Factors associated with treatment defaulting among adult leprosy patients in Sri Lanka: a case-control study

Background Treatment default in leprosy leads to progression of the disease and to disabilities. A defaulter is an individual who fails to complete treatment within a prescribed time frame. Defaulters can act as a source of infection in the community. Therefore, identifying factors contributing to defaulting will be essential to revise existing control strategies. Methods We conducted a hospital-based unmatched case-control study from March to October 2018 to assess the factors associated with treatment defaulting among adult leprosy patients in the Western province, Sri Lanka. Defaulting cases were true defaulters, and defaulters who have restarted treatment and control cases were patients on regular treatment. Defaulting cases were selected using the Clinic Leprosy Register, and three controls per case were selected by a consecutive sampling method. Data collection was carried out at households and clinics using an interviewer administered questionnaire. Multivariate analysis using logistic regression was carried out to identify the risk of each significant factor in the bivariate analysis for defaulting, adjusted for all confounders. Results The study was conducted among 98 defaulting cases and 294 control cases. The following risk factors were identified in the logistic regression analysis; age less than 60 years (adjusted OR = 3.2, 95% CI: 1.55-6.64, P < 0.05), poor knowledge about the disease (adjusted OR = 9.6, 95% CI: 4.96-18.55, p < 0.001), normal treatment duration (Paucibacillary 6 months; Multibacillary 12 months therapy) (adjusted OR = 4.0, 95% CI: 1.82-9.02, p < 0.001), and poor caregiver support (adjusted OR = 7.8, 95% CI: 3.97-15.46, p < 0.001). Conclusions Age less than 60 years, inadequate knowledge about the disease, normal treatment duration, and poor caregiver support were found to be factors associated with defaulting. Patients and caregivers should be educated to continue treatment and provided a travelling allowance for the needy to encourage clinic attendance.