Defaulting From Dots and its Determinants in Three Districts of Arsi Zone, Oromia Regional State, Ethiopia
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Date
2000-12
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Addis Ababa University
Abstract
A case-control study, on defaulting from DOTS was performed in three districts of Arsi
Zone, Oramia Regional State, among patients registered during the period of July 1, 1997
to December 3 1, 1999 to determine the rate of defaulting and to identify factors assoc iated
with it.
A health record review of 1367 new tuberculosis patients put on DOTS during a period of
30 months (July 1997 to December 1999) was carried out in order to determine the rate of
defaulting. All the study subjects were registered and put on DOTS after June 30, 1997 and
completed treatment or declared cured before January 1,2000. The cases and controls were
traced actively and interviewed by trained interviewers using a pre-tested structured
questionnaire. The two groups were compared by social, demographic and health services
variables. The overal l defaulter rate and specific rate by 1I10nth of defaulting, health
in stitutions, di stricts and di stance from hea lth institutions were calculated. All defaulters
and the non-defaulters were selected by paired matching of sex and age using the lottery
method. Two controls were matched individually to each case.
One hundred fifty five cases and one hundred sixty controls were included in the study.
The overall defaulting rate from DOTS was calculated to be 11.3%. The rate of defaulting
in case of sputum smear positive pulmonary tuberculosis was found to be 1 J .6%. The rate
of defaulting was higher in Etheya clinic and Hitosa District. Highest (80%) rate of defaulting occurred during the continuation phase. Medication side effect was found to be
signi fica ntly associated with defaulting from DOTS (OR= 4.20 with 95% CI 1.51 to I 1.66).
Adequate knowledge and fa mily suppot1 were found to be impot1ant possible protective
factors for defa ulting (OR=0.04 with 95% CI 0.02 to 0.10 and OR=0.J9 with 95% Cl 0.08
to 0.46 respectively). Distance from health units and drug intolerance were the major
reasons mentioned for defaulting. However, there is no significant difference between
cases and controls regarding distance, employment statu s, attitude to treatment center, level
of education and average monthly income.
The rate is slightly higher than the critical level of J 0% set by WHO. The major factors
contributing to high rate of defaulting were lack offamily SUpp0l1, inadequate knowledge
about duration of treatment and presence of medication side effects. Health prograt11l11e
that are intended to enhance family suppOt1 and knowledge about duration of DOTS
treatment and Drug tolerance should be strengthened.