Is multidrug-resistant tuberculosis on the rise in Mozambique? Results of a national drug resistance survey

Abstract

To the Editors: Tuberculosis (TB) remains a serious public health problem in many low- and middle-income countries in Africa, Asia and the former Soviet Union [1]. Mozambique is one of them. Despite the fact that in this country, detection of patients with TB has drastically increased during the past decade due to improved notification (from nearly 20,000 new TB cases notified in 1998 to nearly 40,000 in 2008), less than half of the cases of TB estimated to emerge annually are currently being detected. As in other southern African countries, the HIV epidemic is fuelling the TB epidemic in Mozambique, with 60% of patients with TB being co-infected with HIV [1]. Drug-resistant TB is thought to be a major problem, although the latest information available on the magnitude of resistance to anti-TB drugs is from 1998, when the first national drug resistance survey (DRS) was conducted. At that time, multidrug-resistant (MDR)-TB (defined as TB resistant to at least isoniazid and rifampicin, the two main first-line drugs in the treatment of TB) was found among 3.5 and 3.3% of new and previously treated TB cases, respectively [2]. Since then, there has been no further investigation of the magnitude of drug resistance in the country. Based on the latest available data, >3,500 MDR-TB cases are estimated to have emerged in Mozambique in 2008 [3]. Detecting and treating patients with MDR-TB is feasible but substantially more complex and costly than treating patients with fully susceptible Mycobacterium tuberculosis strains. Knowing the …