A community based case control study on risk factors for treatment interruptions in people with tuberculosis in Kollam district, Kerala, southern India

Shameer K. M., Manjunath K., Sam D. Marconi, Krishnaveni V., Rakesh P. S., Jasmin H. Prasad


Background: Treatment adherence to anti-TB treatment is a critical determinant of treatment outcomes, prognosis and further emergence of drug resistance. The objective of the study was to identify the risk factors for treatment interruptions among the newly diagnosed patients with tuberculosis registered for treatment under Revised National Tuberculosis Control Program in Kollam District, Kerala, southern India.

Methods:A community based case control study was undertaken with cases being patients registered for TB treatment under category I in two randomly selected TB Units of Kollam districts with ‘treatment interruption’ as defined by missing at least three consecutive doses of anti TB medicines. Controls were those who successfully completed the anti-tuberculosis treatment regimen. Interview was conducted with a structured questionnaire. Univariate and multivariate analysis was done and odds ratios with 95% confidence interval for the risk factors for treatment interruption were calculated.

Results: A total of 47 cases and 94 controls were interviewed. In the final logistic regression model, hazardous alcohol use (Adjusted OR 16.67, 95% CI 3.22-61.42) and adverse drug reactions (Adjusted OR 2.46, 95% CI 1.07-6.14) were found as statistically significant risk factors for treatment interruption.

Conclusions:Hazardous use of alcohol and adverse effects to drugs are identified as the potential risk factors for treatment interruptions among the people with TB initiated on Category 1 DOTS regimen in Kollam district, Kerala, India. Alcohol use disorder and hazardous drinking among TB patients is a matter of concern that needs to be translated to an effective intervention program.


Alcohol, DOTS, Treatment adherence, Treatment interruption, Tuberculosis

Full Text:



World Health Organisation. Global Tuberculosis Report.Geneva. WHO. 2015

Burman WJ, Cohn DL, Rietmeijer CA, Judson FN, Sbarbaro JA, Reves RR. Nonadherence with directly observed therapy for tuberculosis. Epidemiology and effect on the outcome of treatment. Chest. 1997;111:1168-73.

Paramasivan CN, Venkataraman P. Drug resistance in tuberculosis in India. Indian J Med Res. 2004;120:377-86.

Babiarz KS, Suen S, Goldhaber-Fiebert JD. Tuberculosis treatment discontinuation and symptom persistence: an observational study of Bihar, India’s public care system covering >100,000,000 inhabitants. BMC Public Health. 2014;14:418.

Vijay S, Kumar P, Chauhan LS, Vollepore BH, Kizhakkethil UP, Rao SG. Risk Factors Associated with Default among New Smear Positive TB Patients Treated Under DOTS in India. Pai M, ed. PLoS ONE. 2010;5(4):e10043.

Sarpal SS, Goel NK, Kumar D, Janmeja AK. Reasons for interruption of anti-tubercular treatment among the retreatment patients in category II of RNTCP in Chandigarh, north India. Indian J Tuberc. 2014;61(2):121-8.

Thankappan KR, Valiathan MS. Health at low cost- the Kerala model. The Lancet. 1998;351:1274-5.

Kumar S, Radhakrishna, Chadha VK. Prevalence of tuberculous infection among school children in Kerala. Indian J Tuberc. 2009;56:10-16.

World Health Organisation. The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care. WHO. Geneva. 2001.

World Health Organisation. Diagnostic and treatment delays in Tuberculosis. WHO. 2006. WHO-EM/TDR/009/E

Oberoi S. Updating income ranges for Kuppuswamy's socio-economic status scale for the year 2014. Indian J of Pub Health. 2015;59(2):156-7.

Santha T, Garg R, Frieden TR, Chandrasekaran V, Subramani R. Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, south India. Int J Tuberc Lung Dis. 2000;6:780-8.

Vijay S, Balasangameshwara VH, Jagannatha PS, Saroja VN, Kumar P. Defaults among Tuberculosis Patients treated under DOTS in Bangalore City- A search for solution. Indian J Tub. 2003;50:185-95.

Jakubowiak WM, Bogorodskaya EM, Borisov ES, Danilova DI, Kourbatova EK. Risk factorsassociated with default among new pulmonary TB patients and social support in six Russian regions. IntJ Tuberc Lung Dis. 2007;11:46-53.

PinidiyaPathirage J, Senaratne W, Wickremasinghe R. Prevalence and predictors of default with tuberculosis treatment in Sri Lanka. Southeast Asian J Trop Med Public Health. 2008;39:1076-82.

Muture BN, Keraka MN, Kimuu PK, Kabiru EW, Ombeka VO, Oguya F. Factors associated withdefault from treatment among tuberculosis patients in Nairobi province, Kenya: A case control study. BMC Public Health. 2011;11:696-700.

Suhadev M, Thomas BE, M RS, PM, VC. Alcohol Use Disorders (AUD) among Tuberculosis Patients: A Study from Chennai, South India. PLoS ONE. 2011;6(5):e194.

Sugathan TN, Soman CR, Sankaranarayanan K. Behavioural risk factors for non-communicable diseases among adults in Kerala, India. Indian J Med Res. 2008;127:555-63.

Balakrishnan S, Manikantan J, Sreenivas A, Jayasankar S, Sunilkumar M, Rakesh PS. Social inclusion: An effort to end loss-to-treatment follow-up in tuberculosis. Indian Journal of Tuberculosis. 2016.

Greenfield SF, Shields A, Connery HS, Livchits V, Yanov SA, Lastimoso CS, et al. Integrated management of physician-delivered alcohol care for tuberculosis patients: design and implementation. Alcohol Clin Exp Res. 2010;34:317-30.

Shin S, Livchits V, Connery HS, Shields A, Yanov S, Yanova G, et al. Tomsk Tuberculosis Alcohol Working Group Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia. Addiction. 2013;108:1387-96.

Thomas B, Suhadev M, Mani J, Ganapathy BG, Armugam A, Faizunnisha F, et al. Feasibility of an alcohol intervention programme for TB patients with alcohol use disorder (AUD)-a qualitative study from Chennai, South India. PLoS ONE. 2011;6:e27752.

Chang KC, Leung CC, Tam CM. Risk factors for defaulting from anti-tuberculosis treatment under directly observed treatment in Hong Kong. Int J Tuberc Lung Dis. 2004;8(12):1492-98.

Tekle B, Mariam DH, Ali A. Defaulting from DOTs and its determinants in three district of Arsi Zone in Ethiopia. Int J Tuberc Lung Dis. 2002;6:573.

Comolet TM, Rakotomalata R. Factors determining compliance with tuberculosis treatment in an urban environment, Tamatare, Madagascar. Int J Tuberc Lung Dis. 1998;2:891-7.