Original Article
Determinants of adverse treatment outcomes among patients treated under Revised National Tuberculosis Control Program in Wardha, India: Case–control study

https://doi.org/10.1016/j.mjafi.2017.07.008Get rights and content

Abstract

Background

Tuberculosis (TB) leads to a considerable loss of lung functions and Quality Adjusted Life Years. Several factors are associated with adverse treatment outcomes from TB which further increases this loss. We undertook the study to study the determinants of adverse treatment outcomes among tuberculosis patients treated under the Revised National Tuberculosis Control Program in a tuberculosis unit in India.

Methods

88 cases and 187 controls from among patients registered in Wardha Tuberculosis Unit in the year 2014 were interviewed to study the determinants of adverse treatment outcomes of tuberculosis. All patients with adverse treatment outcomes were taken as cases. Controls were chosen from relapse free successfully treated patients using simple random sampling.

Results

On multivariate analysis indoor air pollution, pulmonary TB, discrimination due to TB and poor satisfaction with services significantly increased the odds of adverse treatment outcomes whereas the senior treatment supervisor visiting the patients during treatment was protective.

Conclusion

Appropriate new interventions and strengthening of the existing mechanisms to reduce treatment interruptions along with proper implementation of the program will help in reducing the adverse treatment outcomes and improving program performance.

Introduction

Tuberculosis (TB) was declared a global emergency in 1993 by World Health Organisation (WHO).1 India has registered a Treatment Success Rate (TSR) of >85% in New Sputum Positive (NSP) cases of TB. But the TSR of ∼70% in retreatment cases is comparatively less.2 Retreatment patients are at greater risk of death and further adverse treatment outcomes.2, 3 Furthermore, treatment interruptions and defaults are associated with drug resistance which further deteriorates the treatment outcomes.4 TB has a negative impact on the physical and social aspects of a person's life and leads to a considerable loss in Quality Adjusted Life Years with every episode.5

Several factors like increasing age, male sex,3, 6 addictions,3, 7 type of disease,8 previous history of TB,9 poor compliance and treatment interruptions,7, 10 comorbidities,8, 9, 10, 11 and side effect of drugs6 have been associated with various adverse treatment outcomes. Lower education levels,11 dissatisfaction with services,12 poor information sharing by service providers and work related factors13 have been associated with defaulting from treatment.

As it is important to understand the local epidemiology for appropriate control measures, the present study was undertaken to study the determinants of adverse treatment outcomes among TB patients treated under RNTCP in Wardha Tuberculosis Unit (TU).

Section snippets

Materials and methods

The present case control study was carried out from November 2015 to September 2016 in Wardha TU in Central India. The district has 3 TUs spanning across 8 administrative blocks. The study was carried out in one of the TU (population ∼5 lakh). The study population consisted of patients registered under RNTCP in the TU in the year 2014.

All patients with any adverse treatment outcome (deaths, defaults, relapse, treatment failure, shift to category IV) were selected as cases (n = 91). Simple random

Results

Out of the 91 cases and 209 controls selected for participation, 3 cases and 22 controls were excluded (Fig. 1). Thus, a total of 275 patients were interviewed (88 cases and 187 controls). The treatment outcomes of participants have been shown in Table 1.

On univariate analysis, among the socio-demographic factors, the odds of adverse treatment outcome increased significantly with age, sex, lower education levels, occupation, low SES, and exposure to indoor air pollution (Table 2).

Among the

Discussion

In this study out of the 275 participants about 28% patients were cured, 40% were declared treatment completed, 10% died, 16% defaulted, 2% relapsed after successfully completing the therapy, 3% experienced treatment failures, and 0.7% were shifted to Category IV. Indoor air pollution, pulmonary TB, discrimination, satisfaction with services, and STS visits at patient's residence were seen to influence the odds of adverse treatment outcomes significantly.

Indoor air pollution was associated with

Conflicts of interest

The authors have none to declare.

Acknowledgement

We acknowledge the help received from staff members at the District TB Centre.

References (30)

  • V.K. Mishra et al.

    Biomass cooking fuels and prevalence of tuberculosis in India

    Int J Infect Dis

    (1999)
  • Kim JY, Shakow A, Castro A, Vande C, Farmer P. Tuberculosis Control. World Health Organization. Available from:...
  • Central TB Division

    Reach, treat, cure TB. TB India 2015 RNTCP annual status report

    (2015)
  • M. Vasantha et al.

    Survival of tuberculosis patients treated under DOTS in a rural Tuberculosis Unit (TU), South India

    Indian J Tuberc

    (2008)
  • Y.-S. Kwon et al.

    Risk factors for death during pulmonary tuberculosis treatment in Korea: a multicenter retrospective cohort study

    J Korean Med Sci

    (2014)
  • T.L. Miller et al.

    Personal and societal health quality lost to tuberculosis

    PLoS ONE

    (2009)
  • U.M. Jha et al.

    Risk factors for treatment default among re-treatment tuberculosis patients in India, 2006

    PLoS ONE

    (2010)
  • T. Santha et al.

    Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000

    Int J Tuberc lung Dis

    (2002)
  • J. Shuldiner et al.

    Mortality of tuberculosis patients during treatment in Israel, 2000–2010

    Int J Tuberc lung Dis

    (2014)
  • A. Babalık et al.

    A retrospective case-control study, factors affecting treatment outcomes for Pulmonary Tuberculosis in Istanbul, Turkey

    Balkan Med J

    (2013)
  • R. Panjabi et al.

    Recurrent tuberculosis and its risk factors: adequately treated patients are still at high risk [review article]

    Int J Tuberc Lung Dis

    (2007)
  • M.D.S. Garrido et al.

    Factors associated with tuberculosis treatment default in an endemic area of the Brazilian Amazon: a case control-study

    PLoS ONE

    (2012)
  • S. Vijay et al.

    Risk factors associated with default among new smear positive TB patients treated under DOTS in India

    PLoS ONE

    (2010)
  • M. Thirunavukarasu et al.

    Tuberculosis default: a qualitative exploration in rural Puducherry

    Natl J Res Community Med

    (2014)
  • Central TB Division

    Revised National Tuberculosis Control Programme: Training Course for Program Manager (Modeules 1–4)

    (2011)
  • Cited by (5)

    • Magnitude and determinants of psychological morbidities among pregnant women: Results from a pregnancy cohort in rural Central India

      2024, Medical Journal Armed Forces India
      Citation Excerpt :

      To study the determinants of psychological morbidities during pregnancy, we used a structured questionnaire to record sociodemographic details, pregnancy-related questions, family support, intimate partner relation, job security and history of any mental illness. For socioeconomic status, ration cards issued by the Government of Maharashtra under the Public Distribution System was checked (yellow card for Below Poverty Line (BPL) families, orange and white card for Above Poverty Line (APL) families).16 Relationship with the intimate partner was categorised as partners being unsupportive or uninvolved in collective decision making, those being alcoholic or verbally/physically abusing the woman, and those with partners supporting the decision of the woman.

    • Social factors tend to decline age-standardized all-cause mortality rates in China during 2005–2015: evidence from an ecological study

      2021, Public Health
      Citation Excerpt :

      As we found, improvements in medical services and lifestyle promotion could decrease cardiovascular disease.22 The incidence and the risk of adverse outcomes of TB are high in areas with underdeveloped economics and poor medical services condition.30,31 Besides, those areas with low income per capita seem to relate to high COPD mortality32 and experienced a double burden of neonatal causes and infectious diseases.27,33

    View full text