Tracing as part of tuberculosis control in a rural Cambodian district during 1992

The rural Cambodian district of Banteay Meas, population 74,464.

To evaluate the effectiveness of a district based tracing program developed to improve tuberculosis control program treatment results. Specifically, to assess factors affecting patient non-adherence to therapy and return of patients to treatment.

All patients started on treatment during 1992 were included. Standardized cohort analysis methods were applied to assess treatment outcome for all tuberculosis cases registered during Trimesters I-III. Absconders for the year were traced and followed as a separate cohort. Those returning to therapy were followed until the end of the study period in October 1993.

Activity in 1992 included 171 admissions and 46 absconders. Of the 46, 57% were met at home. Among those met, 81% returned to treatment. Males absconded more than females even though females accounted for a majority of admissions. Socioeconomic factors (68%) were cited most often as the reason for non-adherence. Distance was not a factor. Cohort analysis showed improvement in the treatment completion rate (54.8% vs 69.2% vs 64%) coupled with a drop in the absconding rate (35.5% vs 25% vs 20%). Of the 21 patients returning, 76% have either completed or nearly completed treatment.

These results support tracing as an effective means to improve patient adherence in rural Cambodia, thereby strengthening tuberculosis control programs at district level.