A case control study for factors of Multidrug Resistant Tuberculosis in East Sikkim, India

Abstract

Abstract Background Tuberculosis (TB) remains a major public health problem in the developing world and India is the highest TB burden country in the world in terms of absolute number of incident cases that occur each year. The emergence of Multidrug Resistant Tuberculosis (MDR TB) is posing threat to global efforts of TB control. The hilly state of Sikkim has the highest proportion of MDR TB cases in India. Hence there is an emerging need to identify the factors for the rapid rise of MDR TB in Sikkim. Methods All the MDR TB cases registered under Revised National TB Control Programme in East district of Sikkim in the first & second quarter of 2019 was compared with double the number of matched controls taken from the same geographical area and ethnicity but not from the same family members. Results A total of 78 cases and 156 controls were studied. The mean age of the study participants was 43 years (SD ± 14 years). The most statistically significant risk factors were as follows: overcrowding (OR 2.68); household air pollution (OR 2.55); inadequate ventilation (OR 2.05); previous history of tuberculosis (OR 4.03) with history of relapse/failure; known contact of MDR tuberculosis (OR 4.01); having diabetes (OR 3.96); smoking (OR 3.96) Conclusions This study shows that clinical and demographic features can be used to indicate higher risks of drug resistance in this setting. Information was obtained on why Sikkim being a small State with very less population and a good per capita expenditure in health has the highest proportion of MDR-TB in India. Key messages Sikkim is the smallest state in India with the highest proportion of MDR TB. Previous history of TB with history of relapse/failure, contact of MDR TB emerged as the most significant risk factors.