Comparative Study of Drug Resistance in Smear Positive New and Re-Treatment Cases of Tuberculosis in the Somali Region, Ethiopia

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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. 10 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.



Comparative Study of Drug Resistance in Smear Positive New


Addis Abeba Universty