Default from tuberculosis treatment programme in Sagamu, Nigeria

The study was embarked on to determine the risk factors associated with default from tuberculosis treatment in Sagamu, Nigeria.

A retrospective study of 774 adult patients aged 15 years and above registered for antituberculosis DOTS therapy was conducted between January 1997 and December 2003 at the Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Patients who defaulted (cases) during the course of treatment were compared with non-defaulters (controls) who commenced and completed their TB treatment at the same time.

There were 178 (23%) defaulted cases during the study period. Defaulting rate was highest (78.1%) during the continuation phase of the treatment. There was a significant downward trend in default rate from 37.9% in 1997 to 8.4% in 2003 (p < 0.001). HIV-positive patients had twice the risk of default during the intensive phase of treatment than HIV-negative patients (OR 2.61: CI 0.84-7.97; P = 0.06). Important risk factor associated with non-compliance was male sex 9 OR 1.64: CI. 1.15-2.34; p < 0.01). HIV status (OR: 1.4 CI: 0.77-2.57; p > 0.05), previous treatment (OR: 0.75 CI: 0.43-1.30: p > 0.05), sputum smear result (1.02: CI: 0.59-1.74: p > 0.05) were not significantly associated with default from treatment.

Defaulting was higher in men than women. A downward trend over time was observed. Alternative strategies such as the use of family members to oversee treatment may be desirable in men. There is also a need to shorten duration of treatment, decentralize and make DOTS more accessible, and ensure adequate uninterrupted drug supply to TB treatment centres.