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Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study
BACKGROUND: The directly observed therapy-short course (DOTS) strategy was introduced in Shaanxi province, China to improve tuberculosis (TB) control by means of improved case detection (target: > = 70%) and treatment success rates (target: > = 85%) in new smear positive (SS+) TB patients. At...
Autores principales: | , , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2010
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838810/ https://www.ncbi.nlm.nih.gov/pubmed/20205941 http://dx.doi.org/10.1186/1471-2458-10-112 |
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author | Ai, Xianqin Men, Ke Guo, Liujia Zhang, Tianhua Zhao, Yan Sun, Xiaolu Zhang, Hongwei He, Guangxue van der Werf, Marieke J van den Hof, Susan |
author_facet | Ai, Xianqin Men, Ke Guo, Liujia Zhang, Tianhua Zhao, Yan Sun, Xiaolu Zhang, Hongwei He, Guangxue van der Werf, Marieke J van den Hof, Susan |
author_sort | Ai, Xianqin |
collection | PubMed |
description | BACKGROUND: The directly observed therapy-short course (DOTS) strategy was introduced in Shaanxi province, China to improve tuberculosis (TB) control by means of improved case detection (target: > = 70%) and treatment success rates (target: > = 85%) in new smear positive (SS+) TB patients. At a provincial level the targets were both reached in 2005. However in 30 (28%) out of 107 counties of Shaanxi province the cure rate was below 85%. This study aimed to investigate patient and treatment characteristics associated with non-cure after tuberculosis (TB) treatment in these counties. METHODS: In this case-control study, new smear positive TB cases in 30 counties with a cure rate <85% were included. Cured patients were compared to non-cured patients using logistic regression analysis to assess determinants for non-cure. RESULTS: Of the 659 patients included, 153 (23.2%) did not have cure as treatment outcome. Interruption of treatment was most strongly associated with non-cure (OR = 8.7, 95% CI 3.9-18.4). Other independent risk factors were co-morbidity, low education level, lack of appetite as an initial symptom of TB disease, diagnosis of TB outside of the government TB control institutes, missing sputum re-examinations during treatment, and not having a treatment observer. Twenty-six percent of patients did not have a treatment observer. The non-cure rate was better for those with a doctor (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17-0.88) as treatment observer than for those with a family member (OR 0.62, 95%CI 0.37-1.03). The main reason for interrupted treatment mentioned by patients was presence of adverse effects during treatment (46.5%). CONCLUSIONS: Interruption of treatment was most strongly associated with non-cure. Although treatment observation by medical staff is preferred, in order to diminish the proportion of patients who do not have a treatment observer and thereby reduce the proportion of patients who interrupt treatment, we suggest making it possible for family members, after sufficient training, to be treatment observers in remote areas where it is logistically difficult to have village doctors observe treatment for all patients. |
format | Text |
id | pubmed-2838810 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-28388102010-03-16 Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study Ai, Xianqin Men, Ke Guo, Liujia Zhang, Tianhua Zhao, Yan Sun, Xiaolu Zhang, Hongwei He, Guangxue van der Werf, Marieke J van den Hof, Susan BMC Public Health Research article BACKGROUND: The directly observed therapy-short course (DOTS) strategy was introduced in Shaanxi province, China to improve tuberculosis (TB) control by means of improved case detection (target: > = 70%) and treatment success rates (target: > = 85%) in new smear positive (SS+) TB patients. At a provincial level the targets were both reached in 2005. However in 30 (28%) out of 107 counties of Shaanxi province the cure rate was below 85%. This study aimed to investigate patient and treatment characteristics associated with non-cure after tuberculosis (TB) treatment in these counties. METHODS: In this case-control study, new smear positive TB cases in 30 counties with a cure rate <85% were included. Cured patients were compared to non-cured patients using logistic regression analysis to assess determinants for non-cure. RESULTS: Of the 659 patients included, 153 (23.2%) did not have cure as treatment outcome. Interruption of treatment was most strongly associated with non-cure (OR = 8.7, 95% CI 3.9-18.4). Other independent risk factors were co-morbidity, low education level, lack of appetite as an initial symptom of TB disease, diagnosis of TB outside of the government TB control institutes, missing sputum re-examinations during treatment, and not having a treatment observer. Twenty-six percent of patients did not have a treatment observer. The non-cure rate was better for those with a doctor (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17-0.88) as treatment observer than for those with a family member (OR 0.62, 95%CI 0.37-1.03). The main reason for interrupted treatment mentioned by patients was presence of adverse effects during treatment (46.5%). CONCLUSIONS: Interruption of treatment was most strongly associated with non-cure. Although treatment observation by medical staff is preferred, in order to diminish the proportion of patients who do not have a treatment observer and thereby reduce the proportion of patients who interrupt treatment, we suggest making it possible for family members, after sufficient training, to be treatment observers in remote areas where it is logistically difficult to have village doctors observe treatment for all patients. BioMed Central 2010-03-07 /pmc/articles/PMC2838810/ /pubmed/20205941 http://dx.doi.org/10.1186/1471-2458-10-112 Text en Copyright ©2010 Ai et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research article Ai, Xianqin Men, Ke Guo, Liujia Zhang, Tianhua Zhao, Yan Sun, Xiaolu Zhang, Hongwei He, Guangxue van der Werf, Marieke J van den Hof, Susan Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study |
title | Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study |
title_full | Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study |
title_fullStr | Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study |
title_full_unstemmed | Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study |
title_short | Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study |
title_sort | factors associated with low cure rate of tuberculosis in remote poor areas of shaanxi province, china: a case control study |
topic | Research article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838810/ https://www.ncbi.nlm.nih.gov/pubmed/20205941 http://dx.doi.org/10.1186/1471-2458-10-112 |
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