Prevalence of Tuberculosis, Multidrug Resistance Tuberculosis and Associated Risk Factors among Smear Negative Presumptive Pulmonary Tuberculosis Patients in Addis Ababa, Ethiopia
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Date
2018-06
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Addis Ababa University
Abstract
Background: Diagnosing active smear negative PTB, which represent the majority of
tuberculosis (TB) cases left difficult. Therefore, treatment is often carried out empirically, based
on clinical criteria, resulting in misdiagnosis and treatment. The distribution and magnitude of
smear negative PTB, smear negative MDR PTB and associated factors in the same day diagnosis
strategy are not clearly known in the study area. Objective: The objective of the study was to
determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear
negative pulmonary tuberculosis patients by Xpert MTB/RIF Assay in Addis Ababa, Ethiopia.
Methods: An analytic cross sectional study design was used. A total of 418 patients were
consecutively enrolled and two (spot-spot) sputum samples were collected, stained with Ziehl
Neelsen (ZN) method and examined for AFB in the selected health facilities from August 01 to
December 30, 2017. All smear negative sputum were transported and examined by FM
microscopy, Xpert MTB/RIF and Culture. Data was entered and cleared by EPI data and
analyzed by SPSS Ver.20. Results: A total of 27/418 (6.5%) (In 95 % confidence interval (CI),
4.103-8.816) were Xpert MTB/ RIF and 26/408 were culture confirmed SNPT cases. The
positivity rate among male and female was 10.2% and 3.5% (p=0.005) respectively. From 26
culture positive isolates 03 (11.54 %) (95 % C.I, 0.00-23.82) were MDR TB; from this 02/23
(8.7 %) were among new and 01/03 (33.3%) was among retreatment cases. All Smear negative
MDR TB cases were diagnosed from men. All rifampicin resistant SNPT isolates by Xpert
MTB/ RIF assay were found to be MDR TB and 07/26 (26.9%) isolates were INH mono
resistant. Being health care worker and history of migration found to be a potential risk factor for
developing SNPT. The odds of having SNPT is 68.7 times higher in health care workers as
compared to other job category AOR 68.7 (95% C.I, 2.447-1929.15 : p<0.013). None migrants
have 0.121 times less likely to have smear negative pulmonary TB in comparison with migrants,
AOR 0.121(95 % C.I, 0.20-0.730, p< 0.021). Conclusion: Overall prevalence of SNPT in Addis
Ababa was 6.5% by Xpert MTB/ RIF assay and 6.4 % by culture in Spot- Spot sample collection
and diagnosis strategy. This study also demonstrated 11.54 % smear negative MDR TB
prevalence. Being health care worker and history of migration were found to be a potential risk
factor for developing SNPT. Key words: Prevalence, smear negative PTB, smear negative MDR
TB, Xpert MTB/RIF Assay
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Keywords
Diagnosing active smear negative