Factors associated with occurrence of multi drug resistant tuberculosis in a Harare city, 2015
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Introduction: Multi drug resistance tuberculosis (MDR-TB) is a form of tuberculosis (TB) caused by bacilli resistant to Isoniazid and Rifampicin. Rifampicin and Isoniazid are the two most important first line anti TB medicines. The World Health Organisation has declared MDR TB a public health emergency of global concern. Drug resistance can either be primary or acquired during TB treatment. The MDR TB notification rate has been increasing in Zimbabwe since 2010. New MDR TB cases have also been on an increase from a low of 42 in 2011 to a high of 60 in 2014. Annual newly notified drug susceptible TB cases have been on a decline over the past five (5) years. A study was carried out to determine the major risk factors associated with occurrence of MDR TB in Harare, Zimbabwe. Methods and Materials: An unmatched case control study was conducted in Harare City. The outcome of interest in the study was MDR TB. A semi structured interview guide questionnaire was used to collect information on exposure from the respondents. A case was a TB patient confirmed by Gene Xpert and Drug Sensitivity Test (DST) to have resistance to Rifampicin. A control was a TB patient who had completed treatment and had a recorded cured outcome. A checklist was used to assess case detection activities in the TB service at health facilities. Data collected were entered into the EPI Info 3.5.4. The same software package was used to calculate frequencies, means and odds ratios. Stratified and forward logistic regression was carried out to determine independent risk factors associated with MDR TB. Results: A total of 42 cases and 84 controls were enrolled in to the study. A total of 5 poly clinic Presumptive TB registers and Health Facility TB registers were reviewed. There was no delayed case finding for risk MDR TB presumptive case in Harare. The significant risk factors in the study were having a history of previous TB treatment (OR=65.9 95% CI 19-223), having been a TB contact before (OR=2.56 95% CI 1.06-6.15), history of stopping TB treatment in previous catergory (OR=6.62 95% CI 1.91-23).Smoking, alcohol use, HIV (OR=1.13 95% CI: 0.3-2.76) and diabetes mellitus (OR=1.15 95% CI=0.21-10.00) were not significantly associated with MDR TB in Harare. A history of travelling outside the country was associated with less risk of having MDR TB (OR=0.66 95% CI: 0.3-1.4). Those who were employed were less likely to have MDR TB (OR=0.12 95% CI 0.04-0.29). There was a significant difference in knowledge on risk of defaulting TB treatment (p=0.02) and treatment completion (p=0.007) between cases and control. Conclusion: History of TB treatment was the leading risk factor. A history of being a TB patient contact, a history of stopping TB treatment were significantly associated with having MDR TB in the City MDR TB. HIV and diabetes mellitus were not significantly associated with having MDR TB. Based on the findings of this study MDR TB in Harare City is likely to be acquired than primary, as those who had prior exposure to anti-TB medicine were more likely to have MDR TB. There was no delayed case finding for high risk presumptive MDR TB patients. Those who were employed were less likely to have MDR TB.