A qualitative exploration of tuberculosis patients who were lost to follow-up in Malaysia

Traditional medicine in Filipino patients' therapeutic itineraries

In medical anthropology and public health, there has been a longstanding scholarly focus on the different forms of traditional medicine (TM); how they can collaborate with biomedical health systems; and how people actually embrace both as part of their medical pluralism. However, less attention has been paid on the temporal relationships between TM and biomedicine within individual patient pathways. This paper charts the roles that TM play within the therapeutic itineraries of Filipino patients. In unearthing these connections, we draw from an extensive, multi-sited qualitative study featuring over 30 FGDs involving various demographics and geographic settings in the Philippines. We find that TM figures in people's therapeutic itineraries before, alongside, and after treatment; and that even before consulting traditional healers, people engage in traditional practices on their own. Some diseases are perceived as not warranting biomedical help, while others are seen as deserving a 'trial' of TM before biomedical consult; there are also conditions that are seen to be benefit from both - and traditional medicine is also considered a 'last resort' if biomedical treatments fail. By identifying the ways in which the temporalities of TM interact with biomedicine, our findings can inform health communications and other public health efforts, while providing a contemporary picture of TM in the country.

Characteristics, predictors and consequences of tuberculosis treatment interruption: A multicentre retrospective cohort study

OBJECTIVES

Treatment interruption is associated with poor tuberculosis (TB) treatment outcomes and increased drug resistance. To address the issue, we aimed to investigate the characteristics, predictors and consequences of treatment interruption.

METHODS

We conducted a retrospective cohort study by retrieving 4 years (2018-2021) of TB patients' records at 10 public health clinics in Sarawak, Malaysia. Adult patients (≥18 years) with drug-susceptible TB were selected. Treatment interruption was defined as ≥2 weeks of cumulative interruption during treatment. The Chi-square test, Mann-Whitney U test, Kaplan-Meier and Cox proportional hazards regression were used to analyse the data, with p < 0.05 being considered statistically significant.

RESULTS

Out of 2953 eligible patients, 475 (16.1%) experienced TB treatment interruption. Interruptions were most frequent during the intensive phase (46.9%, n = 223), with the greatest risk within the first 4 weeks of treatment. The median time to interruption was 2 weeks in the intensive phase and the cumulative interruption probability at the end of the intensive phase was 12.9%. Notably, treatment interruption occurred during both intensive and continuation phases for 144 patients (30.3%), while the remaining 108 (22.7%) experienced interruptions only during the continuation phase with a median time to interruption of 16 weeks. Three predictors were identified to increase the risk of treatment interruption: adverse drug reaction (aHR = 8.53, 95% Cl: 6.73-10.82), smoking (aHR = 2.67, 95% Cl: 2.03-3.53) and illicit drug use (aHR = 1.88, 95% Cl: 1.03-3.45). Conversely, underlying diabetes was associated with a reduced likelihood of treatment interruption (aHR = 0.72, 95% Cl: 0.58-0.90). Treatment interruption led to significant differences in treatment restarts (62.3% vs. 0.7%), changes in medications (47.8% vs. 4.9%), prolonged treatment duration (247 days [IQR = 105] vs. 194 days [IQR = 44.3]) and lower successful outcomes (86.5% vs. 99.9%).

CONCLUSION

Understanding the temporal characteristics, predictors and negative consequences of treatment interruption can guide the development of time-relevant approaches to mitigate the problem.