| Abstract: | ABSTRACT
Background: Tuberculosis (TB) remains a major global health problem and ranks as the second leading cause of death among deaths caused by infectious diseases worldwide. Despite the availability of short course regimens as first line anti tuberculosis drugs, emergence of drug resistant Mycobacterium tuberculosis strains pose a major challenge to the prevention and control efforts of national tuberculosis programs (NTPs). In developing countries, including Ethiopia, the burden of tuberculosis and /or drug resistance profile of M.tuberculosis remains largely unexplored, mainly due to lack of quality controlled second line laboratory tests.
Objectives: To assess the mycobacterial genotypic diversity and drug resistance pattern of M. tuberculosis complex in North West Ethiopia: resource limited settings. Moreover, it was to assess the knowledge, attitude and practice (KAP) of TB suspects towards tuberculosis
Methods: Health care institution-based cross-sectional study was designed and conducted to assess: 1) Mycobacterial strain diversity 2) drug resistance pattern of Mycobacterium tuberculosis and 3) to evaluate the KAP of TB suspects towards TB in North West Ethiopia: resource limited settings. Study Subjects from health facilities in Benishangul Gumuz region and Awi zone of Amhara region who consented to participate were included in the study. 112 Smear positive samples were collected from study participants, stored and transported to Armauer Hansen Research Institute (AHRI) TB laboratory. At AHRI laboratory Lowenstein–Jensen (LJ) culture, drug susceptibility testing, RD9 deletion typing and Spoligotyping were performed from April 2013 through June 2014. Drug susceptibility testing (DST) was done by the proportion method on 24 well plates using 7H10 medium. The isolates were further characterized by spoligotyping and compared with updated SpolDB4.0 database to identify the circulating strains. Information for KAP study was collected on well-structured questionnaires. SPSS V.20 statistical software was used for data entry, data cleaning and analysis.
Results: DST result of isolates from 87 samples showed one or more drug resistance in 16.5% with higher rate of monoresistance to isoniazid (6.9%). Multidrug resistance of 2(2.3%) was observed with 1(1.3%) and 1(8.3%) distribution among new and retreatment cases respectively.
From 75 Mycobacterium tuberculosis isolates typed, 39 particular spoligotype patterns with 32(42.7%) of “New” isolates was observed. SIT289, SIT53, SIT149, SIT37 and SIT134 were the predominant strains circulating in the study region with proportion of 14.7%, 12.0%, 8.0%, 5.3% and 4.0% respectively
From 383 participants involved for KAP study 231(60.3%) were male and 152(39.7%) were female. Most frequent respondents’ sources of information about TB were health professionals in 131(34.2%) and 20(5.2%) had never heard about tuberculosis. 254(66.3%) knew that TB transmission is aerosol while 81(21.1%) do not know about it. 223(58.2%) responded TB transmission can be prevented by covering mouth and nose while coughing and sneezing but 125(32.6%) do not know about means of TB prevention. Respondents’ lack of knowledge 169(49.6%) and 63(18.5%) were reasoned accessibility and affordability for their delay in health service seeking behavior.
Conclusion: Although current level of drug resistance appears to be low, the risk for a sudden increase is high because of the relatively higher monoresistance to INH. It is essential to maintain high quality DOTS in the area to keep MDR low.
Majority of respondents also had poor knowledge and several misconceptions about TB that needs to be addressed through continuous health education on cause, transmission, prevention, treatment and services available.
Key words: Mycobacterium tuberculosis, Strain diversity, Drug resistance, KAP, Benishangul Gumuz region, Northwest Ethiopia |
