Study of Non compliance to Directly Observed Treatment Short-course (DOTS) at a tertiary hospital in Dhule district (Maharashtra)

Abstract

Background: India has been engaged in TB control activities for more than 50 years. Yet TB continues to be severest health crisis. TB kills an estimated 480000 Indians every year and more than 1400 per day. Tuberculosis is a preventable & curable communicable disease requiring prolonged treatment. The therapeutic regimens recommended by WHO and used in India, under National Tuberculosis Elimination Programme (NTEP) have been shown to be very effective for both preventing and treating tuberculosis. But poor compliance to treatment is a major barrier to its control and cause for drug resistance. Study objective: Study objective was to find out extent and causes of non-compliance to DOTS at a tertiary hospital. Material and Methods: Present study was cross sectional study. Using purposive sampling method all 112 sputum positive pulmonary tuberculosis patients, registered from January 2020 to December 2020 in the DOTS centres under department of Respiratory Medicine, A. C. P. M. Medical College and Hospital, Dhule (Maharashtra) India, were included in study. Age less than 18 years and drug resistant cases were excluded. The information was obtained from treatment cards of patients. Information of non-compliant was further elicited from the patients/DOTS providers. A criterion for non-compliance (Lost to follow up) was patient missed treatment for one month or more at any time during the treatment period. Results: During study period, total 112 cases were enrolled. In present study non-compliance was observed in 9 cases (08.03 %). In non-compliant cases, majority were from 31-40 year age group (33.34 %), male (66.67%), educated up to 12th standard (44.45 %), housewives (22.22 %), labourer (33.34 %) by occupation, belonging to Kuppuswamy’s socioeconomic class V (44.45 %), living alone/with friends (11.11 %), married (77.78 %). Among non-compliant cases other factors such as alcohol consumption (22.22 %), smoking (33.33 %) & family history of TB (11.11 %) were noted. Among non-compliant cases, majority were newly diagnosed (77.78 %) followed by previously treated (22.22 %). Factors observed for non-compliance were patients feeling better so no need to continue treatment (44.45 %), side effects of drugs (22.22 %), migrated to other places (22.22 %). & fear of social stigma (11.11 %) Conclusion: In spite of one to one counseling at treatment initiation and retrieval action during follow up, non-compliance was observed in 9 cases (8.03%). Associated factors like male sex, young age, previous treatment and causes of non compliance like stopping treatment after feeling better, intolerance to anti TB drugs, migrating to other places and fear of stigma suggests improvement in health education to patient and family members, stringent follow up by healthcare providers, and use of newer treatment tracking methods.