Determinants of Multi Drug Resistant Tuberculosis (MDR-TB) among Tuberculosis Patients in Addis Ababa, Ethiopia: Case Control Study
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Date
2012-04
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Addis Abeba Universty
Abstract
Background: Tuberculosis (TB) is a major cause of death in developing countries; it comprises
of 25% of avoidable adult deaths. Even though the global burden and incidence rates of TB have
been declining since 2004, drug-resistant tuberculosis remains a growing threat to public health
despite advances made in treatment and diagnosis over the past decade. Multidrug-resistant
tuberculosis (MDR-TB) which is resistant to at least two drugs of the most powerful first-line
treatment, rifampicin (RIF) and isoniazid (INH) is one of the challenging problem worldwide.
Ethiopia ranks 15th among 27 high burden MDR-TB countries in the world with an estimated
5200 new cases of MDR-TB each year.
Objective: of the study was to assess the potential determinants of MDR-TB among tuberculosis
patients in Addis Ababa.
Method: A facility based unmatched case control study design was conducted from December 21,
2011 to January 30, 2012. Cases were tuberculosis patients with culture-proved mycobacterium
tuberculosis resistant to at least both to isoniazid (INH) and rifampicin (RIF) and controls were
Tuberculosis patients with smear positive mycobacterium tuberculosis who turned negative for the
recent test after 2nd, 5th or 6th months of treatment course. The case to control ratio was 1 : 2.
Cases were selected from two hospitals which give MDR-TB treatment namely St. Peter and
Defence Teaching and Referral hospitals. Controls were selected from two hospitals (Federal
police and Defence Teaching and Referral hospitals) and seven health centres. Simple random
sampling was used to select patients from the register of each hospital and health centres involved.
To identify the determinants a multi variate logistic regression was done.
Results: A total of 75 cases and 148 controls were interviewed. Among the respondents
41(54.7%) of cases and 84(56.8%) of controls were males. The mean (standard deviation) age
among cases and controls were 30.6(10.4) and 28.6(9.9) respectively. The likelihood of MDR-TB
were higher among those who reside out of Addis Ababa ( AOR=18.85 (2.21, 161.10), HIV
infected (AOR=9.10( 1.48, 54.37) and on previous treatment of TB ( AOR=65.57(14.21, 302.64)
and proved to be statistically significant.
Conclusion: Previous treatment of TB, HIV infection and residence out of Addis Ababa were the
independent predictors of MDR-TB and thus needs a better attention of the national TB
prevention and control activities according to the contextual situations so that to avert the rising
problem from the country and furthermore, to keep the health of the community.
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Keywords
Determinants of Multi Drug Resistant