Delineating the factors associated with recurrence of tuberculosis in programmatic settings of rural health block, Himachal Pradesh, India.

ABSTRACT

BACKGROUND: Tuberculosis (TB) recurrence observed to be an important event in its treatment and has future implications under national TB control efforts. The present study was carried out to assess the recurrence rate along with its risk factors among patients undergoing treatment for TB under Revised National TB Control Program (RNTCP). MATERIAL AND METHODS: Total 204 patients in health block of district Una, Himachal Pradesh were studied using pretested structured interviewer-administered questionnaire. Along with univariate a non-hierarchal multi-way frequency analysis (MFA) was done to study the one and multi-way effects between the discrete variables included in a hypothesized model. The variables were under-nutrition, pulmonary TB, injecting drug use (IDU), multi-drug resistant (MDR) TB, and past TB (recurrent cases). RESULTS: Total 29 cases (14.2%) had recurrence (17.7/100,000 population) with significantly high fraction for alternate residence (Recurrent 50.0%, Non-recurrent 47.4%; p = 0.001), Multi-drug resistance (MDR) TB (Recurrent 13.8%, Non-recurrent 2.3%; p = 0.003), and sputum negative patients (Recurrent 51.7%, Non-recurrent 14.5%; p = 0.000). Non-recurrent cases had significantly high fraction for sputum positive cases (Recurrent 48.3%, Non-recurrent 72.1%; p = 0.011), and extra-pulmonary TB (Recurrent 00.0%, Non-recurrent 13.4%; p = 0.036). MFA observed all significant one-way effects. Significant two-way effects were IDU and pulmonary TB (p = 0.001), MDR and past TB (p = 0.004), IDU and past TB (p = 0.019), and IDU and MDR-TB (p = 0.039). CONCLUSION: Proportion of TB recurrence was expected with a significant difference between the history of change of residence, MDR-TB, pulmonary and extra-pulmonary nature of the disease. Hypothesized model observed with a significant association of IDU, pulmonary TB, MDR-TB and past TB.