MDR-TB in Tanzania: Prevalence, risk factors and pattern of anti TB Drug resistance

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Hongo, Makori Robert
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The University of Zambia
The emergence of drug resistance tuberculosis (DR-TB) is a significant challenge for TB control and prevention programmes, and the major problem is multidrug resistant tuberculosis (MDR-TB) which can develop to extensively drug resistant tuberculosis (XDR-TB). This epidemiological scenario of TB is worsened by its worldwide distribution with a growing trend displaying new and highly antibiotic resistant strains. Thus the present study was carried out to determine the emerging epidemiological trends of TB in the presence of MDR-TB and XDR- TB in Tanzania as well as to ascertain the likely risk factors linked to the occurrence and distribution patterns of anti TB drugs resistance and to determine XDR-TB prevalence among MDR-TB Isolates. We used survey proportion estimates of positive cases whilst possible risk factors were investigated using the multiple logistic regression model. Consequently, 278 MDR-TB isolates from the Central Tuberculosis Reference Laboratory (CTRL) which were diagnosed as new and re-treated tuberculosis cases collected between January 2011 and December 2014 were included in the study after subjecting them to a series of selection criteria for inclusion and exclusion. Isolates were tested for susceptibility to first line and second line drugs. From the MDR-TB 278 isolates, 136 (48.9%) were resistant only to H, R, S, E, 20 (7.2%) were resistant only to H,R,E, 61,(21.9%) were resistant only to H, R ,S, 60 (21.6%) isolates were resistant only to H and R alone and Only 1 isolate (0.4%) were resistant to Km and Oflx. The general tuberculosis prevalence was seen to vary markedly among the 20 regions P = 0.0001, with Dar-es-Salaam contributing over 55.4% of the cases screened at CTRL, followed by Kilimanjaro 23.4%. The prevalence of XDR-TB was calculated to be at 0.36. Key factors linked to the MDR/XDR-TB included sex, with males being twice likely to have TB than females with P = 0.041. Age was another factor with high prevalence in the reproductive active group between 21 to 40 years P= 0.028. Others included the regions of origin of the isolates P = 0.004, the patients with history of re-treatment P = 0.004. This study provides preliminary information about the potential risk factors associated with MDR-TB and XDR-TB status in Tanzania. Further, although the prevalence of XDR-TB seems low, its potential risk to public health is important based on traditional methods of diagnosis coupled with poor sanitary measures. Taking into consideration that rifampicin is being used throughout the six months of TB treatment; and the treatment is observed at home by a non-medical professional person, drug resistance surveillance in the country should be maintained among both new and re-treatment cases
Tuberculosis Drugs , Tuberculosis-Patient Compliance--Tanzania , Tuberculosis treatment--Tanzania