PREVALENCE AND RISK FACTORS OF MDR-TB IN WEST ARMACHIHO AND METEMA WOREDAS, NORTHWEST ETHIOPIA

Abstract

BACKGROUND: Multi drug resistant tuberculosis (MDR TB) is an emerging challenge for TB control programs globally. According to the National DRS result in 2005, 1.6% of new cases and 11.8 % of previously treated cases wereMDRTB. According to WHO report on the prevalence of MDR-TB in 2012,Ethiopia stands 15th out of the 27 high priority countries in the world and 3rd in Africa following South Africa and Nigeria. OBJECTIVES: The aim of this study was to assess the prevalence of MDR-TB and associated risk factors in West Armachiho and Metema woredas of North Gondar. METHODS: A cross-sectional study was conducted in West Armachiho and Metema woredasbetweenFebruaryandJune 2014. All smear positive pulmonary tuberculosis patients wereincluded in the study.Socio-demographic and risk factor data were collected using a semistructured questionnaire. Informed consent was obtained from study subjects and two morning sputum samples were collected prior to starting anti-TB treatment for culture and drug susceptibility testing. Culture was performed on Lowenstein Jenson Medium (LJ). Drug susceptibility testing wasfirst performed for rifampicin using GeneXpertMTB/RIF. For those rifampicin resistant strains, DST was performed for both isoniazid and rifampicin to identify MDR-TB using proportional method on LJ media. Finally, data wasentered, cleared and analyzed using statistical Package SPSS version 20. Tables and graphs were used to describe the findings. Logistic regression was used to assess the association. P-value and 95% confidence interval werealso used to assess the statistical significance. RESULTS: Of 124 smear-positive pulmonary TB patients, 117 (94.4%) were susceptible to Rifampicin, while 7(5.7%) were confirmed to be resistant to Rifampicin and Isoniazid. The overall prevalence of MDR-TB was 5.7%(2.3% among new cases and 13.9% among previously treated cases).History of previous treatment(OR=7, P=0.025) wassignificantly associated risk factor for MDR-TB. CONCLUSION AND RECOMENDATION:The overall prevalence of MDR-TB among new and previously treated cases (5.7%) was considerably high. History of previous treatment was risk factor for MDR-TB. Therefore, efforts to reduce the burden of MDR-TB such as early case detection and treatment of MDR-TB, strengthening TB infection control activities and proper implementation of DOTS should be made in the study area.