Risk Factors Associated with Multi Drug Resistant Tuberculosis in Azad Jammu & Kashmir, Pakistan- A Case Control Study, 2020

  • Respiratory Diseases
  • Vaccine preventable diseases
  • Anti-microbial resistance
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Multidrug resistant tuberculosis (MDR-TB) has become a major public health threat especially in developing countries. Despite responsible for escalating morbidity and mortality it also has serious economic implications. Globally, 0.6 million MDR-TB cases have been reported. Pakistan ranks 4th for MDR-TB with approximately 4% annual incident rat. The study is aimed to evaluate the risk factors associated with MDR-TB and to formulate recommendation for prevention and control.

A case control study was conducted with case control ratio 1:2. All registered cases (n=61) at Programmatic Management of Drug Resistant Tuberculosis (PMDT) site in AJ&K during 2015-2018 were enrolled. Cases were laboratory confirmed pulmonary TB patients resistant to either isoniazid or rifampicin reported at PMDT site during 2015-2018. Controls were laboratory confirmed TB patients sensitive to both drugs reported at Directly Observed Treatment short course site. Medical records were reviewed for data collection through pre-tested structured questionnaire. Descriptive analysis was done, odds ratios were computed and risk factors were evaluated by applying logistic regression at CI: 95% and p-value <0.05.

Of 61 cases the median age was 37 years (range 15-88), male to female ratio is 1.4:1 Most affected age group was 15-30 years with an attack rate of 48/100. Risk factor analysis showed those default from first line treatment (OR 5.6 CI 2.8-11.2; P value <0.001), sputum microscopy with 3+ bacilli load (OR 5.2 CI 1.8-14.5; P value <0.001) body mass index (BMI) < 20 (OR 2.5 CI 1.3-4.9; P value <0.001) and contact history with MDR-TB case (OR 2.1 CI 1.1-4.0; P value <0.05) found significantly associated.

Risk factors for MDR-TB in AJ&K were non-adherence to previous TB treatment, low BMI and contact history with MDR-TB patient. We recommended the National Tuberculosis Control Program to target these risk factors as screening tools during case management of all tuberculosis patients.

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