Prevalence and Predictors of Tuberculosis Treatment Default in Abakaliki, Nigeria: An Implication for Patient Centred Education and Treatment Follow-Up

Abstract

Introduction: Tuberculosis (TB) treatment is the most effective strategy for preventing the spread of the disease. Default in TB treatment remains an important contributor to treatment failure, resurgence of multidrug resistance (MDR-TB), prolonged infectiousness, relapse and death. TB treatment default increases the disease burden and poses a threat to its elimination. This study determined the prevalence and predictors of tuberculosis treatment default.  Methods: Records of 686 patients from TB treatment register at Federal Teaching Hospital Abakaliki from year 2012 to 2016 were analysed. Key informant interviews were conducted with nurses to elicit the factors associated with default. Ethical approval and permission were obtained respectively from the ethics committee and TB unit chief nurse. Records of treatment follow-up were grouped as “defaulter” and “non-defaulter”. Data analysis was done using SPSS software, version 20. Chi squared test of statistical significance was done at P = .05, and thematic analysis was done for the qualitative data. Results: Mean age of the patients was 34.9 ± 5.7 years, and prevalence rate of default was 10.6% for the five-year period. Majority (73.1%) defaulted within the intensive phase of treatment. Common reasons for defaulting were: ‘well feeling’, ‘distance to health facility’, and high pill burden. Among the defaulters, 25% were ≤ 29 years, 52.8% were males, and 68.1% lived in rural areas. Predictors of TB treatment default were male gender (AOR =2.1; 95% CI: 1.4-7.5), and rural residence (AOR=1.8; 95% CI: 1.3-5.7). Conclusion: Default rate was high among the patients, and it was mostly associated with the distance from the health facility. We recommend decentralization of treatment centres to rural areas; together with individual patient-centered education and counseling on treatment duration as measures to reduce defaulter rate.