Why TB patients stop treatment in Kalingalinga, Lusaka

Treatment default — when people with tuberculosis (TB) stop taking their medicines before they finish the full course — weakens efforts to control the disease by allowing ongoing transmission, raising the risk of drug resistance and harming patients’ health. In Zambia, which carries a heavy TB burden, these problems are especially acute in crowded urban informal settlements. Despite ongoing work by the national TB programme, there has been limited local research into why patients in these communities stop treatment. To fill that gap, a study led by Chipampe Patricia Lombe focused on Kalingalinga Compound in Lusaka. The research set out to identify the main reasons people default from TB treatment so that responses could be better targeted to local realities. By asking directly about people’s lives, fears and experiences with health services, the study aimed to produce findings that are practical for local health managers and community groups. The work recognizes that both personal and health-system factors play a role, and seeks to point the way toward realistic, community-tailored measures that can help more people complete their TB treatment and reduce the broader burden of the disease in Zambia.

The study used a cross-sectional design and enrolled 180 tuberculosis patients who had defaulted on treatment in Kalingalinga Compound, Lusaka. Participants were chosen by stratified random sampling to ensure representation by age, gender and socio-economic status. Data were collected using structured questionnaires that covered socio-demographic characteristics, patient-related factors and health system influences. The team analysed the information with Statistical Package for the Social Sciences (SPSS) Version 26. Descriptive statistics summarized the data, while inferential statistics — including chi-square tests and logistic regression — were used to identify associations and predictors, with results reported at a 95% confidence interval. Key statistical findings showed that male gender (AOR = 1.86, p = 0.041), age group 30–49 years (AOR = 2.74, p = 0.006) and low education levels (AOR = 3.12, p = 0.004) were significant demographic predictors of default. Patient-related factors strongly associated with default included fear of stigma (AOR = 4.21, p < 0.001), substance abuse (AOR = 2.85, p = 0.004) and inadequate knowledge of TB (AOR = 3.17, p = 0.004). Health system deficiencies such as inadequate counselling services (AOR = 5.12, p < 0.001), inconsistent medication availability (AOR = 3.89, p < 0.001) and long distances to health facilities (AOR = 3.44, p < 0.001) also significantly contributed to non-adherence.

Taken together, the results show that defaulting from TB treatment in Kalingalinga is not caused by a single problem but by a mix of individual, social and service-related issues. The strong links to stigma, limited knowledge and substance abuse point to a need for community-level education and support that can reduce fear and misinformation. At the same time, the associations with inadequate counselling, drug stock problems and long travel distances underscore the importance of strengthening health services — ensuring reliable medication supplies, improving counselling and making care more accessible. The study calls for interventions that are sensitive to gender and age differences, because men and people aged 30–49 were more likely to default. In practical terms, that means combining better health-system delivery with efforts to boost patient knowledge, tackle stigma and provide targeted support for people with substance use problems. The authors argue for holistic, locally tailored strategies that fit the realities of Kalingalinga and similar urban informal settlements, with the goal of improving adherence and reducing the overall TB burden in Zambia.