Determinants of Drug-Resistant Tuberculosis in Southern Ethiopia: A Case–Control Study

Abstract

Background

In most developing countries, including in Ethiopia, the magnitude and risk factors of drug-resistant tuberculosis (DR-TB) are expected to be high. However, this is not well reported because of lack of laboratory facilities, poor surveillance system and limited reporting. The aim of this study was to determine the risk factors of DR-TB among TB patients in southern Ethiopia.

Patients and Methods

Facility-based case–control study was conducted from November 2016 to January 2017 in Sidama Zone and Gurage Zone of the southern Ethiopia region. DR-TB cases were confirmed by drug-susceptibility testing who were on treatment for DR-TB at Yirgalem and Butajira Hospitals. Controls were smear-positive pulmonary tuberculosis (TB) patients who were taking first-line anti-TB medications and sputum smear-negative at the 5^th month of commencing TB treatment. Data were entered and cleaned using EPI-Info version 7 software and analyzed using SPSS version 22 statistical software.

Results

A total of 84 cases and 243 controls participated in the study. About 59% (49 cases) and 55% (132 controls) were male. The median (interquartile range) age was 28 (21–37) years for cases and 27 (25–33) years for controls. Living in a one-roomed house (adjusted odds ratio [AOR]: 6.8, 95% CI: 1.8–25.8), history of contact with DR-TB cases (AOR: 6.8, 95% CI: 1.8–25.3), treatment failure TB cases (AOR: 4.2, 95% CI: 1.1–15.5) and relapsed TB cases (AOR: 4.8, 95% CI: 1.3–18.1) were independent factors associated with DR-TB.

Conclusion

Providing standardized first-line regimen for new case and retreatment TB cases and practicing basic TB-infection control measures could help to minimize the spread of DR-TB.

Keywords:

• drug resistance
• tuberculosis
• southern Ethiopia

Acknowledgment

We would like to thank Hawassa University for funding the study. We also thank data collectors and the study participants.

Abbreviations

AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio; DR-TB, drug-resistant tuberculosis, DOTs, directly observed treatment short course, TB, tuberculosis, SPSS, statistical package for social science.

Data Sharing Statement

The datasets used in this study are available from the corresponding author on reasonable request.

Ethics Statement and Consent to Participate

We first submitted the research proposal to the Institutional Review Board (IRB) office of Hawassa University College of Medicine and Health Sciences and received ethical clearance. Permission letter was obtained from the Southern Nations and Nationalities Regional (SNNPR) Health Bureau, Sidama Zone Health Department and Gurage Zones Health Department. The purposes and the importance of the study were explained to the study participants. Verbal consent was obtained from all study subjects or their guardian (for participants below 18 years of age). Study participants were informed that they have full right not to participate in the study and their clinical services will not be affected due to refusing to be part of the study. To ensure confidentiality, the questionnaire was kept anonymous. The IRB office in Hawassa University College of Medicine and Health Sciences approved the consent process.

Author Contributions

DB designed the study, supervised data collection, performed data analysis and interpretation, and drafted the manuscript. EMW assisted in designing the study, did the data analysis and interpretation, and critically reviewed the manuscript. Both authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.