|Year : 2015 | Volume
| Issue : 3 | Page : 226-229
Assessment of treatment interruption among pulmonary tuberculosis patients: A cross-sectional study
Satya Bhgath Gorityala1, Uday Venkat Mateti2, Venkateswarlu Konuru1, Srinivas Martha3
1 Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Kakatiya University, Hanamkonda, Warangal, Telangana, India
2 Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Kakatiya University, Hanamkonda, Warangal, Telangana; Department of, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India
3 Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Kakatiya University, Hanamkonda; Department of, Balaji Institute of Pharmacy, Laknepally, Narsampet, Warangal, Telangana, India
|Date of Submission||02-Feb-2015|
|Date of Decision||02-Apr-2015|
|Date of Acceptance||21-May-2015|
|Date of Web Publication||6-Jul-2015|
Department of Pharmacy Practice, St. Peter's Institute of Pharmaceutical Sciences, Kakatiya University, Hanamkonda; Department of, Balaji Institute of Pharmacy, Laknepally, Narsampet, Warangal, Telangana
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Multi-drug resistant tuberculosis (TB) is a rising peril of the TB control in India caused mostly by incomplete treatment. Aim: The aim was to assess the treatment interruption among pulmonary TB (PTB) patients. Materials and Methods: A cross-sectional study was carried out for a period of 9 months among PTB patients. Patients admitted with active pulmonary Koch's and history of anti-TB treatment (ATT) for 1-month or more from any source and who returns to treatment after not taking ATT consecutively for 2 months or more were included in the study. The data were collected from the patients or their caretakers to obtain the source of treatment given previously before default, number of treatment interruptions, phase and reasons for treatment interruption treatment. Results: A total of 107 defaulters were identified during the study period. In the present study, 62.6% of the patients interrupted treatment only once, 55.34% of the patient's early continuation (3-4 months) treatment, and 47.66% of the patient's only one reason for the treatment interruptions during the course of the treatment. The most common reason for the treatment interruptions were felt well with TB treatment (29.53%) followed by side effects (16.06%), lack of money (8.29%), and other reasons. Conclusion: The study revealed that most of the defaulters were in the age group between 35 and 60 years, male gender, illiterates, daily wage labor, and married. The treatment interruptions were minimized by putting the efforts to improve direct supervision; pretreatment counseling and retrieve treatment interrupters were recommended.
Keywords: Cross-sectional, Koch, treatment interruption, tuberculosis
|How to cite this article:|
Gorityala SB, Mateti UV, Konuru V, Martha S. Assessment of treatment interruption among pulmonary tuberculosis patients: A cross-sectional study. J Pharm Bioall Sci 2015;7:226-9
|How to cite this URL:|
Gorityala SB, Mateti UV, Konuru V, Martha S. Assessment of treatment interruption among pulmonary tuberculosis patients: A cross-sectional study. J Pharm Bioall Sci [serial online] 2015 [cited 2021 Mar 5];7:226-9. Available from: https://www.jpbsonline.org/text.asp?2015/7/3/226/160034
Tuberculosis (TB) is a contagious airborne, chronic granulomatous bacterial infectious disease usually caused by Mycobacterium tuberculosis and occasionally by Mycobacterium bovis, Mycobacterium africanum, and Mycobacterium avium complex.  TB is divided into two types namely pulmonary TB (PTB) and extra PTB (EPTB) based on the site of infection. PTB refers to disease involving the lungs. EPTB refers to TB of organs other than the lungs, e.g., pleura, lymph nodes, abdomen, genitourinary tract, skin, joints bones, and meninges. ,
According to revised national TB control program treatment consists of two phases namely an initial intensive phase and a second continuation phase. The total duration of treatment is 6-9 months. Multiple drugs are given to prevent drug resistance and longer duration of treatment is given to prevent relapse. Sputum microscopy is done regularly to monitor the response to treatment. , Directly observed treatment adapted to the needs of patients and to the working conditions of health care workers is certainly the best method of avoiding treatment interruption. However, even with directly observed treatment, and also during the continuation phase of treatment that is often self-administered, there may be treatment interruptions. The objectives of the study are to assess factors associated with default among PTB patients, number of treatment interruptions, phase and reasons for treatment interruption treatment.
| Materials and Methods|| |
A cross-sectional study was carried out for a period of 9 months in a Government Hospital for diseases of chest and TB, Hanamkonda, under Kakatiya Medical College, to cater the needs of poor and downtrodden patients in four North Telangana districts such as Warangal, Karimnagar, Khammam, and Adilabad. Ethical clearance was obtained from the hospital's Ethics Committee prior to the study initiation. All patients admitted with active pulmonary Koch's and history of anti-TB treatment (ATT) for 1-month or more from any source and who returns to treatment after not taking ATT consecutively for 2 months or more were included in the study. Informed consent was obtained from the eligible patients. Patients with PTB-HIV co-infected, Koch's sequelae without active Koch's who were previously default, relapse, sputum negative, failure and who take medication irregularly were excluded from the study. Patient's demographic details such as age, sex, educational status, marital status, occupational status, and family support were collected from the patients and medical records. Patients or their caretakers were interviewed to obtain the source of treatment given previously before default, number of treatment interruptions, phase and reasons for treatment interruption treatment.
The categorical variables were presented as number and percentage and the data were analyzed using SPSS version 15, Bangalore, South Asia.
| Results|| |
A total of 956 patients were admitted during the study period. Out of 956, 573 patients belonged to PTB and 383 patients belonged to chest diseases. Out of these 573 PTB cases, 173 were newly diagnosed cases and 401 were retreatment cases. Among 401 PTB retreatment cases, 107 default patients who met the study criteria. Out of 107 defaulters, 98 (91.5%) were males and 9 (8.41%) were females. In the present study, 78 (72.89%) of the patients were in the age group between 35 and 60 years, 72 (67.28%) were illiterates, 53 (49.53%) were daily wage labor, and other demographic details are summarized in the [Table 1].
In the present study, 62.6% of the patients interrupted treatment only once, 55.34% of the patient's early continuation (3-4 months) treatment, 47.66% of the patient's only one reason for the treatment interruptions during the course of the treatment, and other details are summarized in the [Table 2]. The most common reason for the treatment interruptions were felt well with TB treatment (29.53%) followed by side effects (16.06%), lack of money (8.29%), and other reasons are summarized in the [Table 3].
| Discussion|| |
In the present study, males have tenfold higher default than females and these results were consistent with similar studies (66% were in one study and 75.6% in another study). , In this study, most of the defaulters were in the age group between 35 and 60 years. In contradictory to our study, the similar study reported that most of defaulters were in the age group 16-30 years.  The study conducted by Bhagat et al. illiteracy rate was 42.5% among defaulters whereas in the present study 67.28% illiterates were found.  Education is a key factor in communicating health information. People with low level of education are more likely do not understand the details of health information and treatment. Illiteracy was predominant among defaulters, so the doctors were unable to give adequate information and make them understand about the disease and treatment.
In the present study, 85.98% of defaults were married. The similar studies conducted by Gupta et al., Mishra et al., were also reported that most of the defaults among married patients. , In contrary, Mainga reported that 76% defaulters were unmarried.  Samson reported default was predominant among singles who has lack support.  Information about marital status of the patient was collected to know whether patients having spouse had any additional support in preventing default among patients, but in contrary married patients defaulted more in the study. The daily wage labors were found to default predominantly constituting 49.53% in contradictory to other studies states that most of the defaulters were unemployed. , Labor defaulted more as they felt asymptomatic and also due to workload.
Out of 159 treatment interruptions, 88 (55.34%) were found to occur between 2 nd and 3 rd months, that is, during early continuation phase followed by 41 (25.78%) during intensive phase and 30 (18.86%) during late continuation phase. Patients were defaulted majorly during early continuation phase because they felt the disease was cured as they were asymptomatic and also due to financial constraints. In a study conducted by Tekle et al., defaults were 81% during the continuation phase of treatment.  Similarly Demissie and Kebede reported that most of the defaults occurred in the 3 rd and 4 th months of treatment and Dodor and Afenyadu have determined the mean defaulting moment to be 3.4 months. , Among 159 treatment interruptions in 107 patients, 99 (62.2%) occurred under government treatment and 60 (37.73%) occurred when the prescribing source was a private practitioner. In government treatment, 54 (33.96%) treatment interruptions were during usage of category-I regimen and 45 (28.03) were during usage of category-II regimen.
In a study conducted by Wares et al., the most common reason for stopping treatment was due to adverse effects of ATT in 11 (36.6%) of defaulters.  Similarly, Jaggarajamma et al. in a study from Tiruvallur district have found drug related problems like nausea, vomiting, and dizziness to be the leading cause of treatment interruption in 59 (42%) patients.  In the present study, ATT-induced side effects were stated as the second most common reason by 31 (16.06%) patients. Nausea, vomiting, and dizziness were more in directly observed treatment short-course when compared to private ATT due to higher doses. Adverse drug reactions are expected to influence adherence to treatment. Patients failed to resist discomfort brought about by the drugs and discontinued treatment. Patients perceived that the health benefit of undergoing treatment was not worth suffering the negative side effects of the medicine. Long term goals of cure and recovery were disregarded for the immediate goal of seeking relief from the discomfort brought about by the side effects of medication. Patients were not educated about the side effects of ATT by health care professionals.
In a study conducted by Mankodi, 3% of defaulters claimed lack of money as the reason for default.  Similarly, Shah et al. reported financial difficulty as one of the common reasons cited by patients for defaulting in 16 (36.36%) patients.  In the present study, lack of Money 16 (8.29%) to buy ATT medication was reported as third most common reason found. In a study conducted by Shargie and Lindtjørn reported 5 (6.7%) patients reported that their disease condition did not improve so they defaulted.  Similarly, Mainga reported 39 (72%) of the respondents had doubts whether the treatment was working or not.  Mankodi reported that 6% of defaulters stopped to take medication because drugs did not seem to have any observable effect.  In the present study did not felt better with treatment was stated as the reason for default by 13 (6.73%) of patients as there was no improvement in their health condition as the symptoms did not subside.
| Conclusion|| |
The study revealed that most of the defaulters were in the age group between 35 and 60 years, male gender, illiterates, daily wage labor, and married. The most common reason for the treatment interruptions were felt well with TB treatment (29.53%) followed by side effects (16.06%), lack of money (8.29%), and others. The treatment interruptions were minimized by putting the efforts to improve direct supervision; pretreatment counseling and retrieve treatment interrupters were recommended.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
McMurray DN. Mycobacteria and Nocardia
. In: Baron S, editor. Medical Microbiology. 4 th
ed. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Available from: http://www.ncbi.nlm.nih.gov/books/NBK7812/
. [Last accessed on 2014 Nov 10].
Naing NN, D′Este C, Isa AR, Salleh R, Bakar N, Mahmod MR. Factors contributing to poor compliance with anti-TB treatment among tuberculosis patients. Southeast Asian J Trop Med Public Health 2001;32:369-82.
Chan-Yeung M, Noertjojo K, Leung CC, Chan SL, Tam CM. Prevalence and predictors of default from tuberculosis treatment in Hong Kong. Hong Kong Med J 2003;9:263-8.
Amoran OE, Osiyale OO, Lawal KM. Pattern of default among tuberculosis patients on directly observed therapy in rural primary health care centres in Ogun State, Nigeria. J Infect Dis Immun 2011;3:90-5.
Bhagat VM, Gattani PL, Aurangabad AM. Factors affecting tuberculosis retreatment defaults in Nanded, India. Southeast Asian J Trop Med Public Health 2010;41:1153.
Gupta S, Gupta S, Behera D. Reasons for interruption of anti-tubercular treatment as reported by patients with tuberculosis admitted in a tertiary care institute. Indian J Tuberc 2011;58:11-7.
Mishra P, Hansen EH, Sabroe S, Kafle KK. Socio-economic status and adherence to tuberculosis treatment: A case-control study in a district of Nepal. Int J Tuberc Lung Dis 2005;9:1134-9.
Samson DR. Risk factors for treatment default among DOTS enrolled TB patients in Baliswan District, Zamboanga City. Zamboanga: Zamboanga University; 2007.
Tekle B, Mariam DH, Ali A. Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia. Int J Tuberc Lung Dis 2002;6:573-9.
Demissie M, Kebede D. Defaulting from tuberculosis treatment at the Addis Abeba Tuberculosis Centre and factors associated with it. Ethiop Med J 1994;32:97-106.
Dodor EA, Afenyadu GY. Factors associated with tuberculosis treatment default and completion at the Effia-Nkwanta Regional Hospital in Ghana. Trans R Soc Trop Med Hyg 2005;99:827-32.
Wares DF, Singh S, Acharya AK, Dangi R. Non-adherence to tuberculosis treatment in the eastern Tarai of Nepal. Int J Tuberc Lung Dis 2003;7:327-35.
Jaggarajamma K, Sudha G, Chandrasekaran V, Nirupa C, Thomas A, Santha T, et al
. Reasons for non-compliance among patients treated under Revised National Tuberculosis Control Programme (RNTCP), Tiruvallur district, south India. Indian J Tuberc 2007;54:130-5.
Mankodi K. Socio-cultural context of TB treatment: A case study of southern Gujarat. Indian J Tuberc 1982;29:87-92.
Shah AI, Najib U, Rasul S, Khan AA. Prime reasons for premature discontinuation of antituberculous therapy: At Mayo Hospital, Lahore, Pakistan. Biomedica 2009;25:133-5.
Shargie EB, Lindtjørn B. Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in Southern Ethiopia.PLoS Med 2007;4:e37.
[Table 1], [Table 2], [Table 3]