Abstract
BackgroundIn the “Centre National Hospitalier de Pneumo-Phtisiologie” of Cotonou, Benin, little is known about the characteristics of patients who have not attended their scheduled appointment, the results of tracing and the possible benefits on improving treatment outcomes. This study aimed to determine the contribution of tracing activities for those who missed scheduled appointments towards a successful treatment outcome.MethodsA retrospective cohort study was carried out among all smear-positive pulmonary tuberculosis patients treated between January and September 2013. Data on demographic and diagnostic characteristics and treatment outcomes were accessed from tuberculosis registers and treatment cards. Information on those who missed their scheduled appointments was collected from the tracing tuberculosis register. A univariate analysis was performed to explore factors associated with missing a scheduled appointment.ResultsOf 457 patients (410 new smear-positive and 47 retreatment tuberculosis), 37 (8 %) missed one or more of their appointments with a total of 44 episodes of missed appointments. The 3.5th (32 %) and 5th (43 %) month appointments were the ones most likely to be missed. Being male was associated with a higher risk of missing appointments (RR = 4.2; 95 % CI = 1.5–11.8, p = 0.004) while having HIV infection was associated with a lower risk (RR = 0.3, 95 % CI = 0.1–0.9, p = 0.03). Principal reasons for missed appointments were travelling outside Cotonou (34 %) and feeling better (21 %). In 24 (55 %) of these 44 episodes of missed appointments, contact was made with the patient who returned to the programme. These follow-up activities increased the treatment success by 4 %.ConclusionIn Cotonou, Benin, less than 10 % of tuberculosis patients miss at least one of their scheduled appointments. Tracing activities increase the treatment success rate by 4 % and current on-going practices in the Programme need to be endorsed and encouraged.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1219-z) contains supplementary material, which is available to authorized users.
Highlights
In the “Centre National Hospitalier de Pneumo-Phtisiologie” of Cotonou, Benin, little is known about the characteristics of patients who have not attended their scheduled appointment, the results of tracing and the possible benefits on improving treatment outcomes
Since 2009, the country has achieved a treatment success of 90 % among new smear-positive TB cases, with approximately 1 % loss-to-follow-up [7, 8]. This excellent outcome is the result of several actions and strategies that are routinely implemented such as the quality of counselling before starting treatment, the application of Directly Observed Treatment (DOT) by health care workers and nutritional support
We examined whether a focus on assisting patients who were irregular with their scheduled appointments was associated with improved treatment outcomes in Cotonou, the economic capital of Benin
Summary
In the “Centre National Hospitalier de Pneumo-Phtisiologie” of Cotonou, Benin, little is known about the characteristics of patients who have not attended their scheduled appointment, the results of tracing and the possible benefits on improving treatment outcomes. Various reasons for poor attendance at clinics include patient-related factors, health care system failures and community beliefs [4] To reduce this problem, NTP officers are encouraged to develop feasible strategies to prevent loss to follow-up and bring back to treatment those who have been declared loss-to-follow-up [2, 3, 5, 6]. Specific objectives were to determine in new and previously treated smear-positive pulmonary tuberculosis (TB) patients diagnosed and treated in the “Centre National Hospitalier de PneumoPhtisiologie” (CNHP-P) of Cotonou: i) the number (and proportion) who were traced for missing SA; ii) factors associated with missing SA; iii) results of the tracing; iv) reasons of missing the SA; and v) of those declared successfully treated, the number and proportion who were previously traced and the contribution of tracing activities to successful treatment outcomes
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