Risk factors associated with default among tuberculosis patients in Darjeeling district of West Bengal, India.
Risk factors associated with default among tuberculosis patients in Darjeeling district of West Bengal, India.
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DOI：
10.4103/2249-4863.161330
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发表时间：
2015-07
影响因子：
1.4
通讯作者：
Dasgupta S
中科院分区：
文献类型：
--
作者：
Roy N;Basu M;Das S;Mandal A;Dutt D;Dasgupta S
根据修订后的国家结核病控制计划（RNTCP），治疗结果“默认”是指治疗开始后连续中断治疗超过 2 个月的患者。旨在评估西孟加拉邦大吉岭地区新痰阳性 (NSP) 结核病 (TB) 患者中与一些社会人口统计学变量相关的违约原因的时间、特征和分布。 2011 年 8 月至 2011 年 12 月，在大吉岭的三个结核病科 (TU) 对 2009 年第一季度至 2010 年第二季度在结核病登记册中登记接受治疗的 NSP 结核病患者进行了一项病例对照研究。未能接受治疗的患者被视为“病例”，完成治疗的患者被视为“对照”（79 例病例和 79 名对照）。卫生工作者使用预先设计的结构化形式对登记的病例和对照进行了访谈。逻辑回归分析、优势比 (OR)、调整优势比 (AOR)。 75%的违约发生在强化阶段（IP）； 54.24% 的检索操作在 IP 期间的 1 天内完成，75% 在持续阶段 (CP) 的 1 周内完成；百分之百的记录检索行动是由合同结核病项目工作人员进行的。最常见的违约原因是饮酒（29.11%）、药物不良反应（25.32%）和距离DOT中心较远（21.52%）。在逻辑回归分析中，独立相关的因素包括饮酒、结核病知识不足、患者提供者互动不足、漏服剂量、抗结核药物不良反应、政府直接观察治疗（DOT）提供者和吸烟。大多数违约发生在密集阶段；治疗前咨询和初次家访在这方面发挥着非常重要的作用。医护人员需要在患者提供者会议上提供适当的咨询。
The treatment outcome “default” under Revised National Tuberculosis Control Program (RNTCP) is a patient who after treatment initiation has interrupted treatment consecutively for more than 2 months. To assess the timing, characteristics and distribution of the reasons for default with relation to some sociodemographic variables among new sputum-positive (NSP) tuberculosis (TB) patients in Darjeeling District, West Bengal. A case-control study was conducted in three tuberculosis units (TUs) of Darjeeling from August’2011 to December’2011 among NSP TB patients enrolled for treatment in the TB register from 1st Qtr’09 to 2nd Qtr’10. Patients defaulted from treatment were considered as “cases” and those completed treatment as “controls” (79 cases and 79 controls). The enrolled cases and controls were interviewed by the health workers using a predesigned structured pro-forma. Logistic regression analysis, odds ratios (OR), adjusted odds ratios (AOR). 75% of the default occurred in the intensive phase (IP); 54.24% retrieval action was done within 1 day during IP and 75% within 1 week during continuation phase (CP); cent percent of the documented retrieval actions were undertaken by the contractual TB program staffs. Most commonly cited reasons for default were alcohol consumption (29.11%), adverse effects of drugs (25.32%), and long distance of DOT center (21.52%). In the logistic regression analysis, the factors independently associated were consumption of alcohol, inadequate knowledge about TB, inadequate patient provider interaction, instances of missed doses, adverse reactions of anti-TB drugs, Government Directly Observed Treatment (DOT) provider and smoking. Most defaults occurred in the intensive phase; pre-treatment counseling and initial home visit play very important role in this regard. Proper counseling by health care workers in patient provider meeting is needed.