Default in the outpatient treatment of tuberculosis in two hospitals in Northern India.

STUDY OBJECTIVE The purpose of the study was to examine default rates in tuberculosis treatment in two hospitals in north India with different follow up arrangements. DESIGN The study was a retrospective cohort study. SETTING Two hospitals were involved. One was the District Tuberculosis Centre for the Kulu Valley area of Himachal Pradesh. The other was a private mission hospital serving the same area. PATIENTS The study involved 321 patients at the tuberculosis centre and 381 at the mission hospital, being all those newly diagnosed with tuberculosis from October 1982 to September 1983; follow-up to October 1984. Patients at the mission hospital were more affluent and had travelled much further to seek treatment; only one reminder was sent to defaulters from treatment. The government hospital had a more active response if the patients missed an appointment, with a home visit by a health worker. RESULTS Rates of permanent default were similar in each hospital and were very high: approximately 40% at 6 months, 60% at 12 months, and 65% at 18 months of treatment. CONCLUSIONS Default was a major problem irrespective of the follow up procedures employed. Recommendations are made concerning treatment and follow up, including better communication about the disease and its treatment, active follow up of defaulters, and review of treatment policies.