Initial default among sputum-positive pulmonary TB patients at a referral hospital in Uttarakhand, India

Trans R Soc Trop Med Hyg. 2013 Sep;107(9):558-65. doi: 10.1093/trstmh/trt065.


Background: Initial default is a serious issue which can enhance the transmission of TB. We determined the magnitude of and the causative factors for initial default among sputum-positive pulmonary TB (PTB) patients.

Methods: In this prospective study, 2310 patients attending a referral hospital in Uttarakhand state, north India, with presumptive TB were investigated and 555 patients with sputum-positive PTB were followed-up for initiation of anti-TB treatment (ATT) during 2010-2012. The patients not confirmed as having started ATT were considered initial defaulters.

Results: Initial default was seen in 120 (21.6%) patients comprising 22 (18.3%) defaulters during diagnosis and 98 (81.6%) defaulters after referral for directly observed treatment, short-course (DOTS). The initial default rate was significantly higher among patients from rural areas than urban areas, illiterate patients than literate patients and smokeless tobacco-users than non-users (p<0.05 for all). The main reasons for initial default among patients referred for DOTS were limited trust in DOTS (n = 44, 44.8%), adverse effects of previous ATT (n = 41, 41.8%), dissatisfaction with health services (n = 38, 38.7%), local deaths while taking DOTS (n = 28, 28.5%), advice by others against DOTS (n = 25, 25.5%), disbelief in the diagnosis (n = 18, 18.3%) and patient death before starting treatment (n = 4, 4.0%).

Conclusion: A high initial default rate was seen among patients with PTB. There is an urgent need to promote public awareness to lower the initial default rate.

Keywords: DOTS; India; Initial default; Loss to follow-up; Pulmonary tuberculosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / therapeutic use
  • Directly Observed Therapy
  • Educational Status
  • Female
  • Geography
  • Humans
  • India / epidemiology
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Patient Dropouts / statistics & numerical data*
  • Patient Education as Topic
  • Prospective Studies
  • Referral and Consultation
  • Sex Factors
  • Sputum / microbiology
  • Treatment Outcome
  • Treatment Refusal / statistics & numerical data*
  • Tuberculosis, Pulmonary / diagnosis*
  • Tuberculosis, Pulmonary / drug therapy
  • Young Adult


  • Antitubercular Agents