True status of smear-positive pulmonary tuberculosis defaulters in Malawi.

ABSTRACT

The article reports the results of a study to determine the true outcome of 8 months of treatment received by smear-positive pulmonary tuberculosis (PTB) patients who had been registered as defaulters in the Queen Elizabeth Central Hospital (QECH) and Mlambe Mission Hospital (MMH), Blantyre, Malawi. The treatment outcomes were documented from the tuberculosis registers of all patients registered between 1 October 1994 and 30 September 1995. The true treatment outcome for patients who had been registered as defaulters was determined by making personal inquiries at the treatment units and the residences of patients or relatives and, in a few cases, by writing to the appropriate postal address. Interviews were carried out with patients who had defaulted and were still alive and with matched, fully compliant PTB patients who had successfully completed the treatment to determine the factors associated with defaulter status. Of the 1099 patients, 126 (11.5%) had been registered as defaulters, and the true treatment outcome was determined for 101 (80%) of the latter; only 22 were true defaulters, 31 had completed the treatment, 31 had died during the treatment period, and 17 had left the area. A total of 8 of the 22 true defaulters were still alive and were compared with the compliant patients. Two significant characteristics were associated with the defaulters; they were unmarried; and they did not know the correct duration of antituberculosis treatment. Many of the smear-positive tuberculosis patients who had been registered as defaulters in the Blantyre district were found to have different treatment outcomes, without defaulting. The quality of reporting in the health facilities must therefore be improved in order to exclude individuals who are not true defaulters.

ABSTRACT

PIP This study investigates the status of patients with smear-positive pulmonary tuberculosis (PTB), and determines the true 8-month treatment outcome of patients who had been registered as defaulters in Queen Elizabeth Central Hospital (QECH) and Mlambe Mission Hospital (MMH), Blantyre, Malawi. All patients registered between October 1, 1994, and September 30, 1995, were studied, with name, age, sex, home address, and treatment unit as the determining factors. Interviews were carried out with patients who had defaulted and were still alive and with matched, fully compliant PTB patients to determine the factors associated with defaulter status. Results showed that of the 1099 patients, 126 (11.5%) had been registered as defaulters, and the true treatment outcome was determined for 101 (80%) of the latter; only 22 were true defaulters, 31 had completed the treatment, 31 had died during the treatment period, and 17 had left the area. A total of 8 of the 22 true defaulters were still alive. Unmarried status and ignorance of the duration of antituberculosis treatment were the significant characteristics of defaulting behavior. Many of the smear-positive tuberculosis patients had been registered as defaulters in the Blantyre District were found to have different treatment outcomes that did not involve defaulting. Thus, the quality of reporting in the health facilities must be improved in order to exclude individuals who are not true defaulters. The public should be given more information about tuberculosis via intensive health education--especially regarding the total duration of treatment and the need to complete the full course.