Abstract
BackgroundWorldwide, there were 650,000 multidrug-resistant tuberculosis (MDR-TB) cases in 2010, and in 2008 the World Health Organization estimated that 150,000 deaths occurred annually due to MDR-TB. Ethiopia is 15th among the 27 MDR-TB high-burden countries. This study identifies factors associated with the occurrence of MDR-TB in patients who underwent first-line TB treatment in Addis Ababa City.MethodsA case control study was conducted at St. Peter Hospital and five health centers in Addis Ababa from 1 November 2011 to February 30, 2012. Cases were MDR-TB patients who were confirmed with culture and drug-susceptibility testing and were in treatment at St. Peter Hospital during the study period. Controls were patients who were on first-line anti-TB treatment and were registered as cured or having completed treatment in the period 9 April 2009– 28 February 2010, in five health centers of Addis Ababa City. Accordingly, 134 cases and an equal number of controls were included in this study. A structured interview questionnaire was used to assess factors that could potentially be associated with the occurrence of MDR-TB.ResultsFactors that were significantly associated with MDR-TB: drug side effects during first-line treatment (adjusted odds ratio (AOR): 4.5, 95% CI; 1.9 - 10.5); treatment not directly observed by a health worker (AOR = 11.7, 95% CI; 4–34.3); interruption of treatment of at least a day (AOR = 13.1, 95% CI 3.0-56.6); duration of treatment between 2 and 7 months (AOR = 14.8, 95% CI 2.3-96.4); and retreatment with the Category II regimen (P = 0.000). In the current study, HIV infection was not significantly associated with the occurrence of MDR-TB.ConclusionsPatients who were not in strict DOTS programs and did not adhere to first-line TB treatment and patients who experienced side effects during first-line treatment and Category II retreatment were at significantly increased risk of developing MDR-TB. The DOTS program should, therefore, be strengthened to increase patient adherence. Drug-susceptibility testing is also highly recommended for all Category I treatment regimen failures before those patients begin the Category II regimen.
Highlights
Worldwide, there were 650,000 multidrug-resistant tuberculosis (MDR-TB) cases in 2010, and in 2008 the World Health Organization estimated that 150,000 deaths occurred annually due to MDR-TB
Results from logistic regression analysis After adjusting for possible confounding factors (Table 4), the study found that MDR-TB development is significantly associated with two or more episodes of TB illness (AOR = 31.8; 95% Confidence interval (CI); 8.7–115.5), interruption of first-line anti-TB treatment for at least a day (AOR = 13.1; 95% CI; 3.0– 56.6), education above 10th grade (AOR = 3.7; 95% CI; 1.1–12.1), and male sex (AOR = 2.7; 95% CI; 1.1–6.5)
Pulmonary TB (AOR = 10.9; 95% CI; 2.8–41.9), drug side effects during first-line treatment (AOR = 4.5; 95% CI; 1.9–10.5), lack of direct observation by health workers (AOR = 11.7; 95% CI; 4.0–34.3), and less than 7 months of first-line anti-TB treatment (AOR = 14.8 95% CI; 2.3–96.4) were significantly associated with MDR-TB development
Summary
There were 650,000 multidrug-resistant tuberculosis (MDR-TB) cases in 2010, and in 2008 the World Health Organization estimated that 150,000 deaths occurred annually due to MDR-TB. Ethiopia is 15th among the 27 MDR-TB high-burden countries. Multidrug-resistant tuberculosis (MDR-TB) is a type of TB that is resistant to at least the first line anti-TB drugs, Rifampacin and Isoniazid. MDR-TB occurs either when a person is infected with a resistant strain or when improper treatment leads to drug selection of the resistant strain [1]. When insufficient treatment leads to selection of spontaneously resistant strains (i.e., drug resistance is acquired), the disease is termed secondary MDR-TB [2]. Ethiopia is 15th among the 27 MDR-TB high-burden countries, with an estimated 5,200 cases occurring each year [4]
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