Development of multidrug resistant tuberculosis in Bangladesh: a case-control study on risk factors.

Mahfuza Rifat,Ashaque Husain,Md Wahiduzzaman Akhanda,Christopher Oldmeadow,Md Akramul Islam,John Hall,Abul Hasnat Milton,Bodrun Naher Siddiquea,Ulrike Gertrud Munderloh

doi:10.1371/journal.pone.0105214

Abstract

ObjectiveTo determine the risk factors for developing multidrug resistant tuberculosis in Bangladesh.MethodsThis case-control study was set in central, district and sub-district level hospitals of rural and urban Bangladesh. Included were 250 multidrug resistant tuberculosis (MDR-TB) patients as cases and 750 drug susceptible tuberculosis patients as controls. We recruited cases from all three government hospitals treating MDR-TB in Bangladesh during the study period. Controls were selected randomly from those local treatment units that had referred the cases. Information was collected through face-to-face interviews and record reviews. Unadjusted and multivariable logistic regression were used to analyse the data.ResultsPrevious treatment history was shown to be the major contributing factor to MDR-TB in univariate analysis. After adjusting for other factors in multivariable analysis, age group “18–25” (OR 1.77, CI 1.07–2.93) and “26–45” (OR 1.72, CI 1.12–2.66), some level of education (OR 1.94, CI 1.32–2.85), service and business as occupation (OR 2.88, CI 1.29–6.44; OR 3.71, CI 1.59–8.66, respectively), smoking history (OR 1.58, CI 0.99–2.5), and type 2 diabetes (OR 2.56 CI 1.51–4.34) were associated with MDR-TB. Previous treatment was not included in the multivariable analysis as it was correlated with multiple predictors.ConclusionPrevious tuberculosis treatment was found to be the major risk factor for MDR-TB. This study also identified age 18 to 45 years, some education up to secondary level, service and business as occupation, past smoking status, and type 2 diabetes as comorbid illness as risk factors. National Tuberculosis programme should address these risk factors in MDR-TB control strategy. The integration of MDR-TB control activities with diabetes and tobacco control programmes is needed in Bangladesh.

Highlights

Despite an overall decreasing incidence and mortality rate for tuberculosis (TB), multidrug resistance tuberculosis (MDR-TB) continues to be a serious threat to the current global tuberculosis control effort [1,2]
Previous history of tuberculosis treatment was a major contributing factor to MDR-TB
29.3% of participants had a history of previous tuberculosis treatment that was 98% of the MDR-TB and 6.4% of non-MDR-TB patients

Summary

Introduction

Despite an overall decreasing incidence and mortality rate for tuberculosis (TB), multidrug resistance tuberculosis (MDR-TB) continues to be a serious threat to the current global tuberculosis control effort [1,2]. MDR-TB is caused by bacteria that are resistant to at least isoniazid and rifampicin, the most effective anti-TB drugs for treating TB [3]. Bangladesh is one of the 27 high burden countries for MDR-TB [5]. In Bangladesh, 1.4% of new tuberculosis patients, and 29% of previously treated tuberculosis patients are estimated to be MDRTB [1]. The proportion of MDR-TB is still low, due to the overall high TB burden in Bangladesh the absolute number of MDR cases is quite large (estimated 1900 for new and 2300 for previously treated patients) [1]. Bangladesh is unique in that it has one of the highest population densities in the world, is one of the high burden countries for TB, but has a low prevalence of HIV [6]

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Discussion

Conclusion