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Objectives: To explore the magnitude of sex bias and determinants of treatment abandonment (TA) in childhood cancer in India. Methods: Individual data of children (0–19 y) registered between January 1, 2017 and July 31, 2022, was compiled. TA was defined as defaulting curative intent treatment ≥4 wk. Defaulting treatment irrespective of intent ≥4 wk was defined as Treatment Default (TD). The primary outcome was the proportion of male-to-female children with TA. Secondary outcomes included the proportion of male-to-female children with upfront TA, TA at relapse, TD, TD-p (TD only in the palliative setting). The impact of clinico-demographic factors on TA was analysed using multivariable regression and propensity score matching (PSM). Results: Three thousand two hundred eighty four patients were analysed. The overall male-to-female ratio (MFR) was 2.08 (95% CI 1.94–2.24). Of 2906 patients treated with curative intent, 415 (14·3%) abandoned treatment. TA was higher in females than males (16·4% vs. 13·3%; p = 0·022) with adjusted MFR of 0·81 (0·66–0·98). The adjusted MFR of TA for treatment-naïve and relapsed patients and TD were 0·73 (0·59–0·91), 1·13 (0·65–1·96) and 0·84 (0·71–1·00) respectively. Sex independently predicted TA on multivariable analysis. However, on PSM analysis including socio-economic variables, lower maternal education predicted higher TA in children with cancer (10·1% vs. 6%, p = 0·015). Conclusions: Child sex predicted TA in childhood cancer in India with more females abandoning treatment. Maternal education is a more crucial factor predicting TA over child sex, when socio-economic factors were considered. Hence, policies promoting female education and gender equality may mitigate sex-based gaps in childhood cancer care. [ABSTRACT FROM AUTHOR]

Patricia Mae Dhlakama,1 Constance Matshidiso Lelaka,2 Azwihangwisi Helen Mavhandu-Mudzusi1 1Department of Health Studies, College of Human Sciences: University of South Africa, Pretoria, Gauteng Province, South Africa; 2The Discipline of Social Work, School of Human & Community Development, University of the Witwatersrand, Johannesburg, 2000, South AfricaCorrespondence: Constance Matshidiso Lelaka; Patricia Mae Dhlakama, Email tshidi.lelaka@wits.ac.za; pmdhlakama5@gmail.comPurpose: The study explored the psychosocial profile of women who defaulted Option B+ HIV treatment at Chitungwiza Municipality clinics in Zimbabwe. Option B+ is a strategy to prevent mother-to-child transmission (PMTCT) of HIV to reduce MTCT rate to less than or equal to 5%.Methods: An interpretive phenomenological analysis (IPA) design was used. Data were collected from 04 September to 12 October 2020 on twelve purposively selected HIV-positive breastfeeding women aged 18 to 40 years, who defaulted Option B+ HIV treatment. Unstructured individual face-to-face interviews were utilised. Data were analysed thematically using the interpretive phenomenological analysis framework for data analysis.Results: The study findings revealed that participants experienced the following: psychosocial and emotional challenges due to HIV positive results, shown emotional distress and suicidal tendencies which affected their mental health. Their relationship was derailed due to abuse, infidelity, partner’s high-risk behaviour and to lack of support stemming from their partners and family members.Conclusion: Strengthening adherence support interventions and effective counselling on HIV-positive status disclosure and male partner involvement is important for retaining women in care and for improving their quality of life. Comprehensive, integrated, and tailor-made interventions should be adopted. Couple HIV counselling and testing should be encouraged. Psychosocial and mental health should be encouraged. Furthermore, community sensitization, risk reduction behaviour, education on purpose and side effects of ART as well as the benefits of Option B+ to new enrolments should be intensified and strengthened to minimize defaulting of treatment and LTFUP. Vigorous patient tracing and visit reminders help retain women in care.Keywords: breastfeeding, HIV, Option B+, PMTCT, pregnant, psychosocial, treatment default, women

Bacterial meningitis is a severe type of disease that can lead to disability or sometimes death worldwide. A bacterial meningitis model incorporating carriers and treatment default is presented and analyzed. The model formulated Beddington–De Angelis incidence function to capture the crowding effect of infected individuals. Mathematical analysis presented establishes the basic reproduction number , and the global asymptotic stability of the equilibrium points for the model. Bifurcation analysis is carried out using the center manifold theory and it is found that a forward bifurcation occurs provided certain conditions are adhered to. Numerical simulations for the dynamics of bacterial meningitis in the presence of a default in treatment are presented. It is established that adherence to antibiotic treatment reduces the number of cases of bacterial meningitis while default will increase the reproduction number and drives the model to an endemic equilibrium state. To contain bacterial meningitis, there is need to ensure that there is regular contact tracing in areas that are prone to bacterial meningitis and patients need to be educated on the importance of adherence to treatment. [ABSTRACT FROM AUTHOR]

The Direct Observed Treatment Short course is a therapeutic intervention implemented by the government to treat patients infected with tuberculosis. But treatment default is still a problem that results to an increasing mortality rate among enrolled clients. This study aims to determine the factors influencing treatment default among DOTS enrolled pulmonary tuberculosis in Jolo RHU. The objectives of the study were the following: knew the socio-demographic factors influencing treatment default among pulmonary tuberculosis patient in terms of educational attainment, occupation, and family income, the treatment regimen related factors influencing the treatment default among pulmonary tuberculosis patient in terms of duration of treatment, problem with tablets, social/economic factors, adverse effect, and availability of medicine, and the significant relationship when grouped according to profile. The respondents involved in various occupations and were earning between 1000 and below and up to 3001 to 5000. This study utilized Inferential-evaluative research design. The Inferential was through correlational approach and quantitative techniques in the analysis and interpretation of data gathered. The study used descriptive statistics such as: frequency, percentage, and weighted mean as a tools of analysis of the data collected. The findings of the study revealed that most of the respondents' educational attainment were at elementary level with 20 respondents having 66.66%, secondary level with 9 respondents having 30%, and vocational graduate of 1 respondent with 3.3%. However, the respondents show in their occupation that majority were from vendors of 20 respondents having 66.66%, followed by laborers of 4 respondents having 13.335, tricycle drivers of 2 respondents having 6.66%, construction workers of 2 respondents having 6.66%, fisherman with 1 respondent having 3.33%, and street sweeper having 1 respondent with 3.33%. Lastly, majority of the respondents earning P1,000 and below were the highest defaulters. 25 respondents having a family income of P1,000 and below showing 83.33%, only 5 respondents earning P3,001 to 5,000 family income which shows 16.66%, and none of them were earning P1,000 - 3,000. Likewise, it was revealed that the respondents were highly influenced by the statement that the treatment duration is too long. Likewise, the statement that too many tablets at a time and that the tablet is big has a high influenced on their treatment default. For Social/Economic Factors, they were moderately influenced on poor access to a DOTS facility to geographical factors and cultural belief limits the choice of treatment. They cannot decide however that post-disaster scenario influences treatment default among pulmonary tuberculosis patients. Also, the respondents were highly influenced with the experienced of orange colored urine, pain at the injection site, and hearing impairment. But they are moderately influenced with the experienced of skin allergy, flu-like symptoms, impairment of visual acuity, and burning sensation in the feet. On the availability of medicine, they are highly influenced that medicine is always available at the center. An average of 4.67 confirms that they were highly influenced to the problem with tablets. The average of 3.88 confirms they were moderately influenced with the social/economic factors. An average of 4.15 confirms that they were moderately influenced with adverse effect of the treatment regimen. The overall average of 4.24 means denotes that the respon]dents were moderately influenced with all the treatment regimen related factors influencing treatment default among Pulmonary Tuberculosis patients. Further, it was revealed in the result on the significant differences when the respondents were grouped in terms of profile resulted to L=.05, df=1 for numerator and df=16 for denominator, the F critical value is 4.49 therefore, the hypothesis is accepted and it was analyzed through ANOVA. Moreover, it was revealed that the result on the significant differences when respondents were grouped in terms of Educational Attainment, at a= .05, df=2 for numerator and df=27 for denominator, the F critical value is 6.49 therefore, the hypothesis is accepted. Result also revealed that on the significant differences when the respondents are grouped according to Occupation, at a=.05, df=5 for numerator and df=24 for denominator, the F critical value is 4.49 therefore, the hypothesis is accepted. In the same manner that the result on the significant differences when the respondents are grouped according to Income, at a= .05, df=5 for numerator and df=24 for denominator, the F critical value is 9.28 therefore, the hypothesis is accepted. Based on the findings of the study, it can be concluded that most of the pulmonary tuberculosis patient belong to the marginalized group of our society they only earn 1000 and below per month, in their early 30's in age, and less educated. Since the treatment regimen related factors has no relationship with the treatment default among pulmonary tuberculosis patients, other factors not mentioned in the study could cause the treatment default. Profiles do not have relationship to the treatment default among pulmonary tuberculosis patients. The participants in this study have given the assurance of the ethical consideration. They were informed that this study will address them with highest respect of confidentiality and anonymity. It is also adhered that respondents were respected during the launching of the questionnaire. The following recommendations are forwarded based on the conclusions of the study that factors must be examined which may have triggered the treatment default among pulmonary tuberculosis patients. Future research on the topic must investigate the role of RHU's in the treatment of pulmonary tuberculosis patient and the barangay health workers. Also an awareness seminar among the residents in their area of responsibility on the effect of defaulting treatment of pulmonary tuberculosis patient must conducted. [ABSTRACT FROM AUTHOR]

Background. Tuberculosis is an infectious disease caused by bacteria called Mycobacterium tuberculosis. The treatment of drug-resistant tuberculosis is complex, costly, and usually has poor outcomes. Treatment default is well known as a very significant factor associated with drug-resistant tuberculosis. The aim of this study was to investigate the hazard ratios associated with treatment default among tuberculosis patients in Adamawa State, Nigeria. Materials and Methods. The Cox proportional hazards regression was used to determine the hazard ratios associated with tuberculosis patient treatment default in Adamawa State, Nigeria. The Kaplan-Meier method was used to analyze time-to-event data. The study assessed the survival status and treatment outcomes of tuberculosis patients over a six-month period (January 2019 to June 2019). Data analysis was done using R - Programming Software and the statistical significance was considered at p < 0.05. Results. Out of the 197 (124 males and 73 females) tuberculosis patients, 148 (75.1%) individuals were diagnosed with pulmonary tuberculosis and 49 (24.9%) individuals were diagnosed with extrapulmonary tuberculosis. The treatment outcomes were as follows: 33 (16.8%) patients were cured; 36 (18.3%) individuals completed their treatment; 3 (1.5%) patients died during treatment; 105 (53.3%) subjects defaulted; 8 (4.1%) patients were lost to follow-up; the remaining 12 (6.1%) individuals were still on treatment at the end of the study. According to the Cox proportional hazards analysis, HIV-positive status (p < 0.05, 95% CI [0.361 - 0.879]), primary education level (p < 0.01, 95% CI [1.248 - 3.354]), poor quality of life (p < 0.01, 95% CI [1.239 - 3.511]) and age over 60 years old (p < 0.05, 95% CI [0.569 - 2.206]) were significant hazard ratios to experience the event (treatment default) in the study area. Conclusions. This study revealed that HIV-positive tuberculosis patients, older patients, patients with primary education, and those with poor quality of life are significant risk factors to experience treatment default in the study area. Therefore, it is recommended that stakeholders managing the treatment and care of tuberculosis patients should be dedicated and intentional in the provision of psychosocial therapy to patients with poor quality of life.

Introduction: Treatment default is one of the main challenges in tuberculosis (TB) control and is considered a major barrier to achieving the sustainable development goals (SDG). Identifying the factors associated with this outcome can help us provide appropriate strategies for decision making. This study investigates the determining factors of treatment default among TB patients. Methodology: In this case-control study, all 88 TB patients experiencing treatment default during an11-year-period in Mazandaran province, Iran, were compared with 176 randomly selected TB patients without a history of default. Cases and controls were matched based on the year of incidence as well as the treatment center. Related factors of treatment default were determined using multivariate logistic regression models. Results: For men, the odds ratio of experiencing treatment default was 1.67 (p=0.165). In addition, considering ages >64 years as the reference group, the odds ratios for 15- to 24- and 55- to 64-year-olds were 0.95 (p=0.940) and 0.37 (p=0.123), respectively. The corresponding odds ratios for patients 25–34, 35–44 and 45–54 years of age were 1.29 (p=0.547), 1.40 (p=0.472), and 1.39 (p=0.512) respectively. Moreover, the odds ratios for urban residents, patients with a history of imprisonment, a history of previous treatment, adverse treatment effects, previous exposure, non-Iranians and patients with smear-positive TB were 1.72 (p=0.070), 1.24 (p=0.657), 1.47 (p=0.756), 0.99 (p=0.998), 0.98 (p=0.960), 9.29 (p=0.010), and 2.27 (p=0.049) respectively.Conclusion: Non-Iranian nationality and smear-positive TB were detected as predictors of treatment default among patients with tuberculosis.

Objective: To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa. Methods: A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05. Results: A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p 64 years: 3.9%; p 2 months: 4.8%; p 24 years old compared to younger cases (25–34 years: AOR 0.8, 95% CI 0.77–0.87; 35–44 years: AOR 0.6, 95% CI 0.50–0.64; 45–54 years: AOR 0.4, 95% CI 0.32–0.49; 55–64 years: AOR 0.3, 95% CI 0.21–0.43; >64 years: AOR 0.3, 95% CI 0.19–0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46–0.57). Conclusions: Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes.

Objectives This study aimed to measure the treatment default rate among children with severe acute malnutrition (SAM) who were admitted to the outpatient therapeutic programme (OTP) in Yemen and determine its risk factors. Methods A prospective study was conducted among children with SAM who were newly admitted to the 11 OTPs in primary health centres of Sana'a city. A pretested semistructured questionnaire was used for data collection at admission and at after 2 months of admission to the OTP. Univariate and multivariate analysis using binary logistic regression were used to analyse the risk factors of treatment default. Results This study included 339 SAM children. Of those, 186 (55%) children discharged as defaulters, 141 (42%) were cured, and 12 (3%) were transferred to other treatment sites. Many factors related to poor accessibility, poor satisfaction with staff and system, and treatment and acceptability of OTP services factors were significantly associated with treatment default. Having difficulty to attend OTP every week (OR 8.4), unavailability of medication during follow-up visits (OR 5.0), not liking to eat Plumpy'Nut (OR 5.8), and not gaining weight since the start of treatment (OR 9.3) were the strongest predictors of treatment default. Conclusions This study showed a high default rate among SAM children in Sana'a city. Factors related to poor accessibility, poor satisfaction with staff and system, and factors related to treatment and acceptability of OTP services were significantly associated with high default rate. Expansion of OTP services and training OTPs staff on SAM treatment protocols are highly recommended. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the risk factors for tuberculosis (TB) treatment default in a priority city for disease control in Brazil. A cohort of TB cases diagnosed from 2008 to 2009 was followed up from patients’ entry into three outpatient sites, in Juiz de Fora, Minas Gerais (Brazil), until the recording of the outcomes. Drug addiction, alcoholism and treatment site appeared to be independently associated with default. Current users of crack as the hardest drug (odds ratio (OR) 12·25, 95% confidence interval (CI) 3·04–49·26) were more likely to default than other hard drug users (OR 5·67, 95% CI 1·34–24·03), former users (OR 4·12, 95% CI 1·11–15·20) and those not known to use drugs (reference group). Consumers at high risk of alcoholism (OR 2·94, 95% CI 1·08–7·99) and those treated in an outpatient hospital unit (OR 8·22, 95% CI 2·79–24·21%) also were more likely to default. Our results establish that substance abuse was independently associated with default. National TB programmes might be more likely to achieve their control targets if they include interventions aimed at improving adherence and cure rates, by diagnosing and treating substance abuse concurrently with standard TB therapy. [ABSTRACT FROM PUBLISHER]

Background : To detect the predictors of treatment defaults in Pulmonary Tuberculosis (PTB) and Extra Pulmonary Tuberculosis (EPTB). Methods: In this cross sectional study 140 adults, with diagnosis of pulmonary tuberculosis (PTB) and extra pulmonary tuberculosis (EPTB), with treatment defaults, were included. The study protocol incorporated demographic, clinical characteristics of patients, structured questionnaire, physical examinations, radiological, laboratory investigations and relevant predictors for TB treatment defaults. The statistical analysis was performed using SPSS 20. Results: Mean age of study group was 42.3±20.3. Majority (67.1%) were male. Ninety four (67.1%) had PTB and 46 (32.9%) had EPTB. Factors identified to be associated with TB treatment default were male gender, distance from the health post, displacement, financial constraints, no body at home to bring medicine or take patients to hospital, routes closed in winters, subjective improvement of symptoms and travelling/shifting to other place. Conclusions: Treatment default is seen in pulmonary and extra pulmonary tuberculosis. Due to lack of uniform diagnostic and therapeutic strategy in EPTB treatment, most physicians treat on clinical symptoms for a prolonged duration of 12 to 24 months. [ABSTRACT FROM AUTHOR]

Summary Objective To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa. Methods A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05. Results A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p < 0.001), <25 years old (9.1% vs. 25–34 years: 8.7%; 35–44 years: 7.0%; 45–54 years: 5.2%; 55–64 years: 4.4%; >64 years: 3.9%; p < 0.001), undergoing TB retreatment (11.0% vs. new cases: 6.3%; p < 0.001), had a negative pre-treatment sputum smear result (7.8% vs. positive smear results: 7.1%; p < 0.001), were in the first 2 months of treatment (95.5% vs. >2 months: 4.8%; p < 0.001), and had unknown HIV status (7.8% vs. HIV-positive: 7.0% and HIV-negative: 5.7%; p < 0.001). After controlling for potential confounders, multivariate analysis revealed a two-fold increased risk of defaulting treatment when being retreated compared to being treated for the first time for TB (adjusted OR (AOR) 2.0, 95% CI 1.85–2.25). Female cases were 40% less likely to default treatment compared to their male counterparts (AOR 0.6, 95% CI 0.51–0.71). Treatment default was less likely among cases >24 years old compared to younger cases (25–34 years: AOR 0.8, 95% CI 0.77–0.87; 35–44 years: AOR 0.6, 95% CI 0.50–0.64; 45–54 years: AOR 0.4, 95% CI 0.32–0.49; 55–64 years: AOR 0.3, 95% CI 0.21–0.43; >64 years: AOR 0.3, 95% CI 0.19–0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46–0.57). Conclusions Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes. [ABSTRACT FROM AUTHOR]

Defaulting is an important issue across all medical specialties, but much more so in cancer as delayed or incomplete treatment has been shown to result in worse clinical outcomes such as treatment resistance, disease progression as well as lower survival. Our objective was to identify psychosocial variables and characteristics associated with default among cancer patients. A total of 467 consecutive adult cancer patients attending the oncology clinic at a single academic medical centre completed the Hospital Anxiety and Depression Scale and reported their preference for psychological support at baseline, 4-6 weeks and 12-18 months follow-up. Default was defined as refusal, delay or discontinuation of treatment or visit, despite the ability to do so. A total of 159 of 467 (34.0%) cancer patients were defaulters. Of these 159 defaulters, 89 (56.0%) desired psychological support, compared to only 13 (4.2%) of 308 non-defaulters. Using a logistic regression, patients who were defaulters had 52 times higher odds ( P = 0.001; 95% confidence interval 20.61-134.47) of desiring psychological support than non-defaulters after adjusting for covariates. These findings suggest that defaulters should be offered psychological support which may increase cancer treatment acceptance rates and improve survival. [ABSTRACT FROM AUTHOR]

Background: Despite the high efficacy of tuberculosis (TB) drug regiments, one of the barriers in the TB control program is the non-compliance to treatment. Morbidity, mortality, and risk to become resistant to drugs are emerging among defaulters. Thus, the aim of this study is to identify the factors, especially knowledge and perceptions of TB and association with treatment default among patients treated in primary care settings, East Nusa Tenggara. Methods: This study was part of a bigger cohort community-based controlled trial study. The subjects were newly diagnosed pulmonary TB patients from four districts in East Nusa Tenggara. Knowledge, perception of TB, and other related factors were assessed prior to the treatment. Patients who interrupted the treatment in two consecutive months were classified as defaulters, as World Health Organization stated. Odds ratio (OR) looking for factors associated with becoming defaulter was analyzed. Results: A total of 300 patients were recruited for this study. At the end of the treatment, 255 patients (85%) completed the treatment without interruption from regular visit. In univariate analysis, none of the socio-demographic factors attributed to treatment default yet lack of knowledge and incorrect perception of TB prior therapy (OR 2.49 1.30-4.79 95% Cl, p = 0.006; OR 5.40 2.64-11.04 95% Cl, p < 0.001, respectively). In multivariate analysis, only incorrect perception of TB showed significant association with treatment default (OR 4.75 2.30-9.86 95% Cl). Conclusions: Assessing the knowledge and perception of TB prior to the treatment in newly pulmonary TB patients is important as both of them were known as risk factor for treatment default. Education and counseling may be required to improve patients' compliance to treatment. [ABSTRACT FROM AUTHOR]

Introduction: Radiotherapy (RT)-based curative regimens for head and neck squamous cell carcinomas (HNSCC) deliver a dose of 66-70 Gray (Gy) over a period of 6-7 weeks, and incomplete treatments are unlikely to result in cure. Non-compliance to RT is major contributory factor to treatment failure. Aims: To assess the proportion of patients who do not complete planned treatment after initiation of curative RT. This study also aims to explore a possible relationship of non-compliance due to socio-economic, disease-related and treatment-related factors. Materials and Methods: The records of HNSCC patients treated from January 2012-December 2013 were audited. Data from the treatment records were to collect patient-related, disease-related, and social demographic parameters. Of the patients who had not completed treatment, the reasons behind the same were investigated. Results: Of the 324 patients of HNSCC who were initiated on radical RT, a total of 76 patients were found to have discontinued treatment without authorization of the treating clinician. There was no significant predilection for treatment non-compliance with regards to patient age, educational status, religion, site of the disease, use of neoadjuvant chemotherapy, or use of concurrent chemotherapy. There tended to be a higher association of treatment non-compliance among patients residing >100 km away from the treatment center, patients hailing from hilly regions, patients without the below poverty line (BPL) card, unemployed patients, and patients with stage IV-A/B disease. Of the 76 patients who did not complete treatment, telephonic questionnaire could be obtained from 54 patients. Causes for non-compliance included preference for traditional healers (22.2%), fear of toxicity (7.4%), logistic reasons (18.5%), financial reasons (24.1%), and lack of interest/faith in RT (5.6%). Conclusion: There is a high incidence of treatment default among patients of HNSCC during RT in this region. The revelation of the higher propensity for treatment default among patients from distant, hilly regions, unemployed, patients without BPL cards, and stages-IVA/IVB highlights the need for specific interventions for these special populations. [ABSTRACT FROM AUTHOR]

Objective To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria. Methods Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death. Results Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1–1.9), smear-negative TB case (aOR 2.3; CI 1.5–3.6), extrapulmonary TB case (aOR 2.7; CI 1.3–5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1–2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4–6.1) and smear-negative TB cases (aOR 2.4; CI 1.7–3.5), rural residents (aOR 1.7; CI 1.2–2.6), HIV co-infected (aOR 2.5; CI 1.7–3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1–2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2–2.6). Conclusions Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Studies have shown an association between smoking and tuberculosis (TB) infection, disease and TB-related mortality. We thus documented the impact of smoking and others factors on TB treatment default. METHODS: A cohort of 1039 new TB cases matched on smoking status was followed between 2004 and 2009 in eight Moroccan regions. Treatment default was defined according to international criteria. Univariate analyses were used to assess associations of treatment default with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding. RESULTS: Patients, mean age was 35.0 , 13.2 years. The rate of treatment default was 30.2%. Default was significantly higher among men, smokers, persons living in urban areas and non-practicing Muslims. After adjusting for confounding variables, factors that remained significantly associated with treatment default were: being male (OR = 3.2; 95% CI: 1.2,8.7), absence of religious practice (OR = 2.0; 95% CI: 1.4,2.9) and living in an urban area OR = 3.0; 95% CI: 1.8,4.9). CONCLUSION: The high rate found for default suggests important programme inadequacies and an urgent need for change. Therefore continued research of predictors of default and strategies to reinforce adherence is recommended.

Background The effectiveness of India's TB control programs depend critically on patients completing appropriate treatment. Discontinuing treatment prior to completion can leave patients infectious and symptomatic. Developing strategies to reduce early discontinuation requires characterizing its patterns and their link to symptom persistence. Methods The 2011 BEST-TB survey (360 clusters, 11 districts) sampled patients (n = 1007) from Bihar's public healthcare system who had initiated treatment >6 months prior to being interviewed, administering questionnaires to patients about TB treatment duration and symptoms, prior treatment, and sociodemographic characteristics. Multivariate logistic regression models estimated the risk of treatment discontinuation for these characteristics. Similar models estimated probabilities of symptom persistence to 25 weeks post-treatment initiation adjusting for the same predictors and treatment duration. All models included district fixed effects, robust standard errors, and adjustments for the survey sampling design. Treatment default timing and symptom persistence relied solely on self-report. Results 24% of patients discontinued treatment prior to 25 weeks. Higher likelihood of discontinuation occurred in those who had failed to complete previous TB treatment episodes (aOR: 4.77 [95% CI: 1.98 - 11.53]) and those seeing multiple providers (3.67 per provider [1.94 - 6.95]). Symptoms persisted in 42% of patients discontinuing treatment within 5 weeks versus 28% for completing 25 weeks of treatment. Symptom persistence was more likely for those with prior TB treatment (aOR: 5.05 [1.90 - 13.38]); poorer patients (2.94 [1.51 - 5.72]); and women (1.79 [1.07 - 2.99]). Predictors for treatment discontinuation prior to 16 weeks were similar. Conclusions Premature TB treatment discontinuation and symptom persistence is particularly high among individuals who have failed to complete treatment for a prior episode. [ABSTRACT FROM AUTHOR]

Summary: Ensuring completion of tuberculosis (TB) treatment remains a major public health problem. In HIV-infected patients, TB is the most common severe opportunistic infection. Few studies have evaluated risk factors for TB treatment default in HIV-infected patients. We conducted a prospective, observational study of HIV-infected TB patients in Thailand. Patients underwent standardised evaluations at the beginning of TB treatment, at the end of the intensive phase and at the end of TB treatment. TB treatment outcomes were assessed according to WHO guidelines. The analysis was limited to patients who defaulted or who had treatment success. Of the 554 patients analysed, 61 (11%) defaulted. In multivariate analysis, factors associated with TB treatment default included incarceration history [adjusted odds ratio (AOR) 2.0, 95% CI 1.1–3.7), smoking (AOR 2.3, 95% CI 1.3–4.1) and having a symptom complaint score >15 (AOR 3.4, 95% CI 1.4–8.0); one marker of wealth, namely owning a refrigerator, was protective (AOR 0.4, 95% CI 0.2–0.8). Default during TB treatment was a significant problem in HIV-infected patients. Reducing default may require enhancing services for patients with a history of incarceration or smoking and designing patient-centred systems to address poverty and patient wellness. [Copyright &y& Elsevier]

Abstract Background Persons who default from tuberculosis treatment are at risk for clinical deterioration and complications including worsening drug resistance and death. Our objective was to identify risk factors associated with tuberculosis (TB) treatment default in South Africa. Methods We conducted a national retrospective case control study to identify factors associated with treatment default using program data from 2002 and a standardized patient questionnaire. We defined default as interrupting TB treatment for two or more consecutive months during treatment. Cases were a sample of registered TB patients receiving treatment under DOTS that defaulted from treatment. Controls were those who began therapy and were cured, completed or failed treatment. Two respective multivariable models were constructed, stratified by history of TB treatment (new and re-treatment patients), to identify independent risk factors associated with default. Results The sample included 3165 TB patients from 8 provinces; 1164 were traceable and interviewed (232 cases and 932 controls). Significant risk factors associated with default among both groups included poor health care worker attitude (new: AOR 2.1, 95% CI 1.1-4.4; re-treatment: AOR 12, 95% CI 2.2-66.0) and changing residence during TB treatment (new: AOR 2.0, 95% CI 1.1-3.7; re-treatment: AOR 3.4, 95% CI 1.1-9.9). Among new patients, cases were more likely than controls to report having no formal education (AOR 2.3, 95% CI 1.2-4.2), feeling ashamed to have TB (AOR 2.0, 95% CI 1.3-3.0), not receiving adequate counseling about their treatment (AOR 1.9, 95% CI 1.2-2.8), drinking any alcohol during TB treatment (AOR 1.9, 95% CI 1.2-3.0), and seeing a traditional healer during TB treatment (AOR 1.9, 95% CI 1.1-3.4). Among re-treatment patients, risk factors included stopping TB treatment because they felt better (AOR 21, 95% CI 5.2-84), having a previous history of TB treatment default (AOR 6.4, 95% CI 2.9-14), and feeling that food provisions might have helped them finish treatment (AOR 5.0, 95% CI 1.3-19). Conclusions Risk factors for default differ between new and re-treatment TB patients in South Africa. Addressing default in both populations with targeted interventions is critical to overall program success.

Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders. [ABSTRACT FROM AUTHOR]

Background & Objectives: : Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL., Methods: : In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients' database. Modified Kuppuswamy scale was used to classify socio-economic status., Results: : A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7±4.9 vs. 59±7.2 and 58.1±4.6 per cent in middle and lower strata (P =0.026). Five year overall survival was higher in the higher SE group; being 91.2±3.5, 78.3±5.6 and 78.8±3.9 per cent (P =0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 (P =0.015); 1.98 (P =0.027)]., Interpretation & Conclusions: : Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality., Competing Interests: None

Introduction: Studies have shown an association between smoking and tuberculosis (TB) infection, disease and TB-related mortality. We thus documented the impact of smoking and others factors on TB treatment default., Methods: A cohort of 1039 new TB cases matched on smoking status was followed between 2004 and 2009 in eight Moroccan regions. Treatment default was defined according to international criteria. Univariate analyses were used to assess associations of treatment default with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding., Results: Patients' mean age was 35.0 ±13.2 years. The rate of treatment default was 30.2%. Default was significantly higher among men, smokers, persons living in urban areas and non-religious Muslims. After adjusting for confounding variables, factors that remained significantly associated with treatment default were: being male (OR = 3.2; 95% CI: 1.2-8.7), being a non-religious Muslim (OR = 2.0; 95% CI: 1.4-2.9) and living in an urban area OR = 3.0; 95% CI: 1.8-4.9)., Conclusion: The high rate found for default suggests important program's inadequacies and an urgent need for change. Therefore continued research of predictors of default and strategies to reinforce adherence is recommended.