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ORIGINAL ARTICLE
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 160-163

Sputum conversion and defaulter rate in the directly observed therapy short course among new sputum positive cases in Tirupati, Andhra Pradesh


Department of Community Medicine, SV Medical College, Tirupati, Andhra Pradesh, India

Date of Web Publication17-Sep-2014

Correspondence Address:
Gottumukkala Ravi Prabhu
Department of Community Medicine, SV Medical College, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.140933

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  Abstract 

Background: The directly observed therapy short course (DOTS therapy) has achieved a case detection rate of 70% and cure rate of 85% in new sputum positive cases of tuberculosis. Despite this, a few patients still default from treatment. This study is an attempt to find the sputum conversion and defaulter rates among new sputum positive cases treated by tuberculosis center attached to a tertiary care hospital, Tirupati, Andhra Pradesh.
Materials and Methods: This longitudinal observational study was conducted during the period from January to December, 2011 among 200 new sputum positive patients attending Revised National Tuberculosis Control Program unit. The patients were followed-up at their houses individually and necessary information collected. Sputum results after 2, 3 and 6 months were obtained from Tuberculosis Clinic Laboratory Register.
Results: The sputum conversion rate was found to be 54.0% after 2 months and 85% at the end of treatment. The defaulter rate was found to be 15% with higher prevalence in relation to male sex (18.8%), 15-44 years (25.9%) and unskilled labor (23.9%). The main reasons for default were found to be travel (33.3%) and lack of motivation (26.7%).
Conclusion: Even under DOTS therapy, the defaulter rate can be significantly high indicating the need for constant supervision.

Keywords: Cure rate, defaulter rate, directly observed therapy, short course therapy, new sputum positive, sputum conversion


How to cite this article:
Gopikrishna B, Prabhu GR. Sputum conversion and defaulter rate in the directly observed therapy short course among new sputum positive cases in Tirupati, Andhra Pradesh. J NTR Univ Health Sci 2014;3:160-3

How to cite this URL:
Gopikrishna B, Prabhu GR. Sputum conversion and defaulter rate in the directly observed therapy short course among new sputum positive cases in Tirupati, Andhra Pradesh. J NTR Univ Health Sci [serial online] 2014 [cited 2020 Apr 4];3:160-3. Available from: http://www.jdrntruhs.org/text.asp?2014/3/3/160/140933


  Introduction Top


India accounts for 20% of the global incidence of tuberculosis with annual incidence of 1.8 million cases out of which 0.8 million are infectious sputum positive cases. [1] The Revised National Tuberculosis Control Program (RNTCP) launched in 1997 covers the entire country since 2006 with directly observed treatment short course (DOTS), which revolutionized the management of tuberculosis. The program has achieved 70% case detection rate and 85% cure rate among new sputum positive cases. [2]

Despite DOTS therapy, it was found that a few patients still default from treatment. This present study attempts to find sputum conversion and defaulter rates among new sputum positive cases treated at a RNTCP Unit, Tirupati.


  Materials and Methods Top


This longitudinal observational study was conducted from January 2011 to December 2011 in the tuberculosis center at the tertiary care hospital attached to SV Medical College, Tirupati.

The objective of this study is to know the sputum conversion rate and defaulter rates among the new sputum positive cases. Considering the logistics of time and feasibility, study was planned to be conducted among 200 new sputum positive cases. Hence, 200 new sputum positive cases attending the RNTCP unit of Tirupati from January 2011 were enrolled for the study.

The subjects were followed-up for a period of 6 months for studying the sputum conversion, cure and defaulter rates during intensive and maintenance phases of treatment. The sputum results after 2, 3, and 6 months of treatment were obtained from the Tuberculosis Clinic Laboratory Register. Thus, the patients were followed-up to December 2011 to obtain the findings of three sputum examinations.

Patients were followed-up at their houses individually and the necessary information was collected using pretested interview schedules. Several attempts were made to contact the defaulters with the help of DOTS providers and persuaded to approach RNTCP center for continuation of treatment.

Data was analyzed using MS-excel and Epi-info 3.3.4 version (Centre for Disease Control, Atlanta, USA) of Centers for Disease Control and Prevention, Atlanta, USA and appropriate tests of statistical significance were applied.


  Results Top


Majority of the study subjects were in the productive age group of 15-44 years (78.0%), males (72.0%) belonging to Scheduled Caste/Tribe and Backward Classes (72.0%). The main occupation was unskilled labor (35.5%) and unemployment (13.0%) - percentages mentioned here are tallying with [Table 2] data. In terms of socioeconomic status, most of them belong to either middle class (46.0%) or lower class (39%) - percentages mentioned here are tallying with [Table 2] data [Table 1].
Table 1: Baseline Data Of The Study Subjects


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Table 2: Sputum Conversion (After 2 Months) By Selected Variables


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The sputum conversion was found in 54.0% after 2 months, 78% by 3 months and 85% at the end of treatment. There were however 15% defaulters in the study. The sputum conversion was found to be higher in relation to 15-45 years (55.1%), females (62%), other social classes (62.7%), other occupation (60.2%) and upper socio-economic status (73.3%). However, the differences with regard to any of the above variables were not statistically significant [Table 2].

The defaulter rate was found to be 15%, mostly in the intensive phase itself. The main reasons for default were found to be travel (38.3%) and lack of motivation (26.7%). It was found to be comparatively higher with regard to 15-44 years (25.8%), male sex (18.8%), other social classes (10.7%), and unskilled labor (10.1%). The differences were significant with regard to sex and occupation [Table 3].
Table 3: Defaulter Rate By Selected Variables


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  Discussion Top


The age distribution of the smear positive cases under DOTS Program in India shows that the peak is seen in 25-34 years' age group. [3] Majority of the cases were seen in the productive age group of 15-44 years in the present study. However, the lower prevalence in the higher age groups may be due to lower attendance in that age group because of relative neglect and discrimination in society. This point was also collaborated in another study in Bangalore. [4]

Prevalence of tuberculosis increases with age in males while the rise is evident up to 45 years only in females. [5] This study showed higher prevalence in males than in females.

Many socioeconomic factors are linked to the problem of tuberculosis. This study found a higher prevalence with regard to unskilled occupation and lower socioeconomic groups. A study in Wardha [6] also found higher prevalence with unemployment and lower per-capita income ranges.

In this study, the sputum conversion was 54% and 78% at the end of 2 and 3 months respectively. The cure rate was around 85%. A similar sputum conversion of 62.2% in grade 3 smear patients and 76.8% in lower grade smears was found in New Delhi Study. [7] The study in South India [8] found 74% cure rate and 17% defaulter rate. The operation research studies in New Delhi [9] found the cure rates to be 71% and 75% with a defaulter rate of 6% and 11% respectively. A study in Nanded, Maharashtra showed a sputum conversion rate of 84.0% and a defaulter rate of 10.3%. [10] A study in Guwahati showed a similar high prevalence of 74% among 15-49 years' group. [11] A study in Tamil Nadu [12] found a similar defaulter rate of 15%.

The defaulter rate was found to be higher with regard to males, unskilled group, unemployed group and Scheduled Castes/Tribes. A multivariate analysis in South India [13] also found that the defaulter rate was associated with factors like male sex, unskilled occupation, alcoholism etc.


  Conclusion Top


Even under DOTS Program, the defaulter rate is significantly high indicating the need of constant supervision of DOTS therapy. The relative complacency of the health care providers can lead to noncompliance and higher defaulter rate.

 
  References Top

1.Govt. of India. Annual Report 2009-10. New Delhi: Ministry of Health and Family Welfare; 2010.  Back to cited text no. 1
    
2.Govt. of India. TB India 2010. RNTCP Status Report. TB Control Division. New Delhi: Ministry of Health and Family Welfare; 2010.  Back to cited text no. 2
    
3.World Health Organization. Global TB Control. WHO Report 2008. 295. Country Profile India. WHO press, 1211 Geneva, Switzerland. p. 75-6.  Back to cited text no. 3
    
4.Chakraborty AK. Tuberculosis case finding among symptomatics in the community - A reappraisal. Indian J Tuberc 1981;28:12-7.  Back to cited text no. 4
    
5.Tuberculosis Prevention Trial - Chennai. Trial of BCG vaccines in South India for tuberculosis prevention. Indian J Med Res 1980;72 Suppl:1-74.  Back to cited text no. 5
    
6.Chakraborty AK. Prevalence and Incidence of Tuberculosis Infection and Disease in India: A Comprehensive Review. WHO/TB. 231. Geneva: WHO press, 1211, Geneva, Switzerland 1997; p. 1-26.  Back to cited text no. 6
    
7.Singla R, Singla N, Sarin R, Arora VK. Influence of pre-treatment bacillary load on treatment outcome of pulmonary tuberculosis patients receiving DOTS under revised national tuberculosis control programme. Indian J Chest Dis Allied Sci 2005;47:19-23.  Back to cited text no. 7
    
8.Santha T, Garg R, Frieden TR, Chandrasekaran V, Subramani R, Gopi PG, et al. Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000. Int J Tuberc Lung Dis 2002;6:780-8.  Back to cited text no. 8
    
9.Singh V, Jaiswal A, Porter JD, Ogden JA, Sarin R, Sharma PP, et al. TB control, poverty, and vulnerability in Delhi, India. Trop Med Int Health 2002;7:693-700.  Back to cited text no. 9
    
10.Pardeshi GS. Time of default in tuberculosis patients on directly observed treatment. J Glob Infect Dis 2010;2:226-30.  Back to cited text no. 10
[PUBMED]    
11.Bawri S, Ali S, Phukan C, Tayal B, Baruwa P. A study of sputum conversion in new smear positive pulmonary tuberculosis cases at the monthly intervals of 1, 2 and 3 month under directly observed treatment, short course (dots) regimen. Lung India 2008;25:118-23.  Back to cited text no. 11
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12.Chandrasekharan V, Gopi PG, Subramani R, Thomas A, Jaggarajamma K, Narayanan PR. Default during the intensive phase of treatment under DOTS programme. Indian J Tuberc 2005;52:153-6.  Back to cited text no. 12
    
13.Dandona R, Dandona L, Mishra A, Dhingra S, Venkatagopalakrishna K, Chauhan LS. Utilization of and barriers to public sector tuberculosis services in India. Natl Med J India 2004;17:292-9.  Back to cited text no. 13
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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