Which is the most common reason for loss to follow-up in randomized controlled trials conducted in India?

Explanation

## Most Common Cause of Attrition in Indian RCTs **Key Point:** Migration or change of residence is the most frequent cause of loss to follow-up in RCTs conducted in India, particularly in urban and semi-urban settings where population mobility is high. ### Context of Loss to Follow-Up in Indian RCTs **High-Yield:** In low- and middle-income countries (LMICs) like India, demographic and socioeconomic factors dominate attrition patterns: - High internal migration for employment - Seasonal migration in agricultural populations - Inadequate contact information systems - Lack of stable residential addresses ### Comparison of Attrition Causes in Indian RCTs | Cause | Frequency | Preventability | Typical Rate | |-------|-----------|-----------------|---------------| | **Migration/residence change** | **Most common** | **Moderate** | 30–40% of losses | | Lack of perceived benefit | Common | Low (depends on efficacy) | 15–25% of losses | | Adverse effects | Variable | High (depends on drug safety) | 5–15% of losses | | Competing priorities | Common | Low (socioeconomic factor) | 15–25% of losses | ### Strategies to Minimize Migration-Related Attrition 1. **Baseline data collection:** - Multiple contact numbers (participant + family members) - Workplace address and contact - Nearest relative's address 2. **Active follow-up:** - Home visits with trained field workers - Community health worker involvement - Regular phone/SMS reminders 3. **Study design modifications:** - Shorter follow-up intervals - Flexible visit windows - Decentralized data collection points **Clinical Pearl:** Studies in rural India show that migration-related losses can exceed 40% if adequate tracking mechanisms are not in place. This is why community-based participatory research models are increasingly preferred in Indian settings. **Mnemonic:** **TRACK** — Telephone contacts, Relatives' addresses, Alternate workplace, Community health workers, Keep updated records.