Evaluation of tuberculosis defaulters in Yemen from the perspective of health care service

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Abstract

Objectives

To identify the risk factors associated with tuberculosis (TB) defaulters in Yemen and their main reasons for defaulting treatment. This is imperative because non-compliance with TB therapy can result in drug resistance, prolonged infectiousness and death. Resolving these objectives will help us to understand why TB patients in Yemen default, the relatively high default rate in Yemen (above the World Health Organization recommended rate of 10%) as well as the impact of socioeconomic and cultural factors on TB treatment.

Methods

A prospective cohort study was conducted from 1 March 2013 until the end of December 2015 in two major cities with prevalent TB defaulters in Yemen (Taiz and Al Hudaydah cities). A quantitative method, namely multivariate logistic regression analysis (MLRA) and open-ended questionnaires were used to determine the risk factors of the defaulters and their reasons for defaulting respectively.

Key findings

Among the 413 TB patients enrolled in the study, 52 (12.6%) defaulted. Using MLRA, the following risk factors associated with defaulters were identified: living in rural areas, illiteracy, smoking habit, stigmatization, body mass index, comorbidity, side effect associated with treatment and travel cost. In addition, several reasons for defaulting were reported in the study. Based on the open-ended questionnaires, the patients indicated high travel cost (48.1%), side effect (32.7%), stigmatization (30.8%), improvement of condition during treatment (19.2%), medication cost (15.4%), missed work during treatment period (13.5%), far distance of TB centre (11.5%) and dissatisfaction with health services (11.5%) as the main reasons for defaulting. At the end of 2015, only 32 patients were traced via phone calls and reported health conditions.

Conclusion

This study presented the risk factors associated with TB defaulters in Yemen as well their reasons for defaulting which are mostly socioeconomic, particularly travel cost. By identifying these risk factors and reasons for defaulting, this study proposes defaulter rates in Yemen can be reduced through incorporating the results into future treatment strategies to prevent undesirable consequences, especially in the absence of primary diagnosis tools and improper tracing method for defaulters.

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