Defaulters from follow-up after pre-partum cardiac failure

The problem of default from follow-up prejudices the study of disease in Africa. During studies of 224 patients with pre-partum cardiac failure were found that 119 had defaulted from follow-up for six months or more, after an average period of 22 months from their admission. A sociologist tried to find all these patients at home and interviewed those who were found. If the patient was not found, information was sought from the village head and from friends and relatives. Thirteen patients had died. The 69 who were traced gave a total of 101 reasons for default. Domestic reasons prodominated, of which poverty, moving home and the difficulties of travel were the most important. Among personal reasons, feeling well was the commonest single reason, and was given by 19 patients. The results show that the problems of a subsistence agricultural economy dominate the reasons for default, and that such problem cannot be overcome without changes in society. Our findings are relevant in the care of all chronic diseases and throughout rural Africa.