Patient characteristics associated with failure of tuberculosis prevention

Noncompliance to DOTS: How it can be Decreased

BACKGROUND

Tuberculosis is a communicable disease requiring prolonged treatment.The therapeutic regimens as recommended by WHO have been shown to be highly effective for both preventing and treating tuberculosis but poor adherence to medication is a major barrier to its global control.

AIM

The aim was to elicit reasons of treatment default from a cohort of tuberculosis patients treated under Directly Observed Treatment Short course chemotherapy.

SETTINGS AND DESIGN

Thiscross-sectional study was conducted in Agra city using the multistage simple random sampling.

MATERIALS AND METHODS

A total of 900 patients attending DOTS centres of the selected designated microscopy centers (DMCs) were included in the study from January 2007 onward. The information was obtained from treatment cards of patients and those who defaulted were further interviewed in community.

STATISTICAL ANALYSIS

Chi-square test was applied to observe the significance of association using the Epi Info software (version 6).

RESULTS

More default was observed among the age group of >45 years (22.8%), male (18.7%), business men (30.6%), and retired and unemployed patients. Other factors associated with higher default were pulmonary disease (18.2%), retreatment cases (30.6%) and category II patients (26.4%). Important reasons of default were side effects following medication (43.2%), improvement in symptoms (14.4%), and lack of time (13.5%). No relief in symptoms and lack of awareness were other important reasons.

CONCLUSIONS

Noncompliance was found to be mainly due to side effects of medicines, lack of time, and unawareness. So educating the patient about various aspects of tuberculosis and some measures to decrease side effects are of utmost importance.

Cultural feasibility assessment of tuberculosis prevention among persons of Haitian origin in South Florida

A cultural feasibility study was conducted among persons of Haitian origin in South Florida to identify factors which might influence utilization of screening and treatment services for latent tuberculosis infection in this population. Five focus group interviews conducted among men and women explored cultural beliefs and practices related to TB, barriers and incentives to screening, and approaches to increasing treatment adherence. Key findings include the influence of social stigma and fears related to confidentiality of medical status as disincentives to screening. Cultural sensitivity to being labeled as a high risk group for these infections also emerged as a critical variable. Community-based approaches to health education for this population are described. Study recommendations include the planning of programs based on a service delivery model that stresses respect and personal attention to clients, improved interpersonal skills of health center staff, and coordination of services between private doctors and public health agencies.

Effectiveness of the Immigration Medical Surveillance Program for tuberculosis in Ontario

BACKGROUND

Citizenship and Immigration Canada (CIC) screens immigrants for TB and permits those with inactive pulmonary TB to enter Canada conditionally, subject to medical surveillance; we studied this program in Ontario.

METHOD

This was an administrative database study with linkage of national and provincial data.

RESULTS

In 1994-95, 1,341 cases of foreign-born active TB were diagnosed and a CIC record was found for 1,095. 149 (14%) were classified for surveillance and 142 were included in the analysis. A significant proportion (39/142: 27%) were diagnosed either before or as a result of immigration screening in Canada. These persons had arrived as visitors or refugees and were excluded from further analysis. Only 21 of the remaining 103 persons (20%) with immigration screening before the diagnosis of TB adhered to surveillance. Only 1 of 16 (6%) eligible persons was given therapy to prevent future episodes of active TB. Most presented with symptoms (82/103:82%) suggesting potential for TB transmission in Ontario.

INTERPRETATION

The current TB surveillance system for high-risk immigrants to Ontario is not effective in identifying and treating latent infection, and thus not effective in preventing future cases.