True status of smear-positive pulmonary tuberculosis defaulters in Malawi

The article reports the results of a study to determine the true outcome of 8 months of treatment received by smear-positive pulmonary tuberculosis (P TB) patients who had been registered as defaulters in the Queen Elizabeth C entral Hospital (QECH) and Mlambe Mission Hospital (MMH), Blantyre, Malawi. The treatment outcomes were documented from the tuberculosis registers of all patients registered between 1 October 1994 and 30 September 1995, The t rue treatment outcome for patients who had been registered as defaulters wa s determined by making personal inquiries at the treatment units and the re sidences of patients or relatives and, in a few cases, by writing to the ap propriate postal address. interviews were carried out with patients who had defaulted and were still alive and with matched, fully compliant PTB patie nts who had successfully completed the treatment to determine the factors a ssociated with defaulter status. Of the 1099 patients, 126 (11.5%) had been registered as defaulters, and th e true treatment outcome was determined for 101 (80%) of the latter, only 2 2 were true defaulters, 31 had completed the treatment, 31 had died during the treatment period, and 17 had left the area, a total of 8 of the 22 true defaulters were still alive and were compared with the compliant patients. Two significant characteristics were associated with the defaulters: they were unmarried; and they did not know the correct duration of antituberculo sis treatment. Many of the smear-positive tuberculosis patients who had been registered as defaulters in the Blantyre district were found to have different treatment outcomes, without defaulting. The quality of reporting in the health facil ities must therefore be improved in order to exclude individuals who are no t true defaulters.