Title: Identifying and managing defaulters
Course: Communicable Diseases Part 2 - Ethiopia (Full)

Identifying and managing defaulters

A defaulter is an individual who fails to complete treatment within the maximally allowed period of time. Whenever a PB patient has missed more than three months treatment, or an MB patient more than six months treatment, they should be declared as defaulters from treatment and should be referred immediately to the clinician for further management. Any defaulter, particularly one who remains very irregular on treatment and repeatedly defaults despite every effort on the part of the health staff, should also be referred, so that a more experienced person can decide if further treatment is required and if so, how much.

You have an important role to play in helping prevent patients from interrupting treatment and becoming a defaulter. You can also retrieve a defaulter — taking steps to bring patients back into treatment by getting information about those who fail to show up on clinic day, by asking other patients or by sending a reminder directly to the patient. But if she/he does not turn up after 28 days, you should visit him/her at home to find out the reason for non-attendance. Then you should complete the defaulter retrieval form (make sure you know where these forms are located in your place of work) and take any other appropriate action, such as referring the patient to a clinician for assessment.

There are a number of ways in which you can help ensure that patients keep to their treatment until completion. You should always inform patients of what's required by way of treatment and why, and you should make sure that drug collection is accessible and flexible. Giving medicines regularly and identifying and referring patients with complications promptly are also important. Also, you should try to trace patients who miss a drug collection date or clinic day, carry out regular patient's review and discuss findings with them during clinic visits. As a Health Extension Practitioner, you have a big responsibility for helping to motivate patients by adopting a professional attitude and by using encouraging words. Box 19.2 summarises the key points you need to remember for patients and their families.

Box 19.2 Key points for patients and their families

- Educate patients, their families and the public about leprosy treatment.
- Ensure that patients adhere to treatment and that they get the support and encouragement they need.
- Tell patients and their families that leprosy is curable, and the drugs help stop the disease from spreading.
- Tell patients to keep the drugs in a safe, dry, shady place and out of the reach of children.
- Make sure patients know that if the drugs are spoiled (change colour or broken), they will be replaced, as MDT drugs are free of charge.
- Make your patients aware that leprosy drugs can turn their urine red or skin darker, but they should not worry if this happens because it will go away when treatment is completed.
- Tell your patients that MDT is safe during pregnancy, and safe for patients being treated for tuberculosis (TB) and those who are HIV-positive.
- Make sure patients tell you about any problems and that they come monthly for their check-up and to collect their medicines.