir la LTFU y mejorar el éxito terapéutico.

Drug addiction and alcoholism as predictors for tuberculosis treatment default in Brazil: a prospective cohort study.

This study aimed to evaluate the risk factors for tuberculosis (TB) treatment default in a priority city for disease control in Brazil. A cohort of TB cases diagnosed from 2008 to 2009 was followed up from patients' entry into three outpatient sites, in Juiz de Fora, Minas Gerais (Brazil), until the recording of the outcomes. Drug addiction, alcoholism and treatment site appeared to be independently associated with default. Current users of crack as the hardest drug (odds ratio (OR) 12·25, 95% confidence interval (CI) 3·04-49·26) were more likely to default than other hard drug users (OR 5·67, 95% CI 1·34-24·03), former users (OR 4·12, 95% CI 1·11-15·20) and those not known to use drugs (reference group). Consumers at high risk of alcoholism (OR 2·94, 95% CI 1·08-7·99) and those treated in an outpatient hospital unit (OR 8·22, 95% CI 2·79-24·21%) also were more likely to default. Our results establish that substance abuse was independently associated with default. National TB programmes might be more likely to achieve their control targets if they include interventions aimed at improving adherence and cure rates, by diagnosing and treating substance abuse concurrently with standard TB therapy.

Evaluation of outpatient therapeutic programme (OTP) for treatment of severe acute malnutrition in Yemen: a focus on treatment default and its risk factors.

OBJECTIVES: This study aimed to measure the treatment default rate among children with severe acute malnutrition (SAM) who were admitted to the outpatient therapeutic programme (OTP) in Yemen and determine its risk factors. METHODS: A prospective study was conducted among children with SAM who were newly admitted to the 11 OTPs in primary health centres of Sana'a city. A pretested semistructured questionnaire was used for data collection at admission and at after 2 months of admission to the OTP. Univariate and multivariate analysis using binary logistic regression were used to analyse the risk factors of treatment default. RESULTS: This study included 339 SAM children. Of those, 186 (55%) children discharged as defaulters, 141 (42%) were cured, and 12 (3%) were transferred to other treatment sites. Many factors related to poor accessibility, poor satisfaction with staff and system, and treatment and acceptability of OTP services factors were significantly associated with treatment default. Having difficulty to attend OTP every week (OR 8.4), unavailability of medication during follow-up visits (OR 5.0), not liking to eat Plumpy'Nut (OR 5.8), and not gaining weight since the start of treatment (OR 9.3) were the strongest predictors of treatment default. CONCLUSIONS: This study showed a high default rate among SAM children in Sana'a city. Factors related to poor accessibility, poor satisfaction with staff and system, and factors related to treatment and acceptability of OTP services were significantly associated with high default rate. Expansion of OTP services and training OTPs staff on SAM treatment protocols are highly recommended.

Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa.

OBJECTIVE: To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa. METHODS: A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05. RESULTS: A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p<0.001), <25 years old (9.1% vs. 25-34 years: 8.7%; 35-44 years: 7.0%; 45-54 years: 5.2%; 55-64 years: 4.4%; >64 years: 3.9%; p<0.001), undergoing TB retreatment (11.0% vs. new cases: 6.3%; p<0.001), had a negative pre-treatment sputum smear result (7.8% vs. positive smear results: 7.1%; p<0.001), were in the first 2 months of treatment (95.5% vs. >2 months: 4.8%; p<0.001), and had unknown HIV status (7.8% vs. HIV-positive: 7.0% and HIV-negative: 5.7%; p<0.001). After controlling for potential confounders, multivariate analysis revealed a two-fold increased risk of defaulting treatment when being retreated compared to being treated for the first time for TB (adjusted OR (AOR) 2.0, 95% CI 1.85-2.25). Female cases were 40% less likely to default treatment compared to their male counterparts (AOR 0.6, 95% CI 0.51-0.71). Treatment default was less likely among cases >24 years old compared to younger cases (25-34 years: AOR 0.8, 95% CI 0.77-0.87; 35-44 years: AOR 0.6, 95% CI 0.50-0.64; 45-54 years: AOR 0.4, 95% CI 0.32-0.49; 55-64 years: AOR 0.3, 95% CI 0.21-0.43; >64 years: AOR 0.3, 95% CI 0.19-0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46-0.57). CONCLUSIONS: Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes.

Prevalence and characteristics associated with default of treatment and follow-up in patients with cancer.

Defaulting is an important issue across all medical specialties, but much more so in cancer as delayed or incomplete treatment has been shown to result in worse clinical outcomes such as treatment resistance, disease progression as well as lower survival. Our objective was to identify psychosocial variables and characteristics associated with default among cancer patients. A total of 467 consecutive adult cancer patients attending the oncology clinic at a single academic medical centre completed the Hospital Anxiety and Depression Scale and reported their preference for psychological support at baseline, 4-6 weeks and 12-18 months follow-up. Default was defined as refusal, delay or discontinuation of treatment or visit, despite the ability to do so. A total of 159 of 467 (34.0%) cancer patients were defaulters. Of these 159 defaulters, 89 (56.0%) desired psychological support, compared to only 13 (4.2%) of 308 non-defaulters. Using a logistic regression, patients who were defaulters had 52 times higher odds (P = 0.001; 95% confidence interval 20.61-134.47) of desiring psychological support than non-defaulters after adjusting for covariates. These findings suggest that defaulters should be offered psychological support which may increase cancer treatment acceptance rates and improve survival.

Perfil del paciente con tuberculosis que abandona el tratamiento en Chile: profile of patients in Chile / Tuberculosis treatment default

Treatment default is one of the most important factors that reduce the efficiency of tuberculosis therapy and its causes are associated with factors related to patient, drugs and health system. In Chile, default rate has remained around 7%, despite the different strategies implemented for its prevention. This study corresponds to the analysis of audits performed in cases of default and seeks to define a profile of these patients and determine the main causes that influence this result. Methodology: Descriptive study of the information contained in the audits sent between 2009 and 2013. Results: 134 audits were analyzed. Activity compliance was 35.9% and an incomplete record was observed in most cases. Most patients were male, between 15 and 45 years old and 91% was their first episode of tuberculosis. 62.7% had some risk factor associated with default, especially alcohol and drug abuse and 16.5% were homeless. Most cases default during the intermittent treatment phase and the cause of abandonment was mainly associated with patient factors such as substance abuse, feeling well and job instability. Conclusion: These findings reinforce the importance of applying the score of treatment default risk in patients entering treatment to establish strategies to prevent it.

El abandono del tratamiento de la tuberculosis es uno de los factores más importantes que disminuyen la eficiencia de la terapia. Dentro de sus causas se observan factores relacionados con el paciente, con los fármacos y con el sistema de salud. En Chile, el porcentaje de abandono se ha mantenido en torno al 7%, a pesar de las distintas estrategias implementadas para su prevención. Este estudio corresponde al análisis de las auditorías que se realizan en los casos de abandono y busca definir el perfil del paciente "abandonador" y determinar las causas que mayormente influyen en este resultado. Metodología: Estudio descriptivo de la información contenida en las auditorías de abandono enviadas entre los años 2009 y 2013. Resultados: Se analizaron 134 auditorías de abandono. Se observa un cumplimiento de la actividad de un 35,9% y en la mayoría de los casos el registro es incompleto. La mayoría de los pacientes son de sexo masculino, entre 15 y 45 años de edad y en el 91% es su primer episodio de tuberculosis. El 62,7% presenta algún factor de riesgo asociado al abandono, especialmente alcoholismo y drogadicción y el 16,5% corresponde a personas en situación de calle. La mayoría de los casos abandonó durante la fase intermitente del tratamiento y la causa del abandono estuvo fundamentalmente asociada a factores del paciente, como abuso de sustancias, sensación de mejoría e inestabilidad laboral. Conclusión: Los hallazgos refuerzan la importancia de aplicar el "score de riesgo de abandono" en los pacientes que ingresan a tratamiento para establecer estrategias que permitan prevenirlo.

Evaluation of Factors in Relation with the Non-Compliance to Curative Intent Radiotherapy among Patients of Head and Neck Carcinoma: A Study from the Kumaon Region of India.

INTRODUCTION: Radiotherapy (RT)-based curative regimens for head and neck squamous cell carcinomas (HNSCC) deliver a dose of 66-70 Gray (Gy) over a period of 6-7 weeks, and incomplete treatments are unlikely to result in cure. Non-compliance to RT is major contributory factor to treatment failure. AIMS: To assess the proportion of patients who do not complete planned treatment after initiation of curative RT. This study also aims to explore a possible relationship of non-compliance due to socio-economic, disease-related and treatment-related factors. MATERIALS AND METHODS: The records of HNSCC patients treated from January 2012-December 2013 were audited. Data from the treatment records were to collect patient-related, disease-related, and social demographic parameters. Of the patients who had not completed treatment, the reasons behind the same were investigated. RESULTS: Of the 324 patients of HNSCC who were initiated on radical RT, a total of 76 patients were found to have discontinued treatment without authorization of the treating clinician. There was no significant predilection for treatment non-compliance with regards to patient age, educational status, religion, site of the disease, use of neoadjuvant chemotherapy, or use of concurrent chemotherapy. There tended to be a higher association of treatment non-compliance among patients residing >100 km away from the treatment center, patients hailing from hilly regions, patients without the below poverty line (BPL) card, unemployed patients, and patients with stage IV-A/B disease. Of the 76 patients who did not complete treatment, telephonic questionnaire could be obtained from 54 patients. Causes for non-compliance included preference for traditional healers (22.2%), fear of toxicity (7.4%), logistic reasons (18.5%), financial reasons (24.1%), and lack of interest/faith in RT (5.6%). CONCLUSION: There is a high incidence of treatment default among patients of HNSCC during RT in this region. The revelation of the higher propensity for treatment default among patients from distant, hilly regions, unemployed, patients without BPL cards, and stages-IVA/IVB highlights the need for specific interventions for these special populations.

Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting.

OBJECTIVE: To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria. METHODS: Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death. RESULTS: Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6). CONCLUSIONS: Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme.

Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting

OBJECTIVE@#To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria.@*METHODS@#Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death.@*RESULTS@#Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6).@*CONCLUSIONS@#Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme.

Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting

Objective: To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria. Methods: Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death. Results: Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6). Conclusions: Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme.

Tuberculosis en una población pediátrica atendida en un hospital público. Adherencia al tratamiento: Estudio descriptivo / Tuberculosis in a Pediatric Population Treated at a Public Hospital. Adherence to Treatment. Descriptive Study

A partir de la estrategia de la OMS "Alto a la Tuberculosis", se evaluó la situación en un hospital público. Objetivo primario: Contribuir con la estrategia de reducción de la tuberculosis. Objetivo secundario: a) evaluar la adherencia al tratamiento b) describir las características clínico-epidemiológicas de una población pediátrica atendida en un hospital público. Material y método: Se realizó un estudio observacional, descriptivo, transversal. Se definió: no adherencia al tratamiento, cuando un paciente no recibe los medicamentos durante un mes o más, en cualquier fase del tratamiento. Resultados: Durante los años 2008-2009, se diagnosticó tuberculosis en 30 niños. Mediana de: 56 meses (rango 1m-14 años). Índice de masculinidad: 0.87. Al ingreso 80% eran sintomáticos, 86% eran eutróficos. El foco de contagio se detectó en el 72%. La prueba tuberculínica fue positiva en el 63%. Predominó la forma pulmonar. La forma pulmonar grave se registró en 12/23 y la común o moderada 11/23. La pleural fue más frecuente entre las extrapulmonares. La radiografía de tórax mostró predominio de infiltrado unilateral sin cavidad 11/23. El rendimiento bacteriológico fue del 36,7%. En 2008 la tasa de abandono fue del 50% y en 2009 44,44%. No hubo fallecidos. Conclusiones: Existe una baja detección de casos por antecedente de contacto. No hubo diferencias entre las formas graves y las pulmonares comunes. La tuberculosis pleural predominó como forma extrapulmonar. El abandono de tratamiento fue muy alto por lo cual propusimos realizar intervenciones.

Based on the World Health Organization "Stop TB Strategy", the current situation of the Hospital Prof. Dr. A. Posadas was evaluated. Primary Objective: to contribute to the strategy for tuberculosis reduction. Secondary Objectives: a) to evaluate the adherence to treatment b) to describe clinical and epidemiological features of tuberculosis in a pediatric population at a public hospital. Materials& Method: Observational, longitudinal and retrospective study. Treatment default was defined as the period of one or more months during which a patient does not receive medications, in any phase of treatment. Results: During the years 2008 and 2009, 30 children with tuberculosis were registered. Median age was 56 months (range 1m-14 years). Masculinity Index: 0.87. At the time of the first visit, 80% did not present any symptoms and 86% presented a normal nutritional status. Contacts study was positive in 72% of the cases. Tuberculin test (PPD 2 TU) was positive = 10mm in 63% of the patients. Pulmonary TB was the predominant form of presentation. Severe pulmonary TB was recorded in 12/23 patients and mild or moderate TB, in 11/23 patients. Among the extrapulmonary forms, pleural tuberculosis was predominant. Chest X-ray: unilateral pulmonary TB with no cavity was predominant, 11/23 patients. Bacteriological diagnosis was positive in 36.7% of the patients. Outcome: in 2008, default rate was 50% and in 2009, 44.44%. There were no deceased patients. Conclusions: There is a low case detection by contact history. There were no differences in treatment outcome between severe and non severe pulmonary TB. Pleural tuberculosis was predominant as an extrapulmonary presentation. Treatment default was very high in this population; for this reason individual, particular and general interventions are suggested.

Evaluación de adherencia al tratamiento en un nuevo modelo de atención de niños con tuberculosis en un hospital público / Treatment Assessment in a Pediatric Population Treated for Tuberculosis in a Public Hospital

A partir de la alta tasa de abandono del tratamiento de la tuberculosis observada durante los años 2008-2009, se implementaron intervenciones con el fin de disminuirla. Objetivo primario: Evaluar la adherencia al tratamiento en el nuevo modelo de atención en la población pediátrica con tuberculosis atendida en un hospital público. Objetivo secundario: Describir las características clínico-epidemiológicas de la población pediátrica atendida con tuberculosis. Material y método: Diseño observacional, descriptivo, transversal. Criterios de Inclusión: Niños con diagnóstico de tuberculosis. Se utilizaron las mismas variables, definiciones, indicadores y base de datos del 1er. trabajo. Se implementaron intervenciones en lo individual, particular y general. Estas intervenciones se comenzaron a hacer en el Servicio fuera del marco del trabajo. Resultados: Hubieron 25 niños con tuberculosis. La mediana correspondió a 83 meses (rango 2 m a 15 años). 84% fueron eutróficos. Se detectó foco en el 64%. La prueba tuberculínica fue positiva en el 76%. Predominó la forma pulmonar; la común o moderada se observó en 14/25 y la grave en 7/25. La ganglionar resultó la forma extrapulmonar más frecuente. El patrón radiológico predominante fue unilateral sin cavidad 11/25. El rendimiento bacteriológico fue del 64%. En el año 2010 la tasa de abandono fue del 12%. No hubo fallecidos. Conclusiones: La mayoría de los pacientes presentó formas comunes o moderadas. La TB ganglionar predominó como forma extrapulmonar. La tasa de abandono descendió luego de la implementación del nuevo modelo de atención.

Owing to the high rates of default from tuberculosis treatment observed during 2008 - 2009, interventions were implemented with the purpose of diminishing them. Primary Objective: To make a contribution to tuberculosis treatment adherence. Secondary Objective: a) To evaluate adherence to treatment after implementing individual, particular and general interventions b) To describe clinical and epidemiological features of a pediatric population treated in a public hospital. Materials& Method: Observational, descriptive and transverse design. Inclusion criteria: Patients with tuberculosis diagnosis. The variables, definitions, indicators and database were those used in the previous reported study. Individual, particular and general interventions were implemented. These interventions were carried out outside the service frame of work. Results: 25 children presented with tuberculosis. The median age was 83 months (range 2m to 15 years). 84% presented with a normal nutritional status. Contact investigations were positive for tuberculosis infection sources in 64% of the cases. Tuberculin test was positive in 76% of the cases. Pulmonary TB was the predominant presentation form; mild or moderate pulmonary TB was observed in 14/25, and severe pulmonary TB in 7/25. The most frequent extrapulmonary sites of infection were the lymph nodes. Chest X-ray: unilateral TB with no cavity was predominant, 11/25. Bacteriological diagnosis was positive in 64% of the cases. Outcome: in 2010, 12% of the patients defaulted treatment. There were no deceased patients. Conclusions: Most of the patients presented with mild or moderate TB. Lymph node TB was the predominant extrapulmonary presentation. Default rate decreased with the implementation of the intervention.

Tuberculosis en una población pediátrica atendida en un hospital público. Adherencia al tratamiento: Estudio descriptivo

A partir de la estrategia de la OMS "Alto a la Tuberculosis", se evaluó la situación en un hospital público. Objetivo primario: Contribuir con la estrategia de reducción de la tuberculosis. Objetivo secundario: a) evaluar la adherencia al tratamiento b) describir las características clínico-epidemiológicas de una población pediátrica atendida en un hospital público. Material y método: Se realizó un estudio observacional, descriptivo, transversal. Se definió: no adherencia al tratamiento, cuando un paciente no recibe los medicamentos durante un mes o más, en cualquier fase del tratamiento. Resultados: Durante los años 2008-2009, se diagnosticó tuberculosis en 30 niños. Mediana de: 56 meses (rango 1m-14 años). Indice de masculinidad: 0.87. Al ingreso 80% eran sintomáticos, 86% eran eutróficos. El foco de contagio se detectó en el 72%. La prueba tuberculínica fue positiva en el 63%. Predominó la forma pulmonar. La forma pulmonar grave se registró en 12/23 y la común o moderada 11/23. La pleural fue más frecuente entre las extrapulmonares. La radiografía de tórax mostró predominio de infiltrado unilateral sin cavidad 11/23. El rendimiento bacteriológico fue del 36,7%. En 2008 la tasa de abandono fue del 50% y en 2009 44,44%. No hubo fallecidos. Conclusiones: Existe una baja detección de casos por antecedente de contacto. No hubo diferencias entre las formas graves y las pulmonares comunes. La tuberculosis pleural predominó como forma extrapulmonar. El abandono de tratamiento fue muy alto por lo cual propusimos realizar intervenciones.(AU)

Based on the World Health Organization "Stop TB Strategy", the current situation of the Hospital Prof. Dr. A. Posadas was evaluated. Primary Objective: to contribute to the strategy for tuberculosis reduction. Secondary Objectives: a) to evaluate the adherence to treatment b) to describe clinical and epidemiological features of tuberculosis in a pediatric population at a public hospital. Materials& Method: Observational, longitudinal and retrospective study. Treatment default was defined as the period of one or more months during which a patient does not receive medications, in any phase of treatment. Results: During the years 2008 and 2009, 30 children with tuberculosis were registered. Median age was 56 months (range 1m-14 years). Masculinity Index: 0.87. At the time of the first visit, 80% did not present any symptoms and 86% presented a normal nutritional status. Contacts study was positive in 72% of the cases. Tuberculin test (PPD 2 TU) was positive = 10mm in 63% of the patients. Pulmonary TB was the predominant form of presentation. Severe pulmonary TB was recorded in 12/23 patients and mild or moderate TB, in 11/23 patients. Among the extrapulmonary forms, pleural tuberculosis was predominant. Chest X-ray: unilateral pulmonary TB with no cavity was predominant, 11/23 patients. Bacteriological diagnosis was positive in 36.7% of the patients. Outcome: in 2008, default rate was 50% and in 2009, 44.44%. There were no deceased patients. Conclusions: There is a low case detection by contact history. There were no differences in treatment outcome between severe and non severe pulmonary TB. Pleural tuberculosis was predominant as an extrapulmonary presentation. Treatment default was very high in this population; for this reason individual, particular and general interventions are suggested.(AU)

Evaluación de adherencia al tratamiento en un nuevo modelo de atención de niños con tuberculosis en un hospital público

A partir de la alta tasa de abandono del tratamiento de la tuberculosis observada durante los años 2008-2009, se implementaron intervenciones con el fin de disminuirla. Objetivo primario: Evaluar la adherencia al tratamiento en el nuevo modelo de atención en la población pediátrica con tuberculosis atendida en un hospital público. Objetivo secundario: Describir las características clínico-epidemiológicas de la población pediátrica atendida con tuberculosis. Material y método: Diseño observacional, descriptivo, transversal. Criterios de Inclusión: Niños con diagnóstico de tuberculosis. Se utilizaron las mismas variables, definiciones, indicadores y base de datos del 1er. trabajo. Se implementaron intervenciones en lo individual, particular y general. Estas intervenciones se comenzaron a hacer en el Servicio fuera del marco del trabajo. Resultados: Hubieron 25 niños con tuberculosis. La mediana correspondió a 83 meses (rango 2 m a 15 años). 84% fueron eutróficos. Se detectó foco en el 64%. La prueba tuberculínica fue positiva en el 76%. Predominó la forma pulmonar; la común o moderada se observó en 14/25 y la grave en 7/25. La ganglionar resultó la forma extrapulmonar más frecuente. El patrón radiológico predominante fue unilateral sin cavidad 11/25. El rendimiento bacteriológico fue del 64%. En el año 2010 la tasa de abandono fue del 12%. No hubo fallecidos. Conclusiones: La mayoría de los pacientes presentó formas comunes o moderadas. La TB ganglionar predominó como forma extrapulmonar. La tasa de abandono descendió luego de la implementación del nuevo modelo de atención.(AU)

Owing to the high rates of default from tuberculosis treatment observed during 2008 - 2009, interventions were implemented with the purpose of diminishing them. Primary Objective: To make a contribution to tuberculosis treatment adherence. Secondary Objective: a) To evaluate adherence to treatment after implementing individual, particular and general interventions b) To describe clinical and epidemiological features of a pediatric population treated in a public hospital. Materials& Method: Observational, descriptive and transverse design. Inclusion criteria: Patients with tuberculosis diagnosis. The variables, definitions, indicators and database were those used in the previous reported study. Individual, particular and general interventions were implemented. These interventions were carried out outside the service frame of work. Results: 25 children presented with tuberculosis. The median age was 83 months (range 2m to 15 years). 84% presented with a normal nutritional status. Contact investigations were positive for tuberculosis infection sources in 64% of the cases. Tuberculin test was positive in 76% of the cases. Pulmonary TB was the predominant presentation form; mild or moderate pulmonary TB was observed in 14/25, and severe pulmonary TB in 7/25. The most frequent extrapulmonary sites of infection were the lymph nodes. Chest X-ray: unilateral TB with no cavity was predominant, 11/25. Bacteriological diagnosis was positive in 64% of the cases. Outcome: in 2010, 12% of the patients defaulted treatment. There were no deceased patients. Conclusions: Most of the patients presented with mild or moderate TB. Lymph node TB was the predominant extrapulmonary presentation. Default rate decreased with the implementation of the intervention.(AU)

Determinants of tuberculosis treatment default in Morocco: results from a national cohort study.

INTRODUCTION: Studies have shown an association between smoking and tuberculosis (TB) infection, disease and TB-related mortality. We thus documented the impact of smoking and others factors on TB treatment default. METHODS: A cohort of 1039 new TB cases matched on smoking status was followed between 2004 and 2009 in eight Moroccan regions. Treatment default was defined according to international criteria. Univariate analyses were used to assess associations of treatment default with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding. RESULTS: Patients' mean age was 35.0 ±13.2 years. The rate of treatment default was 30.2%. Default was significantly higher among men, smokers, persons living in urban areas and non-religious Muslims. After adjusting for confounding variables, factors that remained significantly associated with treatment default were: being male (OR = 3.2; 95% CI: 1.2-8.7), being a non-religious Muslim (OR = 2.0; 95% CI: 1.4-2.9) and living in an urban area OR = 3.0; 95% CI: 1.8-4.9). CONCLUSION: The high rate found for default suggests important program's inadequacies and an urgent need for change. Therefore continued research of predictors of default and strategies to reinforce adherence is recommended.