Predictors of treatment interruption among tuberculosis patients in public health centres in Bali, Indonesia

Putu Ika Farmani , Dewa Nyoman Wirawan, Anak Agung Sagung Sawitri, I Wayan Gede Artawan Eka Putra

Putu Ika Farmani
Udayana University. Email:

Dewa Nyoman Wirawan
Udayana University

Anak Agung Sagung Sawitri
Udayana University

I Wayan Gede Artawan Eka Putra
Udayana University
Online First: December 01, 2017 | Cite this Article
Farmani, P., Wirawan, D., Sawitri, A., Putra, I. 2017. Predictors of treatment interruption among tuberculosis patients in public health centres in Bali, Indonesia. Public Health and Preventive Medicine Archive 5(2): 129-134. DOI:10.15562/phpma.v5i2.27

Background and purpose: Tuberculosis treatment interruption (TB TI) is one factor that leads to treatment failure, tuberculosis (TB) drug resistance and drop out. The purpose of this study is to identify the incidence and the predictors of TB TI in public health centres (PHCs) in Bali.

Methods: A retrospective longitudinal study was conducted using secondary data of 644 cohorts of TB patients on the first regiment who enrolled in 11 PHCs in Denpasar Bali during 2011-2012. Information from TB program officers in PHCs was also obtained to determine the differences within the practical implementation of TB treatment. Data were analysed using Kaplan Meier and Cox Proportional Hazard Regression.

Results: The study revealed that 378 patients experienced TB TI with the total events of 535. The incidence rate of TB TI event was 5.1 per 1.000 person days and the median time was 56 days (IQR: 56-57). Predictors of the TB TI were male (AHR=1.22; 95% CI: 1.02-1.45; p=0.027) and a more flexible schedule to take the medicine (AHR=1.47; 95%CI: 1.22-1.76; p<0.0001).

Conclusions: The implementation of fixed schedule and shortened time lapse for patients to take TB drug will enable more close contact between patients and health providers. Intensive adherence counselling especially tailored for male patients is also required.


WHO. Global Tuberculosis Report 2014. France: WHO; 2014.

WHO. Indonesia Tuberculosis Profile. Jakarta: WHO; 2015.

Ministry of Health of Indonesia. Indonesia Health Profile 2012. Jakarta: Ministry of Health of Indonesia; 2013.

Denpasar Health Office. Tuberculosis Program Report 2012. Denpasar: Denpasar Health Office; 2012.

Denpasar Health Office. Tuberculosis Program Report 2013. Denpasar: Denpasar Health Office; 2013.

Sarwani Dewi DS, Nurlaela S, A IZ. Risk factors of multidrug resistant tuberculosis (MDR-TB). Jurnal Kesehatan Masyarakat. 2012; 8(1): 60-66.

Jakubowiak W, Bogorodskaya E, Borisov S, Danilova I, Kourbatova E. Treatment interruptions and duration associated with default among new patients with tuberculosis in six regions of Russia. International Journal of Infectious Disease. 2009; 13(3): 362-368.

Astuti NK. Regularity relationship sputum conversion patients treated with new cases of pulmonary TB after treatment intensive phase [thesis]. Surakarta: Sebelas Maret University; 2010.

Ubaidillah. Factors that influence the treatment irregularity among patient of TB lungs in Lahat, South Sumatra Province: analysis of secondary data [thesis]. Jakarta: University of Indonesia; 2001.

Senewe FP. Factors concerning the complience of taking medecine among the lung tuberculosis patients at public health centers, Depok. Buletin Penelitian Kesehatan. 2002; 30(1): 32-38.

Raharno T. Related factors of the treatment irregular on patients lungs tuberculosis in Installation Unit BP. Kraton Hospital of Pekalongan [thesis]. Semarang: Diponegoro University; 2005.

Simamoro J. Factor affecting the irregularity of patients with tuberculosis getting treatment at the community health centers in Binjai in 2004 [thesis]. Medan: University of Sumatera Utara; 2004.

Ibrahim LM, Hadejia IS, Nguku P, et al. Factors associated with interruption of treatment among pulmonary tuberculosis patients in Plateau State, Nigeria. 2011. The Pan Africa Medical Journal. 2014; 17:78.

Ahmad SR, Velhal GD. Study of treatment interruption of new sputum smear positive TB cases under DOTS Strategy. International Journal of Medical Science and Public Health. 2014; 3(8).

Belilovsky EM, Borisov SE, Cook EF, Shaykevich S, Jakubowiak WM, Kourbatova E V. Treatment Interruptions among patients with tuberculosis in Russian TB Hospitals. International Journal Infectious Disease. 2010; 14(8): 698-703.

Connolly C, Davies G, Wilkinson D. Who fails to complete tuberculosis treatment? Temporal trends and risk factors for treatment interruption in a community-based directly observed therapy programme in a rural district of South Africa. Journal Tuberculosis Lung Disease. 1999; 3(12): 1081-1087.

Ministry of Health of Indonesia. National Guideline of Tuberculosis Control. Jakarta: Ministry of Health of Indonesia; 2011.

Masini EO, Mansour O, Speer CE, et al. Using survival analysis to identify risk factors for treatment interruption among new and retreatment tuberculosis patients in Kenya. PLoS One. 2016: 1-19.

Zuliana I. The effect of individual characteristic, health services factor, and treatment support of the patients TB compliance in work area of Pekan Labuhan’s Public Health Centre in Medan on 2009 [thesis]. Medan: University of Sumatera Utara ; 2010.

Rahmansyah A. The factors that associated to drop out of pulmonary TB cases at Palembang Lung Hospital 2010 [thesis]. Depok: University of Indonesia; 2012.

Gupta S, Behera D. Reasons for interruption of anti-tubercular treatment as reported by patients with tuberculosis admitted in a tertiary care institute. Indian Journal of Tuberculosis. 2011; 58(1): 11-17.

Wu P-S, Chou P, Chang N-T, Sun W-J, Kuo H-S. Assessment of changes in knowledge and stigmatization following tuberculosis training workshop in Taiwan. Elsevier Formos Med Assoc. 2009; 108(5): 377-385.

Ministry of Health of Indonesia. National Basic Health Research. Jakarta: Ministry of Health of Indonesia; 2008.

Ministry of Health of Indonesia. Natioal Basic Health Research. Jakarta: Ministry of Health of Indonesia; 2013.

25. Kleinbaum DG, Klein M. Survival analysis : a self-learning text. Secod Edit. (Gail M, Krickeberg K, Samet J, Tsiatis A, Wong W, eds.). USA: Springer; 2005.

Sagara I, Giorgi R, Doumbo OK, Piarroux R, Gaudart J. Modelling recurrent events: comparison of statistical models with continuous and discontinuous risk intervals on recurrent malaria episodes data. Malaria Journal. 2014; 13(1): 293.

Chen C-Y, Yeh H-H, Huang N, Lin Y-C. Socioeconomic and clinical characteristics associated with repeat suicide attempts among young people. Journal of Adolescent Health. 2014; 54(5): 550-557.

Hirpa S, Medhin G, Girma B, Melese M, Mekonen A, Suarez P. Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa : a case control study. BMC Public Health. 2013; 13(1): 1.

Barroso EC, Mota RMS, Santos RO, Sousa ALO, Barroso JB, Rodrigues JLN. Risk factors for acquired multidrug-resistant tuberculosis. Journal de Pneumologia. 2003; 29(2).

Podewils LJ, Gler MTS, Quelapio MI, Chen MP. Patterns of treatment interruption among patients with multidrug-resistant TB (MDR TB) and association with interim and final treatment outcomes. PLoS One. 2013; 8(7): e70064.

No Supplementary Material available for this article.
Article Views      : 316
PDF Downloads : 130