Risk factors for multi-drug resistant tb among tb cases in the West Nile region of Uganda

Abstract

Introduction Multidrug resistant (MDR) tuberculosis (TB) indicates TB, which is resistant to at least Rifampicin (R) and isoniazid (H) and remains one of the unresolved challenges in the control of TB in Uganda. Current prevalence of MDR is 9.1% of all TB Cases in West Nile region. The Development of drug resistance is majorly as a result of human related factors coupled with poor lifestyle. The west Nile region of Uganda is a high burden region especially among refugee settings with limited information on determinants of MDR TB. This study aimed at identifying independent risk factors for MDR TB among tuberculosis patients in the west Nile of Uganda to inform targeted interventions for the control and prevention of MDR TB. The objectives of the study were to determine the socio demographic risk factors and clinical risk factors for MDR TB among TB cases in the West Nile region of Uganda. Method An unmatched case control study design in a case to control ratio of 1:1 involving quantitative methods was conducted in the West Nile region of Uganda. The study enrolled138 cases (surviving MDR TB patients) and 138 controls (ordinary smear positive TB patients) who were declared cured or who had completed treatment and were smear negative at the end of the treatment period during the study period. Data was collected using structured questionnaire with face to face interview. Data was coded and entered using Microsoft access 2010 computer software and exported to Stata Version 14.0 SE for analysis. Univariate analysis was done to compute means, frequencies and percentages. Bivariate analysis was done using a reverse binary logistic regression model and results interpreted in terms of odds ratios (COR) at 95% level of confidence and 0.05 level of significance. Factors that were statistically associated with MDR TB at bivariate level of analysis were included in a multivariate logistic regression model. Results A total of 276 respondents, 138 cases and 138 controls were enrolled in the study. Being on HAART (AOR = 4.686; 95%CI: 2.250-9.761; p < 0.001) and presence of cavities on Chest X ray at the point of starting TB treatment (AOR = 4.098; 95%CI: 1.228-13.677; p = 0.022) were identified as significant independent risk factors for developing MDR TB. Demographics, other clinical and behavioral characteristics of respondents were not statistically associated with developing MDR TB. Conclusion Being on HAART and presence of cavities were identified as independent risk factors for developing MDR TB. In order to reduce the burden of drug resistance, strategies for controlling MDR TB in the West Nile region of Uganda should focus on HIV prevention, intensive follow up strategies to ensure all patients started on anti-TB drugs do not default their treatment, health practitioners routinely conduct chest x-rays for all TB patients at the point of diagnosis for cavity identification and routinely conduct surveillance/monitoring of all patients on HAART for MDR-TB. TB Patients with preexisting medical conditions such as HIV/AIDS that weaken the body defence system require more attention from health workers to ensure they adhere to their treatment to reduce the risk of developing MDR TB.