Failure to initiate treatment for tuberculosis patients diagnosed in a community survey and at health facilities under a DOTS programme in a district of south India

Abstract

We studied the proportion and fate of tuberculosis patients who were not initiated on treatment (initial
\ndefaulters) in Tiruvallur district of Tamilnadu, where DOTS strategy was implemented. These patients were visited to
\nfind out the reason for default. Treatment was not initiated in 57 (23.5%) of the 243 sputum positive cases diagnosed
\nin a community survey and 156 (14.9%) of 1049 patients diagnosed in health facility. Men were more likely not to have
\ntreatment initiated. The common reasons stated for initial default were unwillingness, symptoms being mild, personal
\nreasons and dissatisfaction. There is an urgent need to improve the patient’s perception of treatment and strengthen the
\nhealth systems’ capabilities to reduce initial default.