Abstract

Although tuberculosis is a curable and preventable disease, defaulting from treatment can prolong infectiousness leading to increased transmission, an increased risk of drug resistance, relapse and death. Our objective was to identify patient related determinants (including knowledge and awareness, opinion about TB services and behavioral factors) of treatment defaulting among TB patients in Khartoum State, Sudan. Between May 2010 to May 2011., we conducted a case control study where the  patients defaulting from treatment were considered as ‘cases’ and those completing treatment as ‘controls’.  There were 2727 TB patients who attended TB treatment clinics during study period. Out of these 2399 patients (86%) had continued their treatment while 328 patients (14%) had interrupted it. 105 cases were traced and interviewed. In addition 210 patients who had continued their treatment were included as controls. In the multivariate analysis the variables that remained in the model were: rural residence (OR= 2.16; 95% CI= 1.19-3.90), “had never heard about TB before had it (OR= 1.81; 95%CI=1.02-3.20 ), lack of knowledge on when to stop TB medication (OR= 2.00; 95% CI= 1.10 -3.64), less support by families, friends and colleagues (OR= 3.23; 95% CI= 1.62- 6-46), too many patients when visiting the TB center (OR= 2.24; 95% CI =1.29 - 3.88), and lack of counseling about TB and its treatment (OR= 4.79; 95% CI= 2.57 -8.95). The results of this study show that patient’s knowledge about TB, its treatment and the experienced professional and peer support are associated with TB treatment continuation. Hence, adequate counseling of patients, including counseling of their peers for social support, and adequate training of the health care providers who have enough time to attend to their patient’s need are potential measures to reduce TB treatment default.

Key words:       Tuberculosis, non-adherence, adherence, defaulter.