Drug Resistance Pattern of Mycobacterium Tuberculosis and its Association with Patients` Knowledge, Attitude and Practice towards Tuberculosis in Eastern Amhara Region
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Date
2011-03
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Addis Abeba University
Abstract
Background: Tuberculosis (TB) remains a serious public health problem, worsened by the
emergence and spread of drug resistance particularly multi-drug resistance that threat global TB
control. Data obtained from KAP survey is essential to plan, implement and evaluate Advocacy,
Communication and Social Mobilization (ACSM)work.
Objectives: The aim of this study was to assess the magnitude of drug resistance pattern of
M.tuberculosis, knowledge, perception and practice of patients` towards TB in Eastern Amhara
Region, North East Ethiopia.
Methods: A cross sectional survey was conducted among new and re-treatment patients (age >
18 years old) from September 2010 to February 2011. A structure and pre-validate
questionnaires was used to collect data. Primary isolation and DST were carried out on egg based
LJ media using indirect proportion method. Chi-Square and multivariate logistic regression was
used.
Results: Out of 230 study participants for DST, 165 were new cases while 65 were previously
treated cases. From these, 66.5% of isolates were sensitive and 4.4% resistance to four f irst line
anti-tuberculosis drugs (HRSE) while the remaining 33.5% was resistance to at least for single
drug. MDR-TB was detected in 6.5 % isolates, of which 4.4% were resistance to all four first
line drugs. Overall resistance to S, R, H and E was found in 27 % (62), 10 % (23), 17.8 % (41),
and 6.5 % (15) respectively. Mono resistance was found in 17.4 % (40) of all isolates
Among new cases primary drug resistance for one or more drugs was observed in 23.6 % (39)cases. Primary MDR-TB was found in 3 (1.81%) cases. Similarly among previously treated cases
resistance to any drug was found in 58.5 % (38) cases. MDR-TB in previously treated cases was
found in 18.46 % (12) Cases; the highest being in failure cases 9.23% (6).
More over the mean and median knowledge score of respondents about PTB was 6.81 and 7
respectively. Majority (53.6%) of study subjects had poor knowledge score, feels not well
informed about TB and had several misconceptions that need to be clarified. Majority (66.6%)ofstudy subjects heard about TB for the first time from health workers. Of study participants,
79.9% mentioned that TB transmits by respiratory droplets through coughing and sneezing and
prevents by covering mouth and nose (66.6%). The four common symptoms mentioned by
respondents were cough (65.6%), weight loss (33.2%), cough > = 2 weeks (32.7%) and shortness
of breath (29.4%). About half of respondent not knew current free cost of TB diagnosis and
treatment. Majority of respondents also worried about the disease due to it might transmits to
their family, might not be cure, social interact (fear of stigma) and unable to do work. Cost (69.9
%) and difficulties in transportation (54.5 %) mentioned as the main reason for their delaines t o
seeking care.
Previous drug exposure and 1
+
bacterial load independently contribute for the development of
drug resistance TB strains. Similarly Illiteracy, rural residence, non-previous history of
contracting TB, experiencing self treatment option, and delayed frequency of visit were
independent predictor of low knowledge score.
Conclusion: Drug resistance TB particularly MDR-TB is an emerging problem in new and retreatment
patients in our study area. Majority of respondents also had poor knowledge and
several misconceptions that need to be clarified. Hence, it is essential to address the problems of
drug resistance through establishing good TB control program including DOTS plus service and
raise KAPs` of patients through establish proper IEC pathway to indicate the level of severity
and to create proper awareness about its cause, transmission, prevention and availability of
service.
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Keywords
Drug,Mycobacterium tuberculosis