Abstract:
Background: Efforts to control the global burden of tuberculosis (TB) have been jeopardized by the rapid evolution
of multi-drug resistant Mycobacterium tuberculosis (MTB), which is resistant to at least isoniazid and rifampicin.
Previous studies have documented variable prevalences of multidrug-resistant tuberculosis (MDR-TB) and its risk
factors in Ethiopia. Therefore, this meta-analysis is aimed, firstly, to determine the pooled prevalence of MDR-TB
among newly diagnosed and previously treated TB cases, and secondly, to measure the association between
MDR-TB and a history of previous anti-TB drugs treatment.
Methods: PubMed, Embase and Google Scholar databases were searched. Studies that reported a prevalence of
MDR-TB among new and previously treated TB patients were selected. Studies or surveys conducted at national or
sub-national level, with reported MDR-TB prevalence or sufficient data to calculate prevalence were considered for
the analysis. Two authors searched and reviewed the studies for eligibility and extracted the data in pre-defined
forms. Forest plots of all prevalence estimates were performed and summary estimates were also calculated using
random effects models. Associations between previous TB treatment and MDR-MTB infection were examined
through subgroup analyses stratified by new and previously treated patients.
Results: We identified 16 suitable studies and found an overall prevalence of MDR-TB among newly diagnosed and
previously treated TB patients to be 2% (95% CI 1% - 2%) and 15% (95% CI 12% - 17%), respectively. The observed
difference was statistically significant (P < 0.001) and there was an odds ratio of 8.1 (95% CI 7.5–8.7) for previously
treated TB patients to develop a MDR-MTB infection compared to newly diagnosed cases. For the past 10 years
(2006 to 2014) the overall MDR-TB prevalence showed a stable time trend.
Conclusions: The burden of MDR-TB remains high in Ethiopian settings, especially in previously treated TB cases.
Previous TB treatment was the most powerful predictor for MDR-MTB infection. Strict compliance with anti-TB
regimens and improving case detection rate are the necessary steps to tackle the problem in Ethiopia.
