Prevalence of Drug-Resistant Tuberculosis in Sudan: A Systematic Review and Meta-Analysis.

Khalid Hajissa,Mahfuza Marzan,Mubarak Ibrahim Idriss,Md Asiful Islam

doi:10.3390/antibiotics10080932

Abstract

Drug-resistant tuberculosis (DR-TB) is still one of the most critical issues impeding worldwide TB control efforts. The aim of this systematic review and meta-analysis was to give an updated picture of the prevalence of DR-TB in Sudan. A comprehensive systematic search was performed on four electronic databases (PubMed, Scopus, Web of Science and Google Scholar) to identify all published studies reporting prevalence data of DR-TB in Sudan. Sixteen eligible studies published during 2002–2020 were included. Using meta-analysis of proportions, the pooled prevalence of TB cases with resistance to any anti-TB drugs was 47.0% (95% CI: 35.5–58.6%). The overall prevalence of mono, multi, poly and extensive drug resistance were estimated to be 16.2% (95% CI: 9.0–23.4%), 22.8% (95% CI: 16.0–29.7%), 6.8% (95% CI: 0.5–13.0%) and 0.7% (95% CI: 0–2.1%), respectively. Considering any first-line anti-TB drugs, the resistance prevalence was highest for isoniazid (32.3%) and streptomycin (31.7%), followed by rifampicin (29.2%). In contrast, resistance against second-line drugs was reported for only two antibiotics, namely, ofloxacin (2.1%) and kanamycin (0.7%). Of note, the resistance profile of the previously treated patients was found to be remarkably high compared with the newly diagnosed TB patients. The relatively high prevalence estimation of anti-TB drug resistance warrants strengthening TB control and treatment strategies in Sudan.

Highlights

Despite the improvements in case identification, cure rates and implementation of a widely adopted control strategy, tuberculosis (TB) remains a significant health threat and continues to be one of the top infectious and fatal diseases [1,2]
After full-text evaluation, only 16 articles addressing the prevalence of drug-resistant TB were included in this systematic review and meta-analysis (SRMA)
It is worth mentioning that the estimation of Drug-resistant tuberculosis (DR-TB) presented by the TB control programs in Sudan are based on systematic sampling from TB treatment centres or potentially endemic settings using a standardised drug susceptibility test

Summary

Introduction

Despite the improvements in case identification, cure rates and implementation of a widely adopted control strategy, tuberculosis (TB) remains a significant health threat and continues to be one of the top infectious and fatal diseases [1,2]. The global TB statistics revealed 10 million infected individuals and approximately 1.4 million deaths in 2019 worldwide [3]. The disease geographic distribution disproportionately varies within countries and across the globe, and poverty is the strongest predictor of incidence [4,5]. In Africa, where inadequate diagnosis and treatment are extremely common, the incidence rate of the disease is high and accounts for 25% of the global TB cases [6]. The prevention of new TB infections and effective treatment of established ones are critical to achieving remarkable reductions in the burden of the disease and associated deaths [7]. The successful treatment rate among TB-confirmed, -reported and

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Results

Conclusion