Risk Factors For Multidrug-resistant Tuberculosis Research Articles

Impact of different tuberculosis history at the onset of future multidrug-resistant tuberculosis: A large, retrospective, population-based cohort study

ObjectivesThe impact of tuberculosis (TB) history on the risk of multidrug-resistant tuberculosis (MDR-TB) is not yet fully understood. We aimed to identify the impact of different TB history at the onset of future MDR-TB. MethodsA large, retrospective, population-based cohort study was performed between 2005 and 2019. A multivariable Cox model was used to evaluate independent risk factors for MDR-TB for individuals with different previous TB history (PTBH), such as newly diagnosed TB history (NDTH) and re-treated TB history (RTH). ResultsOverall, 12 172 individuals with PTBH were included in this study. The main impacts of different PTBH at the onset of future MDR-TB were as follows: (a) low family income, high-risk occupation, TB patients with severe infection, extended or shortened treatment course, 2H3R3Z3E3/4H3R3 and frequency of sputum culture were significantly linked to incident MDR-TB only in individuals with NDTH (P < 0.05); (b) passive mode of TB case finding, individualised treatment regimens, 3HRZES/6HRE, duration of pulmonary cavities, excellent frequency of chest X-ray examination and duration of negative sputum smear were significantly associated with incident MDR-TB only in individuals with RTH (P < 0.05); (c) age <60 years, history of direct contact, human immunodeficiency virus (HIV) infection, unsuccessful treatment and duration of positive sputum culture were related to incident MDR-TB in both categories of PTBH individuals (P < 0.05). ConclusionEarly and differential surveillances, assessments and interventions for reducing the risk of MDR-TB among individuals with different PTBH play a key role.

Analysis of Serial Multidrug-Resistant Tuberculosis Strains Causing Treatment Failure and Within-Host Evolution by Whole-Genome Sequencing.

The cure rate of multidrug-resistant tuberculosis (MDR-TB) is relatively low in China. The reasons for the treatment failure and within-host evolution during treatment have not been sufficiently studied. All MDR-TB patients receiving standard treatment from January 2014 to September 2016 at a designated TB Hospital in Zhejiang Province were retrospectively included and grouped according to their known treatment outcome. Clinical information was collected. Baseline strains of all patients and serial strains of treatment-failure patients were revived. Drug susceptibility tests (DSTs) of 14 drugs and single nucleotide polymorphism (SNP) analysis based on whole-genome sequencing (WGS) were performed. The genetic distance and within-host evolution were investigated based on SNPs. In total, 20 treatment failure patients and 74 patients who succeeded in treatment were included. The number of effective drugs for patients who failed treatment was no more than three. Eighteen (90.0%) treatment-failure patients were characterized by a continuous infection of the primary strain, of which 14 patients (77.8%) developed phenotypic or genotypic acquired drug resistance under ineffective treatment. Acquired resistance to amikacin and moxifloxacin (2.0 mg/ml) was detected most frequently, in 5 and 4 patients, respectively. The insufficient number of effective drugs in the combined treatment regimen was the main reason for MDR-TB treatment failure. The study emphasizes the importance of DST for second-line drugs when implementing the second-line drug regimen in MDR-TB patients. For patients with risk factors for MDR-TB, DST of second-line antituberculosis drugs should be performed at initiation of treatment. Second-line drugs should be selected based on the results of DST to avoid acquired resistance. WGS detects low-frequency resistance mutations and heterogeneous resistance with high sensitivity, which is of great significance for guiding clinical treatment and preventing acquired resistance.IMPORTANCE Few studies have focused on the reasons for the low cure rate of multidrug-resistant tuberculosis in China and within-host evolution during treatment, which is of great significance for improving clinical treatment regimens. Acquired resistance events were common during the ineffective treatment, among which resistance to amikacin and high-level moxifloxacin were the most common. The main reason for the treatment failure of MDR-TB patients was insufficient effective drugs, which may lead to higher levels of drug resistance in MDR-TB strains. Therefore, the study emphasizes the importance of DST in the development of second-line treatment regimen when there is a risk of MDR. By performing whole-genome sequencing of serial strains from patients with treatment failure, we found that WGS can detect low-frequency resistance mutations and heterogeneous resistance with high sensitivity. It is thus recommended to conduct drug susceptibility tests at the beginning of treatment and repeat the DST when the sputum bacteria remain positive.

Prevalence and Determinants of Multidrug-Resistant Tuberculosis in Makkah, Saudi Arabia.

Background and ObjectivesTuberculosis (TB) is a global public health issue. The emergence of multidrug-resistant (MDR) TB has further complicated the situation in the form of poor treatment outcomes and costs to individuals and health-care systems. We therefore aimed to measure the prevalence and associated risk factors of MDR TB among TB patients in Makkah city.Patients and MethodsThis was a cross-sectional study conducted at Al-Noor Specialist Hospital, a public-sector hospital in Makkah. We included records of 158 confirmed TB patients from the list of all patients admitted in the hospital from January 2009 to January 2019 by systematic random sampling. Data were collected on socio-demographics, clinical profile and drug resistance patterns. Analysis was done in SPSS version 21.0.ResultsThe mean age of the participants was 43.4 ± 18.7 years, and two-thirds (66.5%) were male. About 40% of the patients had chronic disease while lung disease other than TB was present in 5% patients. About 13% of cases were extrapulmonary infections. Prevalence of drug resistance was found to be 17.1% among TB patients. Among the resistant cases, streptomycin (25.9%) and isoniazid (11.1%) were the drugs most commonly affected by resistance. Prevalence of MDR TB was 5% among TB patients. Age, smoking, lung disease and previous TB were significant factors associated with MDR TB.ConclusionPrevalence of MDR TB, although comparable to current national estimates, is higher compared to previous reports. There is a need to reduce this burden through strengthening TB control programs to prevent further emergence of a public health threat of MDR TB. History of previous TB was the strongest risk factor in this study. This calls physicians, program managers and policy makers to focus on counselling and support of TB patients for compliance with the regimen to complete treatment without interruption.

Factors associated with multidrug-resistant tuberculosis (MDR-TB) in Bhutan: A nationwide case-control study.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a growing public health concern globally. In Bhutan, the rates of MDR-TB are high. Data on the risk factors of MDR-TB that can help inform policies are limited in Bhutan. This study aimed to determine the risk factors associated with MDR-TB.MethodsA nationwide unmatched case-control study was conducted that included 79 MDR-TB cases and 118 controls. Data was collected by trained health workers through interviews using a structured questionnaire. Logistic regression analysis was performed to identify the risk factors associated with MDR-TB.ResultsThe mean age of the participants was 32.4 and 33.7 years among the cases and the controls, respectively. In the multivariate analysis, the odds of having MDR-TB was higher among those who slept for less than 9 hours a day (AOR: 2.77, 95%CI: 1.11–6.92), frequently travelled in public transport (AOR: 2.96, 95% CI: 1.36–6.48), and had previous TB treatment (AOR: 5.90, 95%CI: 2.55–13.64). A greater number of rooms was also marginally associated with odds of having MDR-TB.ConclusionsThe findings suggest previous TB treatment, inadequate sleep duration, and travelling by public transport to be the risk factors associated with having MDR-TB in Bhutan. Intensification of early case detection, strengthening directly observed treatment strategy, improving treatment adherence, and increasing awareness can help control the rising MDR-TB epidemic.

Determining Mycobacterium tuberculosis Drug Resistance and Risk Factors for Multidrug-Resistant Tuberculosis in Sputum Smear-Positive Tuberculosis Outpatients in Anhui Province, China, 2015-2016.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is currently a major problem in China. The prevention and treatment work for MDR-TB patients started late in Anhui province. To determine the prevalence of MDR-TB in sputum smear-positive TB patients (SSPTBPs) and analyze the risk factors for MDR-TB in Anhui province, we conducted an investigation of drug resistance among SSPTB outpatients from September 2015 to August 2016.MethodsA stratified cluster-randomized sampling method was used to obtain a representative sample. It was estimated that 2290 new cases and 440 previously treated cases of SSPTBPs needed to be recruited from 40 survey sites. Isolates were tested for resistance to six first-line and second-line anti-TB drugs. Information from patient questionnaire survey was used to identify factors linked to MDR-TB.ResultsFinally, a total of 3047 SSPTBPs were recruited from 40 survey sites; of these, 2530 specimens were successfully cultured and had drug susceptibility testing done. The proportions of rifampin resistant (RR)-TB were 11.42% (289/2530, 95% CI: 10.18–12.66%), 7.64% (163/2133, 95% CI: 6.38–8.62%) and 31.74% (126/397, 95% CI: 27.38–36.60%) in all cases, new cases and previously treated cases, respectively, and the proportions of confirmed MDR-TB were 7.63% (193/2530, 95% CI: 6.59–8.66%), 4.97% (106/2133, 95% CI: 4.05–5.89%) and 21.91% (87/397, 95% CI: 17.83–26.00%), respectively. The ofloxacin resistance rate in previously treated SSPTBPs reached 21.66% (95% CI: 17.33–26.75%). Patients who had received two or more anti-TB treatment courses were significantly associated with MDR-TB compared to patients who have received one anti-TB course.ConclusionMDR-TB prevalence was high among SSPTBPs in Anhui province, and past anti-TB treatment course was associated with MDR-TB.

Multidrug-resistant tuberculosis risk factors assessment with intuitionistic fuzzy cognitive maps

Multidrug-resistant tuberculosis risk factors assessment with intuitionistic fuzzy cognitive maps

Multidrug-resistant tuberculosis in the United States, 2011-2016: patient characteristics and risk factors.

OBJECTIVE: To determine risk factors for multidrug-resistant tuberculosis (MDR-TB) and describe MDR-TB according to three characteristics: previous TB disease, recent transmission of MDR-TB, and reactivation of latent MDR-TB infection.SETTING and DESIGN: We used 2011-2016 surveillance data from the US National Tuberculosis Surveillance System and National Tuberculosis Genotyping Service and used logistic regression models to estimate risk factors associated with MDR-TB.RESULTS: A total of 615/45 209 (1.4%) cases were confirmed as MDR-TB; 111/615 (18%) reported previous TB disease; 41/615 (6.7%) were attributed to recent MDR-TB transmission; and 449/615 (73%) to reactivation. Only 12/41 (29%) patients with TB attributed to recent transmission were known to be contacts of someone with MDR-TB. For non-US-born patients, the adjusted odds ratios of having MDR-TB were 32.6 (95%CI 14.6-72.6) among those who were known to be contacts of someone with MDR-TB and 6.5 (95%CI 5.1-8.3) among those who had had previous TB disease.CONCLUSION: The majority of MDR-TB cases in the United States were associated with previous TB disease or reactivation of latent MDR-TB infection; only a small proportion of MDR-TB cases were associated with recent transmission.

Clinical risk factors associated with multidrug-resistant tuberculosis (MDR-TB) in Mali

BackgroundMDR-TB is a major threat to global TB control. In 2015, 580,000 were treated for MDR-TB worldwide. The worldwide roll-out of GeneXpert MTB/RIF® has improved diagnosis of MDR-TB; however, in many countries laboratories are unable to assess drug resistance and clinical predictors of MDR-TB could help target suspected patients. In this study, we aimed to determine the clinical factors associated with MDR-TB in Bamako, Mali. MethodsWe performed a cross-sectional study of 214 patients with presumed MDR-TB admitted to University of Bamako Teaching Hospital, Point-G between 2007 and 2016. We calculated crude and adjusted odds ratios for MDR-TB disease diagnosis using SPSS. ResultsWe found that age ≤40years (OR=2.56. 95% CI: 1.44–4.55), two courses of prior TB treatment (OR=3.25, 95% CI: 1.44–7.30), TB treatment failure (OR=3.82, 95% CI 1.82–7.79), sputum microscopy with 3+ bacilli load (OR=1.98, 95% CI: 1.13–3.48) and a history of contact with a TB patient (OR=2.48, 95% CI: 1.11–5.50) were significantly associated with confirmation of MDR-TB disease. HIV was not a risk factor for MDR-TB (aOR=0.88, 95% CI: 0.34–1.94). ConclusionWe identified several risk factors that could be used to identify MDR-TB suspects and prioritize them for laboratory confirmation. Prospective studies are needed to understand factors associated with TB incidence and clinical outcomes of TB treatment and disease.

Risk factors of multidrug-resistant tuberculosis in China: A meta-analysis.

Multidrug-resistant tuberculosis (MDR-TB) brings major challenges to the health care workers (HCWs). This study is to determine the risk factors for MDR-TB, latent tuberculosis infection (LTBI), and tuberculosis (TB) disease among HCWs in China. A meta-analysis was conducted to evaluate the risk factors for MDR-TB, LTBI, and TB disease among HCWs using a random-effects model, and the pooled odds ratios (ORs) with 95% confidence interval (CI) were used as effect indicators. We identified 46 eligible studies and found eight factors were associated with MDR. The ORs with 95% CI are migrant population 1.96 (95% CI, 1.50-2.57), low family income 2.23 (95% CI, 1.74-2.85), retreatment 7.22 (95% CI, 5.63-9.26), anti-TB treatment history 5.65 (95% CI, 4.80-6.65), multiple episodes of treatment 3.28 (95% CI, 2.60-4.13), adverse reactions 3.48 (95% CI, 2.54-4.76), interrupted treatment 3.18 (95% CI, 2.60-3.89), and lung cavities 1.42 (95% CI, 1.14-1.77). Work duration as a HCW for 5years and above increased the risk of LTBI and TB. HCWs aged 30years and above were more susceptible to TB (OR=1.70, 95% CI: 1.37-2.09). The risk factors for MDR-TB in China are possibly migrant population, low family income, retreatment, anti-TB treatment history, adverse reactions, interrupted treatment, and lung cavities. Longer work duration and greater age are risk factors for LTBI and TB among HCWs.

Risk Factors for Multidrug-Resistant Tuberculosis and Characteristics of Cases: A Case-Control Study of Patients Attending ALERT General Hospital in Addis Ababa, Ethiopia

Background:Tuberculosis remains a major public-health problem in the world, despite several efforts to improve case identification and treatment. Particularly multidrug-resistant tuberculosis is becoming a major threat to tuberculosis control programs in Ethiopia which seriously threatens the control and prevention efforts and is associated with both high death rates and treatment costs. Methods: A case-control study was conducted to assess risk factors and characteristics of MDR-TB cases at ALERT Hospital, Addis Ababa, Ethiopia, where cases were 167 MDR-TB patients, while controls were newly diagnosed and bacteriologically confirmed pulmonary TB cases of similar number, who were matched by sex and age of 5-years interval. Results: The socio-demographic characteristics of the participants indicated that majority (53.3%) were males and 46.7% females; a little over half of cases (55.1%) were in the age group 26 - 45 years, whereas 46.7% of controls were in this age group. According to the multivariable logistic regression analysis, previous history of hospital admission was the only factor that was identified as predictor which increased risk to develop MDR-TB by almost twenty times (AOR = 19.5; 95% CI: 9.17 - 41.62) and P-value of <0.05. All other studied factor such as being unemployed, family size, having member of household member with TB, and history of visiting hospital in past 12 months etc., didn’t show any statistically significant association. Conclusion: The study identified previous history of hospital admission as independent predictors for the occurrence of MDR-TB, while other studied variables didn’t show any strong association. The findings added to the pool of knowledge emphasizing the need for instituting strong infection control practice at health care facilities to prevent nosocomial transmission of MDR-TB.

Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study.

Although the Republic of Angola is one of the 14 countries figuring in the three high tuberculosis (TB) burden country lists, the true multidrug-resistant TB (MDR-TB) situation is unknown. Patients aged 16 years with a diagnosis of pulmonary TB were prospectively enrolled from June 2014 to July 2015. Sputum samples were collected for culture and drug susceptibility testing in all patients, and for Xpert® MTB/RIF testing in all previously treated patients and in new patients whose sputum remained smear-positive after 2 months of treatment. A total of 422 patients were included; Mycobacterium tuberculosis was isolated in 308 sputum samples. The prevalence of MDR-TB was 8.0% (18/225) in new patients and 71.1% (59/83) in previously treated patients. Male sex (OR 2.95, 95%CI 1.35-6.44, P = 0.007), previous anti-tuberculosis treatment (OR 20.86, 95%CI 9.53-45.67, P < 0.001), presence of pleural thickening (OR 7.68, 95%CI 1.57-37.43, P = 0.012) and duration of illness >4 months (OR 3.34, 95%CI 1.45-7.69, P = 0.005) were independent risk factors for MDR-TB. The prevalence of MDR-TB in Cubal, Angola, was higher than estimated by the World Health Organization for Angola and one of the highest worldwide. Facilities to diagnose and treat MDR-TB are urgently needed in Angola.

Quality of DOTS Adherence Counselling among Hospitalized Tuberculosis Patients

Setting: Non-adherence to tuberculosis treatment is a risk factor for multidrug-resistant tuberculosis (MDR-TB). In 2015, 480,000 cases of MDR-TB were notified worldwide, leading to 250,000 deaths. Aim: The quality of the Directly Observed Treatment (DOT) adherence counselling among patients with drug resistant and sensitive was assessed. Methods: A hospital based crossectional analytical study was conducted at the national TB hospital in Windhoek among patients with MDR-TB and drug susceptible TB (DS-TB). The quality of adherence counselling was assessed against the WHO counselling guidelines using an interviewer-administered questionnaire. Quality was measured by completeness, duration and frequency of the adherence counselling sessions or program as well as patient satisfaction and preferences. Quantitative and qualitative data were by descriptive statistics in SPSS v23 and thematic analysis respectively. Results: Of the 50 patients, 60% were male, 76% were aged <45 years and 92% perceived the direct observation of TB treatment as good or excellent. Only 40% of the patients received DOT adherence counselling over the last three months and 16% had not received counselling since admissions. The patient-related factors affecting the quality of DOT adherence counselling were forgetfulness (22%) and/or treatment cessation upon feeling better (12%), limited access to DOT services in the community versus the health facility and lack of individual versus group counselling as well as comprehension of languages and messages used during counselling. Conclusions: The quality of DOT adherence counselling among hospitalized TB patients is sub-optimal. There is need for a standard operating procedure and guidelines for effective adherence counselling among TB patients to optimize treatment outcomes.

Risk factors for multidrug-resistant tuberculosis among tuberculosis patients in Serbia: a case-control study

BackgroundMultidrug resistant (MDR) tuberculosis (TB) represents TB which is simultaneous resistant to at least rifampicin (R) and isoniazid (H). Identifying inadequate therapy as the main cause of this form of the disease and explaining the factors leading to its occurrence, numerous social determinants that affect the risk of developing resistance are highlighted. The objectives of the study was to identify independent factors of MDR-TB among tuberculosis patients.MethodsCase-control study was conducted from 1st September 2009 to 1st June 2014 in 31 healthcare institutions in Serbia where MDR-TB and TB patients were treated. TB patients infected with MDR- M. tuberculosis and non MDR- M. tuberculosis strain were considered as cases and controls, respectively. Cases and controls were matched by the date of hospitalization. The data was collected using structured questionnaire with face to face interview. Bivariate and multivariable logistic regression analysis (MLRA) were used to identify determinants associated with MDR-TB.ResultsA total of 124 respondents, 31 cases and 93 controls were participated in the study. MLRA identified six significant independent risk factors for the occurrence of MDR-TB as follows: monthly income of the family (Odds ratio (OR) = 3.71; 95% Confidence Interval (CI) = 1.22–11.28), defaulting from treatment (OR = 3.33; 95% CI = 1.14–9.09), stigma associated with TB (OR = 2.97; 95% CI = 1.18–7.45), subjective feeling of sadness (OR = 4.05; 95% CI = 1.69–9.70), use of sedatives (OR = 2.79; 95% CI = 1.02–7.65) and chronic obstructive pulmonary disease (OR = 4.51; 95% CI = 1.07–18.96).ConclusionIn order to reduce burden of drug resistance, strategies of controlling MDR-TB in Serbia should emphasize multi-sectorial actions, addressing health care and social needs of TB patients.

Risk factors for the occurrence of multidrug-resistant tuberculosis among patients undergoing multidrug-resistant tuberculosis treatment in East Shoa, Ethiopia

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is resistant to the two main first-line anti-tuberculosis drugs: rifampicin and isoniazid. It is a major threat to public health worldwide. The objective of this study was to assess the potential risk factors for multidrug-resistant tuberculosis among patients undergoing MDR-TB treatment at two community hospitals in Ethiopia.MethodsA case-control study design was conducted from February 1, 2016, to April 29, 2016. TB-positive patients with MDR-TB and non-MDR-TB were considered as cases and controls, respectively. A total of 219 study participants were included in the study. An interviewer-administered structured questionnaire was used to collect primary data from the patients, and a checklist was used to collect data from the clinical records. Bivariate and multivariate logistic regression analyses were used to assess the potential risk factors for the occurrence of MDR-TB.ResultsThe odds of developing MDR-TB were higher in patients previously treated with anti-TB drugs (odds ratio [OR] = 6.1, 95%CI: 2.92–12.62, P < 0.001), those with a history of contact with known TB patients (OR = 2.1, 95%CI: 1.04–4.43, P < 0.001), those living in a rural setting (OR = 5.6, 95%CI: 2.14–14.46, P = 0.001), those with a history of alcohol consumption (OR = 4.3, 95%CI: 2.29–10.49, P < 0.001) and those without a job (OR = 2.4, 95%CI: 1.06–5.42, P = 0.001).ConclusionsThe study revealed that contact with known TB patients, previous TB treatment, residence area, lack of a job, and alcohol consumption were potential risk factors for the occurrence of MDR-TB. Enhancing public health education, intensifying directly observed therapy programmes for all TB patients and designing control strategies are recommended.

Evaluation of Risk Factors for Developing Multidrug Resistant Tuberculosis in Rural Islamabad, Pakistan

Background: Multi Drug Resistant Tuberculosis (MDR-TB) has emerged as a public health issue globally and especially in developing countries. An adequate and baseline epidemiological information on MDR-TB is critical for effective control and prevention of MDR TB. Objective: To evaluate the risk factors for developing MDR-TB among the patients registered under TB-DOTS at Federal General Hospital (FGH) Islamabad. Results: Among total of 27 cases 14 (51%) were male. The mean age of the cases was 31 years (range13-61 years). Most of the cases belonged to age group 20-30 years n=11 (40.7%). On bivariate analysis, out of a total of 27 cases, 07 were found to have defaulted from TB treatment, (OR 6.71, CI 1.7-25), 12 had a contact with MDR TB patient (OR 5.6, CI 2-15), 22 had a poor socio-economic status (OR 3.1, CI 1.1-9.2) and 14 had poor knowledge about MDR-TB (OR 2.8, CI 1.1-7.4). Conclusions: ATT failure, contact with MDR-TB patient, poor knowledge about MDR-TB were found to be associated with having MDR-TB. Awareness campaigns at an institutional and patient levels was recommended. On recommendations of this study awareness campaign was started in FGH regarding significant risk factors for MDR-TB.

Genetic diversity of drug and multidrug-resistant Mycobacterium tuberculosis circulating in Veracruz, Mexico.

BackgroundMexico is one of the most important contributors of drug and multidrug-resistant tuberculosis in Latin America; however, knowledge of the genetic diversity of drug-resistant tuberculosis isolates is limited.MethodsIn this study, the genetic structure of 112 Mycobacterium tuberculosis strains from the southeastern Mexico was determined by spoligotyping and 24-loci MIRU-VNTRs.FindingsThe results show eight major lineages, the most of which was T1 (24%), followed by LAM (16%) and H (15%). A total of 29 (25%) isolates were identified as orphan. The most abundant SITs were SIT53/T1 and SIT42/LAM9 with 10 isolates each and SIT50/H3 with eight isolates. Fifty-two spoligotype patterns, twenty-seven clusters and ten clonal complexes were observed, demonstrating an important genetic diversity of drug and multidrug-resistant tuberculosis isolates in circulation and transmission level of these aggravated forms of tuberculosis. Being defined as orphan or as part of an orphan cluster, was a risk factor for multidrug resistant-tuberculosis (OR 2.5, IC 1.05–5.86 and OR 3.3, IC 1–11.03, respectively). Multiple correspondence analyses showed association of some clusters and SITs with specific geographical locations.ConclusionsOur study provides one of the most detailed description of the genetic structure of drug and multidrug-resistant tuberculosis strains in southeast Mexico, establishing for the first time a baseline of the genotypes observed in resistant isolates circulating, however further studies are required to better elucidate the genetic structure of tuberculosis in region and the factors that could be participating in their dispersion.

An Epidemiological Study to Find out Risk Factors of Multi Drugs Resistance Tuberculosis in Nepal

Introduction: Drug resistant tuberculosis is a threat to tuberculosis control worldwide. Previous anti- tuberculosis treatment is a widely reported risk factor for multi drug resistant tuberculosis (MDR-TB), whereas other risk factors are less well described. In Nepal National Tuberculosis Control Programme initiated DOTSPLUS Pilot project from September 2005 using standardized treatment regimen.Objective: To explore the risk factors for MDR-TB in Nepal.Methodology: Institution based matched case control study with a case: control ratio of 1:2 was carried out in three regions of Nepal. Fifty five cases and 110 controls were selected. Current MDR-TB patients on treatment from DOTS–Plus clinic were enrolled as cases. Controls were age, sex matched cured TB patients and who had completed treatment either from the same centre or any DOTS Centre adjacent to that DOTS Plus Centre. Data was collected by a trained research assistant using interviewer administered structured questionnaire. Matched analysis was done using SPSS 16 version. Confounding effects were controlled by using matching, matched analysis and regression analysis.Results: In matched analysis following were the significant risk factors for MDR-TB in Nepal.(1) HIV Sero positivity (OR 15.9, CI 1.9- 133.0) (2) Travel cost more than 50 NRs per day (OR 6.5, CI 2.4- 9.8) (3) Contact history of TB (OR 3.8, CI 2.2- 6.6) (4) Living in a nuclear family (OR 6.0, CI 2.6- 13.9)(5) Non adherence to DOTS (OR 18.6, CI 2.27- 151.0) (6) Distance to treatment centre more than 5 Km ( OR 3.9, CI 1.5- 10.) (7) Previous history of TB ( OR 12.0, CI 5.4 -26.5)(8) Living in a rural area (OR 4, CI 2.1- 8.5) (9) Unmarried (Crude OR 3.3,CI 1.6- 6.8) (10) Un-employment (OR 3.4,CI 1.6-7.6)(11) Living in a rented house (OR 3.5, CI 1.77- 3.67) (12) Single bed room (OR 2.8, CI 1.13- 6.9). Using muti-variate analysis except living in a rented house and single bed room other variables were positive significant predictors for MDR –TB in Nepal.Conclusions: Many risk factors were related to the DOTS. Strengthening of DOTS programme to tackle the identified risk factors can reduce the MDR –TB burden in Nepal.SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 31-38

Prevalence of Multidrug-Resistant Tuberculosis and Associated Factors in Ethiopia: A Systematic Review.

Background Multidrug-resistant tuberculosis (MDR-TB) has continued to be a challenge for tuberculosis (TB) control globally. Ethiopia is one of the countries with high MDR-TB burden. ObjectiveThe main purpose of this study was to determine the prevalence of MDR-TB and associated factors in Ethiopia. Methods A systematic review of the literatures on prevalence of MDR-TB and associated factors was conducted in the country. ResultsIn our electronic search, 546 citations were depicted. Among the total 546 citations described, a total of 22 articles met eligibility criteria and were included in the review article. According to our review, the prevalence of MDR-TB ranged from 0 to 46.3%. The average mean rate of MDR-TB in Ethiopia was found to be 12.6 ± 15.9%. The overall prevalence of MDR-TB in all TB cases was estimated to be 1.4%. From a total of 3849 patients studied, 527 had MDR-TB. Previous exposure to antituberculosis treatment was the most commonly identified risk factor of MDR-TB in Ethiopia. ConclusionDespite relative decline in incidence of MDR-TB, the distribution and prevalence of MDR-TB continued to be a serious challenge for TB control in Ethiopia. Previous exposure to antituberculosis treatment was also the most common risk factor for MDR-TB. Therefore, strong TB and MDR-TB treatment along with tight introduction of follow-up strategies should be applied for better TB control.

Identification of Risk Factors of Multidrug-Resistant Tuberculosis by using Classification Tree Method

Multidrug-resistant tuberculosis (MDR-TB) has become a major public health problem. We tried to apply the classification tree model in building and evaluating a risk prediction model for MDR-TB. In this case-control study, 74 newly diagnosed MDR-TB patients served as the case group, and 95 patients without TB from the same medical institution served as the control group. The classification tree model was built using Chi-square Automatic Interaction Detectormethod and evaluated by income diagram, index map, risk statistic, and the area under receiver operating characteristic (ROC) curve. Four explanatory variables (history of exposure to TB patients, family with financial difficulties, history of other chronic respiratory diseases, and history of smoking) were included in the prediction model. The risk statistic of misclassification probability of the model was 0.160, and the area under ROC curve was 0.838 (P < 0.01). These suggest that the classification tree model works well for predicting MDR-TB. Classification tree model can not only predict the risk of MDR-TB effectively but also can reveal the interactions among variables.

Prevalence of and risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries: systematic review and meta-analysis.

Tuberculosis, in particular drug-resistant tuberculosis, is of global concern due to the high mortality and morbidity associated with it annually. The aim of this study was to determine the prevalence of and the risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries. Four databases (PubMed, BioMed Central, EMBASE, and Web of Science) were searched using key terms. Nineteen eligible articles were identified, of which 12 and seven were used for quantitative and qualitative analysis, respectively. The overall pooled estimate of the prevalence of multidrug-resistant tuberculosis, including both new and previously treated tuberculosis cases, in Iran, Iraq, Turkey and Pakistan was 16% (95% confidence interval [CI] 11-20). The patients with a previous tuberculosis treatment history (odds ratio [OR] = 6.45; 95% CI 5.12-7.79), those aged <45 years (OR = 1.57; 95% CI 1.12-2.03), and those who were males (OR = 1.83; 95% CI 1.19-2.48) had an increased pool risk of developing multidrug-resistant tuberculosis. The forest plot revealed that the pooled odds for the development of multidrug- resistant tuberculosis were 2.01 (95% CI 1.65-2.36). Poor adherence to treatment was one of the predictors of unsuccessful treatment outcomes. Multidrug-resistant tuberculosis is a great concern for public health programs in many countries globally, including those included in this review. The risk factors for the development of multidrug-resistant tuberculosis, specifically a previous tuberculosis treatment history, should be targeted through the implementation of specialized interventions.