PATTERN OF FIRST-LINE ANTI-TUBERCULOSIS DRUG RESISTANCE AND ASSOCIATED FACTORS IN PATIENTS ATTENDING NATIONAL TUBERCULOSIS AND LEPROSY TRAINING CENTRE AND REFERRAL HOSPITAL ZARIA
PATTERN OF FIRST-LINE ANTI-TUBERCULOSIS DRUG RESISTANCE AND ASSOCIATED FACTORS IN PATIENTS ATTENDING NATIONAL TUBERCULOSIS AND LEPROSY TRAINING CENTRE AND REFERRAL HOSPITAL ZARIA
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Date
2015-01
Authors
RIKOTO, JOSHUA AYUBA
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Abstract
Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis.
Despite the availability of Short-course regimens of first-line drugs that can cure around 90%
of cases, TB remains a major global health problem causing ill-health among millions of
people each year. It ranks as the second leading cause of death from an infectious disease
worldwide. In 2012, nearly 8.6 million people developed TB and 1.3 million died from the
disease worldwide. Among these deaths, there was an estimated 450,000 who developed multidrug
resistant TB (MDR-TB) with an estimated 170,000 deaths. The African Region has 24%
of the world’s cases and the highest rates of cases and deaths per capita. This study was
therefore carried out to determine the pattern of first-line anti-Tb drug resistance and associated
factors in patients attending National Tuberculosis and Leprosy Training Centre/Referral
Hospital Zaria.
Sputum samples were collected from 200 DR-TB suspects median age 32 years (range 15 – 75
years) of which 138 (69%) were males. Among these, 156 (78%) and 44(22%) were new and
retreatment cases respectively. Also, 59.5 % of the patients were in the age group 21-40 years
and 90.6% of them were either unemployed or self employed, and 68.9% either have no formal
education or terminated at secondary school level. The sputum samples were first screened for
M. Tuberculosis complex and rifampicin resistance using GeneXpert(MTB/Rif) and confirmed
with Hain line probe aassay(LPA).
Of the 200 samples, 81(40.5%) were positive for Mycobacterium tuberculosis, out of which
55(67.9%) were rifampicin (RIF) resistant. More males (74.1%) were positive for MTBC and
for MDR-TB (76.2%) than females. The highest resistance to any one drug alone and in
combination with other drugs was found in rifampicin (67.9%). However, rifampicin mono resistance was 13.6%, Isoniazid mono resistance was 1.2% while mono resistance to
streptomycin and ethambutol were not seen. Furthermore, 6 (7.4%) were resistant to all the 4
first line drugs while MDR-TB was (51.8%). On bivariate analysis, six factors were found to
be associated with development of MDR-TB, 4 of which are patient related while 2 are health
care related. Among these, being a retreatment case was the only statistically significant factor
(OR=8.2, P-value <0.01). However, on logistic regression only two of the factors - being a
retreatment case (OR=9.7) and male sex (OR=2.2) remained associated with MDR-TB. The
study found being admitted at a hospital during TB treatment to be a protective factor against
development of MDR-TB (OR=0.48).
The study concluded that there was a high rate of rifampicin resistance and MDR-TB among
patients attending NTBLTC/Referral Hospital Zaria and recommends that health care providers
should adequately educate TB patients on the need for treatment adherence in order to prevent
development of anti-TB drug resistance. The TB-DOTS strategy should also be reinforced to
ensure patient compliance. Availability of drugs should also be ensured at all times and nonfixed
drug combinations should be discouraged.
Key words: MDR-TB, Drug resistance pattern, Drug sensitivity testing, Rifampicin resistance,LPA
Description
A DISSERTATION SUBMITTED TO POST GRADUATE SCHOOL,
AHMADU BELLO UNIVERSITY, ZARIA
IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE AWARD OF MASTER
OF PUBLIC HEALTH (MPH) FIELD EPIDEMIOLOGY AND LABORATORY
MANAGEMENT
DEPARTMENT OF COMMUNITY MEDICINE,
AHMADU BELLO UNIVERSITY, ZARIA
NIGERIA
Keywords
PATTERN,, FIRST-LINE ANTI-TUBERCULOSIS DRUG RESISTANCE,, ASSOCIATED FACTORS,, PATIENTS ATTENDING NATIONAL TUBERCULOSIS,, LEPROSY TRAINING CENTRE,, REFERRAL HOSPITAL ZARIA,