Abstract
Background/objective: A nationwide survey on the resistance to first line anti-tuberculosis (anti-TB) drugs was conducted in Ghana from 2007-2008 by Noguchi Memorial Institute for Medical Research in collaboration with the National Tuberculosis Control Programme. We aimed to characterize mycobacterial species causing pulmonary tuberculosis (PTB) and determine the resistance pattern to first line anti-TB drugs among newly diagnosed and previously treated PTB patients in Ghana. Methods: Two sputum samples from consented new smear positive PTB patients who had never been treated for TB or had been on anti-TB treatment for less than a month and patients who had been treated for TB previously for more than a month in selected diagnostic centres nationwide were collected for culture, identification and drug susceptibility test. Culture positive isolates were tested against streptomycin (S), isoniazid (H), rifampicin (R) and ethambutol (E) using the simplified proportion method and line probe assay (LPA). The LPA was performed in mid-2017. Results: Among 410 samples, 345 positive cultures were obtained and identified as Mycobacterium tuberculosis complex (MTBC). Of the 345 isolates, 133 were further differentiated by GenoType MTBC® as M. tuberculosis, 126 (94.7%) and M. africanum 7 (5.3%). The overall drug resistance patterns were as follows: 43/345 (12.5%), 6/345 (1.7%), 9/345 (2.6%) and 71/345 (20.6%) were resistant to H, R, E and S respectively and 5/345 (1.4%) were multi-drug resistant (MDR). Conclusion: The results indicate high levels of resistance to S and H among new and previously treated TB patients. We recommend adequate surveillance systems including periodic national anti-TB drug resistance surveys.
Highlights
Tuberculosis (TB) is a disease of great antiquity that continues to be a major public health problem worldwide
Background/objective: A nationwide survey on the resistance to first line anti-tuberculosis drugs was conducted in Ghana from 2007-2008 by Noguchi Memorial Institute for Medical Research in collaboration with the National Tuberculosis Control Programme
Two sputum samples from consented new smear positive pulmonary tuberculosis (PTB) patients who had never been treated for TB or had been on anti-TB treatment for less than a month and patients who had been treated for TB previously for more than a month in selected diagnostic centres nationwide were collected for culture, identification and drug susceptibility test
Summary
Tuberculosis (TB) is a disease of great antiquity that continues to be a major public health problem worldwide. The incidence of TB per 100,000 population in Ghana has seen a fifteen year gradual decreasing trend from 214 in 2001 to 160 in 2015 [2] It was observed from the Ghana national TB prevalence survey conducted in 2013 that TB prevalence rate (286 per 100,000 population) was about four times higher than the previous estimate prior to the survey (personal communication with the programme manager for the National Tuberculosis Control Programme (NTP), Ghana, unpublished data). In Ghana, the NTP has over the years focused on ensuring an effective Directly Observed Treatment Short course (DOTS) as a strategy to prevent the development of drug resistant TB. This has worked to a large extent as failure rates for new smear positive TB cases have remained consistently below 2% since 2007 [3]. Studies done in some health facilities in Ghana over the years reported various levels of
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