Comparative Study of Drug Resistance in Smear Positive New and Re-Treatment Cases of Tuberculosis in the Somali Region, Ethiopia
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Date
2002-04
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Abstract
An institution-based retrospective cohort study was carried out in four hospitals located in
four zones of the Somali Region to assess the magnitude and pattern of resistance to 5
essential anti-tuberculosis drugs currently in use and to determine the risk factors associated
with drug resistant TB.
A total of 190 patients were enrolled consecutively between March and August, 2001; culture
was performed on 187 specimens and 127 of these (41 re-treatment and 86 new cases)
underwent drug susceptibility tests (DST) to five first-line anti-tuberculosis drugs (isoniazid,
rifampicin, ethambutol, streptomycin and thioacetazone) at the Ethiopian Health and Nutrition
Research Institute in Addis Ababa. Serology for HIV was done on 112 of the 127 patients
with MTB isolates which were included in the analysis.
Resistance to any drug was 17.4% in new cases and 46.3% in previously treated cases. MDRTB
was seen in 1.2% and 10% of the new and re-treatment cases, respectively. Double drug
resistance ranged between 1.2%-2.3% and 7.3-14.6% for new and re-treatment cases,
respectively while triple and four-drug resistance were 1.2% for new cases and ranged
between 5-7.5% in re-treatment cases. Resistances to all the 5 drugs were 1.9% and 7.3% in
new and re-treatment cases, respectively. The differences in resistance level between the two
groups were statistically significant at the P<0.01 level. Ethambutol resistance of 2.3% in new
cases and 12.2% in re-treatment cases were the highest recorded in the country so far.
Resistance to rifampicin is increasing in Eastern part of Ethiopia.
The over all HIV seroprevalence was 6.3%, lowest in Sub-Saharan Africa; it was 4% in new
cases and 11.4% in the old ones but the difference did not achieve significance due to a small
sample size.
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The prevalence of drug resistance in general and MDR-TB in particular are high in the Somali
region. Regulating the private sector and strict control of drugs in the black market, active
involvement of the public, the private sector and others concerned, and considering alternative
regimens for those harboring resistant strains are suggested for averting the dangers of wide
spread MDR-TB.
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Comparative Study of Drug Resistance in Smear Positive New
Citation
Addis Abeba Universty