Risk Factors associated with defaulting from visceral leishmaniasis treatment: analysis under routine program conditions in Bihar, India

Objective To assess the rate of default from treatment in the Visceral Leishmaniasis (VL) Elimination Program and to identify risk factors and its underlying causes. Methods Case control study conducted between December 2009 and June 2012 in three Primary Health Centres (PHC) of Muzaffarpur District, India. Patients who defaulted from treatment from the PHCs were considered as “cases”, and those who completed their treatment as “controls”. Two controls were included in the study for each case. Respondents’ opinion and satisfaction with the services provided at the PHCs was also elicited. Logistic regression was performed to assess the contribution of socio-demographic variables on patient status, and a discriminant analysis was used (after decomposing the original data) to identify factors that can predict the patient status as defaulter or not, based on factor scores of the components as predictor variables. Results During the study period 16.3% (89/544) of patients defaulted. 87 cases and 188 controls were interviewed through a semi-structured questionnaire. Women had a higher risk for default (OR 1.8, 95% CI 1.1-3.0). Treatment received was miltefosine in 55.6% and sodium stibogluconate (SSG) in 44.4%. Most (86%) defaulters completed their treatment at other health care facilities; 70% of them preferred non-governmental institutions. Most-cited reasons for default were seeking a second opinion for VL treatment and preferring to be treated in specialized VL centers. Discriminant analysis showed only one significant predictor: dissatisfaction with the medical care received in PHCs. Conclusion Efforts are needed to enhance the quality of VL care at PHC level, which will be beneficial in increasing treatment completion rates. This article is protected by copyright. All rights reserved.